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Narcan can also be delivered via nasal spray. I’ve heard of patients waking up and immediately taking a swing at the medic who administered the narcan. It’s fa

Narcan can also be delivered via nasal spray. I’ve heard of patients waking up and immediately taking a swing at the medic who administered the narcan. It’s fast and potent, but only lasts a few minutes. For a really bad OD, you might go through several doses. Where I am Narcan is $50+ per dose, a small price to save a life but kinda crazy when you meet the same patients again and again.

drewcoo 7y ago
What price is a human life worth if $50 multiple times is "kinda crazy?"
- cobbzilla 7y ago
  Oh it’s totally worth it, and said as much. I meant it’s crazy (hard) to imagine oneself needing a life-saver on a regular basis.
  - mikeash 7y ago
    Everybody needs regular food to avoid dying. Many need insulin or heart medication. Many need regular pills to keep their brains from going off the rails. Is this so different?
    - cobbzilla 7y ago
      Most people don’t have their groceries delivered via ambulance, and risk dying if their food doesn’t arrive soon enough. If you did that, then yeah I’d say that’s kinda crazy too.
    - michaelt 7y ago
      Some would see narcan as more like deploying car airbags - good that it's kept you alive, but if you need them routinely you should probably think twice before getting behind the wheel.
      - mikeash 7y ago
        And if you need pills routinely you should probably think twice before having a chronic condition.
        cf498 7y ago
        Overdosing isnt an unfortunate sideffect, its people making an error while dosing. An error that is easily preventable with a bit of care. The airback equivalent is very much fitting, its an emergency aid for once you made a mistake. If you are overdosing regularly, you are majorly screwing up making unnecessary mistakes.
        CydeWeys 7y ago
        I doubt it's easily preventable, or there wouldn't be so much of it. My understanding is that drugs are cut to varying strengths, and sometimes are laced with stuff like fentanyl or other compounds that you weren't expecting and that are highly active at lower doses. Preventing ODs is easy if you have a pure product of an exact known strength and an accurate scale, but these conditions aren't often true in the real world.
        cf498 7y ago
        Its largely preventable if you act with a reasonable level of care. Test the water with a new batch before you use it, even if its just administering a fraction of what you cooked up first. You are unlikely to have such potent stuff that a hundredth of an active dose is giving you an OD. That is unless someone is actively trying to kill you. The equivalent of an allergy test is nothing specific to injecting hard drugs. Addicts often dont do it since the test dosage is wasted and its extra injection. It becomes especially problematic when money is tight and you buy individual bubbles. But that is the inherent risk you take with street drugs and the care and effort you have to invest to not OD. Its like never sharing anything that goes into your veins. Neither an OD nor catching HIV or Hep-C are cases of just bad luck, they are the result of being reckless and skipping an important and necessary step.
- rootusrootus 7y ago
  Well, if you're spending $50 over and over to save the life of someone who then immediately gets back up and goes off to find more heroin, then "what price is a human life worth" is an interesting question indeed. There are billions of us, and some cost a lot more than they contribute.
  - mikeash 7y ago
    While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness. (And even trying to figure it out after the fact is pretty ridiculous for the vast majority.) A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
