Naloxone is not enough

hand drowning

Naloxone saves lives. That’s good. Very good.

However, naloxone is not enough.

Naloxone is not enough for EMS workers.

“As EMS providers, this call is a success,” Hassan says. “In the big picture of health care, is it a success? Well, no, it’s incomplete right now. For it to be a total success he’d get into a rehab program and never do heroin again.”

But, that’s not what usually happens Hassan says. “At some point, we probably took care of him before.”

Naloxone is like a defibrillator. What would we do if patients were being revived by defibrillators and walking out of the emergency department a few hours later with a passive referral to treatment that has a long wait list.

Naloxone is like a defibrillator. What would we do if patients were being revived by defibrillators and walking out of the emergency department a few hours later with a passive referral to treatment that is inadequate and/or has a long wait list?

Naloxone is not enough for addicts.

Joseph says that most of the time he has been brought to an ER because of an overdose, he has been discharged after only about three hours, without any recommendations about getting further treatment.

“They let you kinda sleep it off,” he says. “They just discharge you and they tell you you need to get help — you need to do something.”

. . .

Sometimes, after a Narcan treatment, Joseph says he felt so bad he just went home and shot up more heroin. “It’s a vicious, vicious cycle,” he says.

Naloxone is not enough for doctors.

Many ER doctors say that after a Narcan revival, if a patient appears to be breathing fine and walking, they are indeed discharged within a few hours. Many are so sick and uncomfortable they just want to leave. And even if they do want further counseling and extended treatment for their addiction, access is limited by availability and insurance.

“For myself, basically, they’d have to be able to walk safely, be able to have a conversation, be able to take fluids before they’re released,” says Dr. Edward Bernstein, a professor at Boston University, and an emergency physician at Boston Medical Center. Before the patients leave after a Narcan revival, most are given their own Narcan kit and information about further treatment.

But less than half the overdose patients revived with Narcan at the medical center actually do go on to get follow-up help with their addiction. That’s often because there are no beds available, he says.

“You do feel helpless,” Bernstein says. “Especially since we’re trying our best, and we have all these different tools now.”

Repeatedly having to use Narcan on the same patient can make a health provider feel helpless, Bernstein says. About 30 percent of those revived with Narcan at Boston Medical Center have been revived there more than once, he says, and about 10 percent of patients more than three times. Those statistics are in line with what’s seen in ERs elsewhere, public health officials say.

Naloxone is good, but it’s not enough. We need to talk about what happens after the overdose.

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