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It was a wicked whipsaw. Hordes of new opiate addicts were created, with more addictive compounds than ever before, at unprecedented levels of availability-- a

It was a wicked whipsaw. Hordes of new opiate addicts were created, with more addictive compounds than ever before, at unprecedented levels of availability-- and then their access was yanked away, with seemingly little thought to how addicts would react. Curiously, Fentanyl showed up on the black market in huge amounts around this time... and then users from all walks of life started dropping like flies. Narcan is saving a lot of lives (although it does little or nothing for addiction itself), and kratom looks like a potentially promising way to help addicts stop/reduce their use of harder stuff (if misguided crusaders don't go and ban that everywhere), but everything's a tradeoff and nuance is important. We've got a ton to work on in this area for a long time.

FireBeyond 8y ago
> Narcan is saving a lot of lives (although it does little or nothing for addiction itself) Nothing whatsoever, and from a bigger picture hurts. "Ideal" treatment for opiate overdose? Manage respiratory depression/arrest, slowly titrate IM (not nasal) Narcan to keep level of consciousness lower, get to hospital, offer patient treatment options/longer term help. Blast IN naloxone into someone and they'll almost always AMA (against medical advice) on scene. -- paramedic
- tcj_phx 8y ago
  My girlfriend’s involuntary treatment providers decided to give her a benzodiazepine addiction, on top of the other non-helpful prescriptions they thought she needed. Initially the benzos helped her “anxiety”, but the effect wore off after a month. She ordered heroin from her street pharmacist to get through benzo withdrawal. I said... “we’re not going to do this again.” She said it was barely any heroin at all, that she wasn’t going to get addicted again, and that she just needed it so she could sleep. Just to show me that it wasn’t much she prepared a second shot and injected that too. I don’t think she realized that her tolerance had changed and that benzodiazepines increase the potency of opiates. Then she fell forward, said “I meant to do that”, then her face turned blue and she went non-responsive. I called EMS. They revived her with 2x2mg naloxone. After a few minutes the firefighters decided she was okay. The police officers also decided they didn’t need to intervene. She did very well for about 2 weeks: drinking under control, benzodiazepine withdrawal mostly completed, etc. Narcan/naloxone has much broader effects than just kicking out the opiates from the opioid receptors. The related drug Naltrexone is FDA-approved to help people get their alcohol use under control. I’m not entirely clear on how the anti-opiates help with alcohol use, but I think it has to do with fixing the metabolic problem that is associated with most cases of alcoholism. You’re correct that narcan isn’t much of a treatment by itself. But naltrexone is almost the same drug, keeps people sober long enough to get them stabilized, and partially addresses the long-term emotional pain they’re actually self-medicating for. If addicts are helped out of their “cage”, narcan/naloxone and naltrexone are very useful tools to support them while they recover.
  - FireBeyond 8y ago
    Oh, absolutely. That's definitely a challenging situation, and naltrexone is something to be considered in the longer term help, like you say. It's just not something we administer in EMS, largely for the same reasons, "treat the life threats", in her case respiratory depression/arrest.

FireBeyond 8y ago

> Narcan is saving a lot of lives (although it does little or nothing for addiction itself) Nothing whatsoever, and from a bigger picture hurts. "Ideal" treatment for opiate overdose? Manage respiratory depression/arrest, slowly titrate IM (not nasal) Narcan to keep level of consciousness lower, get to hospital, offer patient treatment options/longer term help. Blast IN naloxone into someone and they'll almost always AMA (against medical advice) on scene. -- paramedic

tcj_phx 8y ago
My girlfriend’s involuntary treatment providers decided to give her a benzodiazepine addiction, on top of the other non-helpful prescriptions they thought she needed. Initially the benzos helped her “anxiety”, but the effect wore off after a month. She ordered heroin from her street pharmacist to get through benzo withdrawal. I said... “we’re not going to do this again.” She said it was barely any heroin at all, that she wasn’t going to get addicted again, and that she just needed it so she could sleep. Just to show me that it wasn’t much she prepared a second shot and injected that too. I don’t think she realized that her tolerance had changed and that benzodiazepines increase the potency of opiates. Then she fell forward, said “I meant to do that”, then her face turned blue and she went non-responsive. I called EMS. They revived her with 2x2mg naloxone. After a few minutes the firefighters decided she was okay. The police officers also decided they didn’t need to intervene. She did very well for about 2 weeks: drinking under control, benzodiazepine withdrawal mostly completed, etc. Narcan/naloxone has much broader effects than just kicking out the opiates from the opioid receptors. The related drug Naltrexone is FDA-approved to help people get their alcohol use under control. I’m not entirely clear on how the anti-opiates help with alcohol use, but I think it has to do with fixing the metabolic problem that is associated with most cases of alcoholism. You’re correct that narcan isn’t much of a treatment by itself. But naltrexone is almost the same drug, keeps people sober long enough to get them stabilized, and partially addresses the long-term emotional pain they’re actually self-medicating for. If addicts are helped out of their “cage”, narcan/naloxone and naltrexone are very useful tools to support them while they recover.
- FireBeyond 8y ago
  Oh, absolutely. That's definitely a challenging situation, and naltrexone is something to be considered in the longer term help, like you say. It's just not something we administer in EMS, largely for the same reasons, "treat the life threats", in her case respiratory depression/arrest.