    - ThrowawayR2 7y ago
      > While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness. I'll point out that people rescued from the brink of death are usually grateful for it, whereas these poor individuals, as noted in the article, often take a swing at their rescuers. I think that pretty much answers the question of whether they cost more than they contribute. > A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why? What makes you think people don't? Have you never observed someone or even yourself doing something unhealthy and thought glumly "Yep, eating/drinking this is going to put him/her/me one step closer to death by a lifestyle disease. Foolish of him/her/me."
      - mikeash 7y ago
        How does them taking a swing at their rescuers tell us anything about their relative costs and benefits to society? What makes me think people don’t? The fact that you begrudge $50 to save an addict’s life, while your theoretical reaction to someone eating themselves to death is “foolish of him” seems to back that up pretty strongly.
AstralStorm 7y ago
The problem with nasal spray is that the patient still has to breathe. That's a tall order for someone who's OD'd. And it is why injectors are used instead.
- monieseee 7y ago
  Doesn't nasal spray directly get into blood through the nose blood vessels? Think about sniffing cocaine.
- throwaway8689 7y ago
  Not sure why you think this will be a problem. The naloxone won't block the nose and will be absorbed through the nasal membranes. If the patient needs extra oxygen or artifical ventilation that's still feasible.
- refurb 7y ago
  Why would they have to be breathing? The drug moves from the nasal mucosa to the bloodstream. As long as you get it in their nose it’ll be absorbed. Now I could see it not working as well if they aren’t breathing since it will likely be distributed over a smaller surface area.
FlyMoreRockets 7y ago
Recently retired EMT here. I never found the nasal spray to be very effective for a number of reasons. The patient has to be breathing, absorption rate is highly variable and it is difficult to adjust the dose. In fact, our protocols did not allow the dose to be adjusted with the intranasal route. IV push is the best, though SQ and IM are pretty good. IM and SQ are slow acting. You have to slowly bring the patient up. The important thing is to titrate dosage to rate and depth of breathing and slowly bring the patient up. If you push a large dose and suddenly rip the patient out of their warm, fuzzy cloud, into a world of hurt, they will often come up swinging. You can breathe for a patient with artificial respiration for as long as needed, there is no rush to slam the Narcan in quickly. In fact, the protocols I ran under said nothing about bringing an OD patient back to consciousness, only to ensure adequate air exchange. Also, talk to the patient with soothing, caring tones. Even though they are not responding, they can still hear you, increasingly so as the Narcan takes effect. I never had a patient swing at me after administering Narcan once learning technique from a master that had administered literally gallons of the stuff over his career. Some of the more jaded EMTs will purposely slam an OD patient with Narcan to punish them for using. This is just wrong.
- throwaway8689 7y ago
  Former UK EMT and I agree with this. Treat everyone, even the frequent flyers, professionally. Same protocol as well; keep me safe from angry addicts by not fully rousing ODs!
watersb 7y ago
Nasal doses of Narcan are available from a pharmacist for free where I live. A government-sponsored thing. Even if it's not as effective, maybe better than nothing. Until professionals arrive.

