Emergency Training & Consulting How big of a problem is opioid abuse?
Could this program increase drug use?
What happens when someone overdoses on opioids?
What treatment is available for the victim?
Who can give naloxone?
What about EMTs from the local ambulance?
Are there similar programs elsewhere in the nation?
How big of a problem is opioid abuse?
While the recent deaths of actors Cory Monteith and Philip Seymour Hoffman have focused media attention on overdose deaths, those of us in emergency services have been treating similar victims for years.
16,000 people die every year as a result of opioid overdoses. A few years ago prescription pain medication represented a significant percentage of these, but as the nation cracks down on pill mills, many abusers are turning back to heroin, which is cheaper and becoming more available, relatively.
Between 2007 and 2012, heroin use increased by 79%, and 81 of first time heroin users have already abused prescription drugs. It is estimated by the Substance Abuse and Mental Health Services Administration that there are 669,000 users of heroin in the US.
Could this program increase drug use?
Long term treatment and rehabilitation remains a significant challenge in this country. However what cannot be denied is that the chance of rehab is zero if the user dies of an overdose. Regardless of one’s personal views on the ‘war on drugs’, these victims are still someone’s son or daughter. There is no evidence that increasing the availability of naloxone will increase drug use.
What happens when someone overdoses on opioids?
In the event of an overdose of narcotics, the victim is often unconscious and may stop breathing. At that time, brains cells can start to die within 4-6 minutes due to no oxygen.
What treatment is available for the victim?
A rescuer, whether a civilian, law enforcement officer (LEO) or member of EMS has a few options. First, they can ventilate the victim with a pocket mask – the breathing part of CPR. While this will sustain the victim’s life, it is not ideal to continue to ventilate a victim all the way to the hospial.
In New Jersey, if the responder is a paramedic with a hospital based mobile intensive care unit (MICU) then they can administer the antidote naloxone, also known as Narcan.
Naloxone competes with the narcotic for space on the narcotic receptor, but will not activate the receptor which would lead to both pain relief and the side effects such as sedation and respiratory depression. Naloxone can be given intravenously, intramuscularly, intranasally and even nebulized like asthma medication. Naloxone has very few side effects, and if administered to a patient who is not breathing, its benefits outweigh the few if any risks.
Who can give naloxone?
Unfortunately, in NJ, the number of paramedic units is limited, and their response can sometimes be 15 minutes or greater. Local Basic Life Support ambulances with EMTs and local police departments can respond more quickly, and while ventilation can delay and prevent death, there are side effects from prolonged ventilation.
Recently, NJ passed a law that will allow a physician to prescribe to a ‘patient’ naloxone to be used on a victim that the ‘patient’ may be in position to assist. While primarily intended for friends and family members of addicts, there is nothing in the law to prevent LEOs from also being prescribed naloxone and using it on a victim of overdose they respond to.
With this in mind, law enforcement officers in one NJ County will be a pilot site for the use of LEO naloxone. If successful, this program will roll out to other counties and law enforcement agencies that are interesting in carrying the medication. Dr. Ken Lavelle, an emergency physician with 26 years of experience in emergency services will be serving as medical advisor to the County Prosecutor’s Office and other police departments that are participating in this pilot.
What about EMTs from the local ambulance?
The administration of naloxone was formerly not in the scope of practice for an EMT – only a paramedic could give it while working on a paramedic unit. But Gov. Christie recently approved a waiver to allow NJ EMTs and Paramedics working on a Basic Life Support ambulance to carry and administer naloxone to overdose victims if they have been trained to do so by their Medical Director.
Are there similar programs elsewhere in the nation?
Other cities and states have already implemented similar programs, including:
- Lorain County, OH
- Suffolk County, NY
- Buffalo, NY
- NYPD 120th Pct – Staten Island
- Multiple sites in Massachusetts including Quincy, MA, which was one of the first and most successful programs, with over 200 reversals in a few years.
If you are interested in Medical Direction, or have any questions, please contact Dr. Lavelle directly at: