Naloxone is not enough

NARCAN-KITFrom USA Today:

Fulcher [an emergency room physician at Sts. Mary & Elizabeth Hospital in Louisville, Ky.]says he generally supports giving greater access to naloxone, which at one point his ER administered so often doctors felt like they were running a drive-through OD clinic. But he says new laws “totally ignore” the overall problem of addiction and may communicate an underlying acceptance of intravenous heroin use. “Politicians will feel like they’ve dealt with the problem,” Fulcher says.

There’s a comment on Join Together that suggests this is a straw man, that no one says naloxone is enough. There’s some truth to this.

At the same time, how much action are we hearing about to increase access to treatment of an appropriate quality, intensity and duration?

UPDATE:
A commenter expressed concern about Dr. Fulcher’s concern that we “may communicate an underlying acceptance of intravenous heroin use.” In her comment she cited a reseacher (and harm reduction activist) Peter Davidson. The exchange touched upon some important themes. Below is my response.

That line made me cringe too. However, not knowing anything about him, I’m willing to give him the benefit of the doubt.

First, you didn’t include an important line from that quote, “‘Politicians will feel like they’ve dealt with the problem,’ Fulcher says.” This changes the context considerably. It makes it sound less like a concern about increased drug use and more like a concern about political indifference.

Second, he’s an ED physician and his reference to ERs feeling like “drive-through OD clinics” suggest he’s witnessing what we see in our community–an OD, naloxone reversal, brief visit to the ED with (at best) a passive referral to treatment, and ODing again, sometimes fatally. It becomes normalized and is not treated like a near fatal event/symptom of a life-threatening illness with a high mortality rate.

Finally, he’s not saying we need less naloxone. He’s saying we need naloxone-plus–that we need naloxone plus addiction treatment.

Given that, I’m willing to interpret his statement as a poorly worded expression of concern about professional and social indifference to non-fatal OD.

It’s interesting. After your comment I looked to read more on Peter Davidson. I see that he created odgame.org.

While I’m not crazy about the style of it, what really bothered me was the content of the game. If you call 911, the game continues for 3 turns (unless you do something to kill the person). However, if you give the person naloxone, it’s game over, with a pat on the back and instructions to:

“If you can’t stay with them, try and leave them with someone else. If that isn’t an option either, at least try and leave them in a public place so there’s a chance some passer-by might notice if they lose consciousness again.”

I think this is exactly what Fulcher was pushing back against. No mention of getting medical help. No mention of treatment. No hope for recovery. No using this as a window of opportunity to intervene. Mission accomplished and we can feel good about ourselves.

Can you imagine instructing people to use an automated defibrillator on someone who has a heart attack and the care ending there with a congratulations? Or worse, leave them in a public place?

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4 responses to “Naloxone is not enough

  1. Pingback: Naloxone is not enough | 12 Step Gazette

  2. Read this article and am concerned about the reference made to “underlying acceptance of intravenous heroin use.”

    There is the misperception that having access to naloxone will keep heroin and other opioid users using these drugs, and would cause these users to use more and more frequently because they have access to naloxone to reverse an overdose if they take too much. This is not the case.

    Peter Davidson, Ph.D. is a researcher in the field of opioid-related overdose prevention and intervention. He is an expert in this field and works for the Division of Global Public Health, Department of Medicine at the University of California, San Diego. When asked for comment, Dr. Davidson offered the following statement regarding this widely held belief:

    “We now have over 10 years’ worth of research showing that not only does having naloxone not increase people’s drug use, but that there’s evidence that the experience of saving someone’s life using naloxone is associated with ceasing heroin use altogether within the next 12 months.”

    Our nation is currently facing opioid overdose rates of epidemic proportions. More people die each day of an opioid overdose than they do from car accidents. This is unacceptable. Until there is a cure for opioid addiction people need access to naloxone.

    • That line made me cringe too. However, not knowing anything about him, I’m willing to give him the benefit of the doubt.

      First, you didn’t include an important line from that quote, “‘Politicians will feel like they’ve dealt with the problem,’ Fulcher says.” This changes the context considerably. It makes it sound less like a concern about increased drug use and more like a concern about political indifference.

      Second, he’s an ED physician and may be witnessing what we see in our community–an OD, naloxone reversal, brief visit to the ED with (at best) a passive referral to treatment, and ODing again, sometimes fatally. It becomes normalized and is not treated like a near fatal event/symptom of a life-threatening illness with a high mortality rate.

      Finally, he’s not saying we need less naloxone. He’s saying we need naloxone-plus–that we need naloxone plus addiction treatment.

      Given that, I’m willing to interpret his statement as a poorly worded expression of concern about professional and social indifference to non-fatal OD.

      Thanks for reading and commenting.

      • It’s interesting. After your comment I looked to read more on Peter Davidson. I see that he created odgame.org.

        While I’m not crazy about the style of it, what really bothered me was the content of the game. If you call 911, the game continues for 3 turns (unless you do something to kill the person). However, if you give the person naloxone, it’s game over, with a pat on the back and instructions to:

        “If you can’t stay with them, try and leave them with someone else. If that isn’t an option either, at least try and leave them in a public place so there’s a chance some passer-by might notice if they lose consciousness again.”

        I think this is exactly what Fulcher was pushing back against. No mention of getting medical help. No mention of treatment. No hope for recovery. No using this as a window of opportunity to intervene. Mission accomplished and we can feel good about ourselves.

        Can you imagine instructing people to use an automated defibrillator on someone who has a heart attack and the care ending there with a congratulations? Or worse, leave them in a public place?