drewcoo 7y ago

What price is a human life worth if $50 multiple times is "kinda crazy?"

cobbzilla 7y ago
Oh it’s totally worth it, and said as much. I meant it’s crazy (hard) to imagine oneself needing a life-saver on a regular basis.
- mikeash 7y ago
  Everybody needs regular food to avoid dying. Many need insulin or heart medication. Many need regular pills to keep their brains from going off the rails. Is this so different?
  - cobbzilla 7y ago
    Most people don’t have their groceries delivered via ambulance, and risk dying if their food doesn’t arrive soon enough. If you did that, then yeah I’d say that’s kinda crazy too.
  - michaelt 7y ago
    Some would see narcan as more like deploying car airbags - good that it's kept you alive, but if you need them routinely you should probably think twice before getting behind the wheel.
    - mikeash 7y ago
      And if you need pills routinely you should probably think twice before having a chronic condition.
      - cf498 7y ago
        Overdosing isnt an unfortunate sideffect, its people making an error while dosing. An error that is easily preventable with a bit of care. The airback equivalent is very much fitting, its an emergency aid for once you made a mistake. If you are overdosing regularly, you are majorly screwing up making unnecessary mistakes.
        CydeWeys 7y ago
        I doubt it's easily preventable, or there wouldn't be so much of it. My understanding is that drugs are cut to varying strengths, and sometimes are laced with stuff like fentanyl or other compounds that you weren't expecting and that are highly active at lower doses. Preventing ODs is easy if you have a pure product of an exact known strength and an accurate scale, but these conditions aren't often true in the real world.
        cf498 7y ago
        Its largely preventable if you act with a reasonable level of care. Test the water with a new batch before you use it, even if its just administering a fraction of what you cooked up first. You are unlikely to have such potent stuff that a hundredth of an active dose is giving you an OD. That is unless someone is actively trying to kill you. The equivalent of an allergy test is nothing specific to injecting hard drugs. Addicts often dont do it since the test dosage is wasted and its extra injection. It becomes especially problematic when money is tight and you buy individual bubbles. But that is the inherent risk you take with street drugs and the care and effort you have to invest to not OD. Its like never sharing anything that goes into your veins. Neither an OD nor catching HIV or Hep-C are cases of just bad luck, they are the result of being reckless and skipping an important and necessary step.
rootusrootus 7y ago
Well, if you're spending $50 over and over to save the life of someone who then immediately gets back up and goes off to find more heroin, then "what price is a human life worth" is an interesting question indeed. There are billions of us, and some cost a lot more than they contribute.
- mikeash 7y ago
  While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness. (And even trying to figure it out after the fact is pretty ridiculous for the vast majority.) A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
  - ThrowawayR2 7y ago
    > While this is true, trying to figure out ahead of time if they’ll cost more than they contribute is the path to madness. I'll point out that people rescued from the brink of death are usually grateful for it, whereas these poor individuals, as noted in the article, often take a swing at their rescuers. I think that pretty much answers the question of whether they cost more than they contribute. > A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why? What makes you think people don't? Have you never observed someone or even yourself doing something unhealthy and thought glumly "Yep, eating/drinking this is going to put him/her/me one step closer to death by a lifestyle disease. Foolish of him/her/me."
    - mikeash 7y ago
      How does them taking a swing at their rescuers tell us anything about their relative costs and benefits to society? What makes me think people don’t? The fact that you begrudge $50 to save an addict’s life, while your theoretical reaction to someone eating themselves to death is “foolish of him” seems to back that up pretty strongly.

AstralStorm 7y ago

The problem with nasal spray is that the patient still has to breathe. That's a tall order for someone who's OD'd. And it is why injectors are used instead.

monieseee 7y ago
Doesn't nasal spray directly get into blood through the nose blood vessels? Think about sniffing cocaine.
throwaway8689 7y ago
Not sure why you think this will be a problem. The naloxone won't block the nose and will be absorbed through the nasal membranes. If the patient needs extra oxygen or artifical ventilation that's still feasible.
refurb 7y ago
Why would they have to be breathing? The drug moves from the nasal mucosa to the bloodstream. As long as you get it in their nose it’ll be absorbed. Now I could see it not working as well if they aren’t breathing since it will likely be distributed over a smaller surface area.

FlyMoreRockets 7y ago

Recently retired EMT here. I never found the nasal spray to be very effective for a number of reasons. The patient has to be breathing, absorption rate is highly variable and it is difficult to adjust the dose. In fact, our protocols did not allow the dose to be adjusted with the intranasal route. IV push is the best, though SQ and IM are pretty good. IM and SQ are slow acting. You have to slowly bring the patient up. The important thing is to titrate dosage to rate and depth of breathing and slowly bring the patient up. If you push a large dose and suddenly rip the patient out of their warm, fuzzy cloud, into a world of hurt, they will often come up swinging. You can breathe for a patient with artificial respiration for as long as needed, there is no rush to slam the Narcan in quickly. In fact, the protocols I ran under said nothing about bringing an OD patient back to consciousness, only to ensure adequate air exchange. Also, talk to the patient with soothing, caring tones. Even though they are not responding, they can still hear you, increasingly so as the Narcan takes effect. I never had a patient swing at me after administering Narcan once learning technique from a master that had administered literally gallons of the stuff over his career. Some of the more jaded EMTs will purposely slam an OD patient with Narcan to punish them for using. This is just wrong.

throwaway8689 7y ago
Former UK EMT and I agree with this. Treat everyone, even the frequent flyers, professionally. Same protocol as well; keep me safe from angry addicts by not fully rousing ODs!

watersb 7y ago

Nasal doses of Narcan are available from a pharmacist for free where I live. A government-sponsored thing. Even if it's not as effective, maybe better than nothing. Until professionals arrive.