COMMENTARY

Should Everyone Carry Narcan®? Let's Think This Through

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

April 06, 2018

By now, it has escaped no one's attention that the United States has a real opioid crisis underway. We see new statistics and alarming data almost every day.

The Surgeon General has made a pronouncement unlike any other, urging more Americans to carry an opioid antidote, the drug naloxone, commonly known as Narcan®.

Does this seem like a rational plan?

I'm not sure it makes much more sense than any of us carrying a bottle of nitroglycerin to treat patients with end-stage angina. Let's think about this.

What, exactly, are we offering to addicts once their condition has been reversed? When you examine states that have been overwhelmed by the opioid crisis, their 911 systems have nearly been undone by the volume of "rescues" they have performed. Without a back-up plan, they see the same patients several times, prompting many to discuss a "three strikes and you're out" option simply to survive. Librarians have stepped in, keeping Narcan supplies in their desks in counties where heroin has converted small cities into an overnight battleground.

Naloxone is merely a Band-Aid for an explosion of crisis proportions. According to current statistics,[1] less than 1 in 10 opioid addicts find assistance via a professional, monitored program that prescribes medication such as buprenorphine/naloxone or methadone, or other therapy to wean them off heroin and opioids. Without such assistance, the odds of survival for any length of time remain low, no matter how much reversal medication is kept nearby.

Yes, definitely, citizens might be willing to carry naloxone and even inject it if needed, but it's not an inexpensive drug. Who is going to fund and replenish the supply, and teach citizens how to properly inject the medication?

From what I've seen so far, government approaches to the opioid crisis seem to start with blame (states suing "Big Pharma" for selling and promoting opioid drugs) or at the wrong end (let's try to reduce opioid deaths by jumping in when they need a reversal agent!).

Why not actually work on the problem? Why not discuss how and why patients become disenfranchised with life, seeking any means of self-medication, especially legal or illegal opioids? Maybe we could help them before they stop breathing? Maybe we could intervene before we need to inject them?

It's just an idea. Tell me what you think.

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