Contributing co-author: Andrew Chen
Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?
Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.
Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.
What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.
Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.
In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.
15 months later, the BPHC conducted a follow-up:
- Contact was made with 278 of the original participants.
- 222 reported witnessing no overdoses during the 15-month span.
- 7 had their naloxone stolen, lost, or confiscated.
- 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!
The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.
Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.
For more information, check out our post Addiction and the brain part IV – Opiates
Citation:
Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)
2 responses to “Saving lives made easy – Treating opiate overdose with intranasal naloxone”
After completing 4 years at the University of Northern Colorado for my Bachelor of Science in 1990, 1 year at Johns Hopkins University for my Masters in Health Science in 1996, and 2 ½ years into my Ph.D. in respiratory medicine at the Medical College of Virginia/Virginia Commonwealth University in 1996-98, I thought I had complete control of my life. Specifically, my career in aerosol respiratory medicine. I had published my first paper in a respectable peer reviewed medical journal (Chest) when I was 27. Several months after that, I presented the paper at a medical conference in Garmisch-Partenkirchen, Germany. It was one of 9 trips I would take to Germany to consult with a medical company established in Starnberg, Germany.
By the time I was in my second year of my Ph.D. I had published/presented 54 medical papers, published 6 peer reviewed medical papers, was contributing author on one book, owned and operated my own consulting company in respiratory medicine, developed a patent for respiratory devices, and was progressing successfully in my Ph.D. I was 31 years old and I was proud of my accomplishments and my continuing success in respiratory medicine. But, that was all about to change. Addiction would enter my life and take away from me my possessions, my profession, my loved ones, and my sanity.
My pathway to addiction started when I made an appointment to see Dr. Cary Suter, M.D. for migraine headaches. I put great trust in him due to the fact that he was the medical schools doctor and was responsible for taking care of the students enrolled in the medical school programs. In a timeframe of 7.9 months I was prescribed 6,647 controlled substance pills. I had pills to help me stay awake and study, pills for helping me sleep, pills for anxiety, and pills for pain. I knew about addiction but I thought I was too intelligent to become addicted. Anyway, these pills were provided to me by the schools doctor who said he had taken pills when he was in medical school to help him succeed. My ignorance would cause me to lose almost a decade of my life and would bring me close to death many times as a result of my severe drug addiction.
Although Dr. Suter lost his medical license for over prescribing controlled substances and not monitoring that prescribing, it was too late for me. I had to drop out of my Ph.D. program due to my addiction. Dr. Suter lost his license 3 months after I dropped out of the program. At this point in my life, I had to confront and accept some very disturbing facts: I no longer was pursuing the goal I had been following for the past 15 years, I was severely addicted to prescription drugs, the doctor who had been prescribing me the drugs had his medical license revoked, and the main focus of my life was to obtain drugs. I was, in essence, trapped in the severity of my addiction. For the first time I had lost complete control over my life.
My first of numerous addiction related detrimental events came when I was presenting a medical paper at a conference in Atlanta, Georgia. Before my lecture I forged a prescription on my computer and proceeded to the pharmacy to have it filled. Since the prescription was for Demerol, the pharmacy called the doctor and verified the prescription was forged. The police were waiting for me (at the conference lecture hall) to finish my lecture and when I did they handcuffed and arrested me. I was taken out in front of all my colleagues and conference members and taken to jail. Needless to say I was immediately fired from my job as a senior aerosol scientist for a prominent German company established in the United States.
For many years I was doctor shopping. I would acquire my drugs in many ways: the internet, hospital emergency rooms, forged prescriptions, clinics, private doctors, and in other countries. I would stay employed by various companies because of my experience in respiratory medicine. But, I would ultimately get fired when my drug addiction interfered with the quality of my work. Eventually, word of my addiction became known to my colleagues and the respiratory medicine industry. From that point on, I was not called upon to lecture, to consult, or in any way work in the respiratory medicine industry. I was, for all intents and purposes, “blackballed” from my profession. It has taken great effort to restore my reputation and I still encounter numerous ‘roadblocks’ to this very day.
My future is still somewhat unknown. I do know that I am very thrilled and inspired living life as a sober individual. And, for the first the first time in 9 years I have a sense of self-confidence and respect for myself. This confidence reminds me that I can do anything I put my mind to. For this reason I have enrolled and been accepted to complete my doctorate in public health. My dissertation concentrates on prescription addiction in today’s society.
It has been a long, arduous, and self-revealing journey through my 9 years of addiction to recovery. Unfortunately along the way I became deceitful, dishonest, unreliable, and untrustworthy. On the other hand I can proclaim that through my adversity came great prosperity. My experiences will allow me to empathize and help countless others starting down or already on their own pathway from addiction to recovery.
Family & friends of opiate addicts MUST have naloxone, on hand at all times. We really need to educate the public on the necessity of this life saving drug…