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The rising cost of naloxone (Narcan) forces a town in Ohio to consider the unthinkable.

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18 Responses to “3 Strikes You’re Dead?”

  1. Kinoons

    Well if narcan costs so much we can just ventilate the patient until it wears off. Hell just teach family members how to use a BVM and you’re set — BVMs are cheap. On a serious note where are these guys getting their narcan and why are they using the autoinjector? Narcan can be given via most any route to include intranasally. A single dose vial of narcan is only $30-$40 compared to a $4000 autoinjector. Anyone can be trained to give intranasal narcan in just a few minutes. When I was a medic in NM heroin overdoses became so common narcan was given to all public service personnel to include the police. I sincerely hope the city in Ohio in question doesn’t really mean they want to stop reponding and instead is just trying to point out their situation as you suggested.

  2. sarah nixon

    Pampering narcotic seekers butts in the ED & acute care settings & docs not knowing HOW to say NO! Many times the burden gets put on the RN to have that conversation, yet the physician continues to enable the patient’s behavior. What might happen? The patient leaves the hospital? The patient finally realizes the hospital will not be used as their personal refill pharmacy? This may curb some of the over users, the abusers.

    • Barb Freeman

      I live on a small island in the, Pacific, with an out of control drug problem. As an RN, I see first hand, the cost on small communities to try and meet the needs of the drug addicted. These patients are often abusive and hostile to medical staff, yet, we still treat them to the best of our ability. We offer drug rehab services only to have those services declined. The patient returns to the ED, again and again. I’ve seen parents and children surrounding the bedside, crying and begging us to treat their family member, then verbally abuse us when their family member’s status declines or pass away… is always the medical staff’s fault their loved one died or did not improve. I am torn, providing Narcan to the drug addicted, may save lives, but encourages drug abuse.

      • sarah nixon

        But do u really think it encourages it? I mean if u think about it in reverse, do u think the addict is thinking, “I’ll just use the max bc they’ll just narcan me.” I just don’t see it that way. I’m just saying if we had a way that legitimately screened the abusers that come to the hospital with their made -up complaints when they run out of their meds or the known addicts that should be put on non-narcotic options for pain relief, we may actually deter this behavior. They may have to stick to their prescriptions or pay the consequences(withdrawal symptoms or criminal issues if they buy off the streets). But it would have to be administration, physician & nursing working together to enforce such NON enabling behavior.

        • sarah nixon

          The EMS issue is a hard one bc they are treating someone in great need. What if they had a unit that just went to ODs & had the cheaper nasal narcan & didn’t take them to the hospital, just provide them with what is needed as if the family had an OTC narcan? Charge the patient for the narcan & quick home visit & provide a rehab pamphlet?

          • Angela Charland

            The problem arises when the narcan wears off and the heroin is still effective. Someone needs to be with the patient to monitor them also we have seen alot of pulmonary edema associated with giving large doses of narcan. These patients require intubation and ICU. Not sure why this is happening but has been a large increase lately

          • sarah nixon

            I just have a real hard time with it bc at that point in their addiction, they are not really looking to be saved, cured or rehabilitated. I know that sounds cold, but the hard truth.

  3. José Arenas

    The primary goal for an EMS team is to save lives. By carrying naloxone when responding to a distress call from an opioid overdose they are meeting the goal of saving that life, but also they are having an impact on the demographic of addicts by reducing the mortality from opioid overdose, in the end you save more lives, yes, but you’re also stuck with more addicts, specially those who tend to overdose and who will likely overdose again. Also you are making the opioid abuser population feel more safe, since an overdose is no longer such a treat to their lives, thus making them more likely to be less cautious and more prone to overdose. Those are the two major factors that contribute to the increase on the demand(and thus on the Price) of naloxone.
    Now that the US are getting more successfull at saving people form opioid overdose I think the real problem is getting more evident, I’m talking about the Opioid epidemic Itself. The solution is never going to be to stop saving lives, but to make sure those people don’t get overdosed again. The obvious solution here is to make mandatory by law for patients saved from an opioid overdose to go full rehab programs before being released again to society, that way they will either still think twice before overdosing again(knowing that an overdose wont get’em killed, but still will haver a huge impact on their lives), or simply will be held in an institution for rehabilitation, thus making it far more difficult for them to get overdosed again, and potentially driving them out of their addiction.
    Where do you get those laws and institutions?, I think that’s exactly why they are trying to rise national level awareness about this issue in Ohio, by making such a polemical policy proposal.

