Paramedics in North Carolina and in Cleveland, Ohio are providing Narcan kits to high risk patients in their communities.
My partner and I often spend time on heroin overdose calls educating the patient’s family, friends or bystanders/social circle on the availability of Narcan (where to get it — local clinic, pharmacy, etc) and how to administer it. We recently had one patient’s neighbor (who had found his friend unresponsive) express gratitude for our lesson and say he would immediately go down to the clinic and get a kit. A woman this week told us she had Narcan in the bathroom, kitchen, living and bedroom in her apartment, and had one kit always in her purse (which unfortunately had been taken from her while she nodded off in the bushes — thus prompting the 911 call for the woman unresponsive). Leaving a Narcan kit with people who were present at an overdose scene makes clear sense.
If we had Narcan kits that we could give out, we could easily disburse them to high-risk individuals.
In North Carolina, EMS is giving Narcan to patients who refuse treatment. I have not had a patient in years who refused treatment after Narcan. Many years ago when my practice was to give 1.2-2.0 mg IV, I did have quite a number of patients refuse. Well, instead of saying, I refuse, they used more colorful language as they ripped the IV out of their arms and walked down the street the colorful language continuing. Now, I mainly use Intranasal (IN) Narcan or IV at very low doses (0.1 increments), and my patients are much more subdued, and go to the hospital. The ones that refuse are the ones who are simply on the nod, and who wake with stimulation (like the woman in the bushes, who actually was roused by a bystander as we arrived, and started walking down the street on her own, although she did stop and let us talk with her).
If opiate overdose patients are going to refuse transport, leaving them Narcan as well as persuading them to have a friend watch them for awhile seems reasonable.
We did have an very interesting conversation with the woman, who not only told us what brand of heroin she had used, she provided commentary on a number of different brands we had seen. She told us that she avoided Chief and OMG because they were white heroin known to be mixed with Fentanyl. She preferred the brownish powder. Every time she foolishly tried white powder brands, she said, she ended up surrounded by firefighters and EMS. She wasn’t looking to die nor was she looking for a magic high. She just needed her daily fix, and for that she had to walk to Park Street everyday to meet her guy.
She got hooked on heroin because it was cheap and she had issues of loneliness and self worth that had caused her to seek escape. She uses heroin every day now. It is as much a part of her life as getting up in the morning, drinking water, eating her daily bread, and forgiving her trespassers.
Kudos to North Carolina and Cleveland.