I was at a recent meeting of a statewide opiate overdose working group, composed of a wide variety of community stakeholders all committed to helping curb the crisis, when I heard one woman say the our goal should be Narcan in every medicine cabinet. Certainly Narcan should be in the homes of any person with a history of opiate use.
Narcan saves lives.
But it is important for those who view Narcan as a magic bullet to understand Narcan does not save a life every time it is used. It is irresponsible for those who know better to issue press releases equating the number of Narcan uses by their organizations with the same number of lives saved.
Narcan does not save patients in true cardiac arrest.
Narcan does not save patients with coma not of opiate etiology.
Narcan does not instantly restore adequate ventilations in those patients who may still be breathing, but who are hypoventilating. If not given in time, Narcan may not save these people unless someone is there to ventilate them.
Narcan does not save patients who are merely dosed on opiates, unresponsive or semi-responsive patients who are breathing/ventilating adequately on their own (These patients don’t need saving).
Here’s what Narcan does do:
Narcan saves the patient whose respirations have become so inadequate that hypoxia is building up, and if not corrected, will ultimately lead to cardiac arrest or anoxic injury prior to the arrival of competent responders equipped with the means to properly ventilate the patient.
This includes patients for who responders have not been summoned and for patients whose responders have arrived but who are not competent with their tools of ventilation.
In addition to saving lives, Narcan spares the need to intubate many patients whose airways would otherwise have to be protected until their opiate wears off.
The number of patients who Narcan saves will be but a portion of those patients who actually receive Narcan, but the lives Narcan is saving is no small accomplishment.
Narcan is saving sons, daughters, spouses, parents, family, friends, and strangers with families and friends of their own.*
We must make timely Narcan available to all patients who fit these categories.
That means Narcan for all responders, Narcan for lay people and indeed Narcan in a medicine cabinet in every home where opiate users reside.
If we want to save more lives we have to expand Narcan provision to include face masks and training in mouth to mouth or perhaps simple cardiac compressions in those without any respirations to provide passive ventilation until the Narcan kicks in or trained responders arrive.
We should also consider upping the initial layperson/single first responder dose (in those areas that haven’t already) of 2 mgs IN to 4 mgs IN to bring effective breathing/ventilation back sooner.
* Narcan is saving some of these patients more than once. Just as we EMS save many of our patients with other diseases (heart, diabetes, lung, psychiatric, trauma) more than once.