    • Shelly Barton

      I agree with much of your reply but actually the most dangerous time for a addict to OD is once out of Rehab. they will have decreased there Opioid tolerance and can no longer tolerate there previous dose without respiratory arrest…

  4. Kerri Symes

    I am a social worker here in Ohio and I wanted to add a few points to the discussion- There is little to no prevention in schools and communities. The funds and energy are focused on overdoses rather than preventing use of heroin and other drugs to start with.
    Also, for those addicts who are willing to seek help- there are only very RARELY beds open in rehabs and drug treatment facilities, and the same goes for psychiatric beds. As social workers, people come to us wanting help, which is incredibly brave, and then we have to tell them that they need to be on the waitlist for MONTHS. By that time, they have already overdosed, or no longer want to seek help.
    What are we supposed to do with no prevention and no long term treatment? This is why, at least in my community in Ohio, Narcan is used so often.

  5. Lacy Conley

    As an ER RN, I find we are using higher and higher doses of Narcan. Where we have used 0.4mg doses in the past, we are using 2, 6, 10 and I’ve heard up to 12-16 mg to resuscitate an overdose pt. I do believe we have given them a cushion, a security blanket in matter of speaking and possibly making them feel more ok about taking high doses of narcotics. Are we enablers? In a way I feel we are. We absolutely need to do something to curb this epidemic, I’m not sure there is one answer. I live in Ohio, I work in West Virginia. Ask us about where to go for recovery, for help, for withdrawal….. We really have nothing in our immediate area. We NEED a place to help these people get off of the narcs, we NEED a drug recovery program. This area has focused on the immediate fix, but not on the long term fix.

    • Peggy Lou Behan

      Seeing the same problem. Instead of repeatedly rescuing, why aren’t we spending that same money to rehabilitate! WV has no help!

  6. James Combs

    Middletown sucks i hear sirens i think there is another OD down the street. I drive to the pot hole streets and bam here is a OD in progress. Theft lets lock soors, screw window’s shut, chain grill to porch all because the dope heads steal then work, The Mcdonalds down the street has OD’S all the time. Once a good town now is nothing but drug user’s across Middletown , I agree with Picard because this town has gotten so bad. Come visit bring security with you if you want to keep your valuables.

  7. Scott Blanchard

    Many fire departments have discontinued paramedic services, opting for privatized EMS. Others have stopped responding to medical emergencies. This is a terrible problem for departments. Also remember most fire departments in the US are volunteer/ paid on call and the labor cost goes up with excessive responses. I don’t believe that withholding response is legal under duty to respond and duty to act. This is no different from people coming to the ED because we can’t turn them away due to EMTALA and because their PCP wants to be paid. Lives will be lost and the only response to a law suit will be the number of zeros following the one on the check. This is a nationwide problem. As an ED nurse we see several overdoses and occasionally the same person in one day and waves of, “bad batches” that take out many.

    As health care professionals we have a moral and ethical duty to respond and to act.

  8. Scott Blanchard

    OTC narcan bothers me from a few angles. One rats flee when there is an emergency, so who will be around when the heroin outlives the half life of the narcan. Two we have been using high dose narcan, including narcan drips, so one OTC dose will not preclude the necessity to call EMS. Many users use alone, the affect is so rapid, you have to have someone to give it to you. I believe it is a false sense of security.

  9. Angela Kise

    I live 10 minutes from Middletown and work in an ER 25 min away. I worked yesterday 9a-7 and we had 7 overdoses in that time frame one of which we had to intubate. Luckily no deaths but when I leave its hard not to think about this epidemic. The resources that it is consuming! We are so jaded seeing the same faces every other day. I’m so glad you are bringing up this topic, what are we to do? Why are the police not more involved, after all these drugs are illegal! In jail/ prison people hopefully would not have the access to these drugs but would have mandated rehab??? Time they are clean, access to food, and counseling…
    How bout 3 strikes you go to prison??Hopefully to turn a new leaf and cherish life outside of prison…

  10. Mary

    I’ve been an RN in the Dayton, Ohio region for over 20 years. Have worked directly with substance abuse, so here’s a thought. . . especially for those who are running low on empathy. Maybe we should rethink how we respond to patient’s who cannot breathe from years of cigarette smoking, especially those who continue to smoke while on oxygen (saw it many times), or the people who are costing the health care system billions due to their morbid obesity that results in cardiovascular disease (EMS runs for MI’s), or the diabetics who insist on eating whatever they want while they continue to lose body parts from the toes up and trash their kidneys? Maybe we should start enacting food rations for the obese individuals (food addiction), and stop making 911 calls to people who have abused tobacco (smoking addiction) their entire life, and now have respiratory failure – among everything else – including cardiovascular disease, CVA’s, the works. Those things have been happening for years while the enabling continues. . . . .Somehow we have more compassion for that irresponsible behavior than the individual enslaved from drug addiction. Pick your coping skill poison, there is not much difference. Funny thing, I’ve ridden through drug and ETOH withdrawal with many patients, and it can be very hard to not be frustrated at times, but the ones that don’t work with this population directly are often the ones that are the most judgmental. Those of us in the mental health arena saw this coming, nobody was listening. Now everyone is an “expert.”