Drug Use & Abuse

Student Name

COH318

Point/Counterpoint Essay

Date

Should Naloxone be allowed to be administered by anyone in order to save a life in case of a narcotic overdose emergency?

Imagine having the power to easily save the life of someone experiencing a narcotic or opioid prescription medication overdose… anyone, anytime, anywhere. Naloxone (Narcan) is an opioid antagonist medication that effectively reverses the effects of a narcotic overdose (usually heroin), is legal to possess with a prescription, is fairly inexpensive, and has no psychotropic effects or potential for abuse (Lankenau et al., 2013, p. 134). However, currently the majority of Emergency Medical Technicians (EMTs) in the United States are not authorized to administer such medications. Those who support widespread distribution of naloxone and advocate for training lay people to use it say it will potentially save more human lives. Those against its widespread use fear possible accidental overdoses, masking the addiction problem, or potential increase in drug use. Weighing these pros and cons, should such an antidote be given free to all narcotic users?

In order to combat the rising number of narcotic overdose cases, distribution programs that allow family members and friends to administer naloxone were established in some areas within the United States, and these programs demonstrated success in saving lives (Faul et. al, 2015, p. e29). These programs increased the ability to save the lives of any narcotic overdose/abuse by a family member, friend, or associate, whether the episode was witnessed or the overdosed user was discovered after some elapsed time. Furthermore, naloxone is easy to administer with proper education, awareness and training, so the benefits greatly outweigh any risks. In the San Francisco DOPE Intervention Project, 90 percent of trained participants who administered naloxone to overdose cases reported positive outcomes (Enteen et al. 2010, p. 939). In most states, the emergency/first responder medical scope-of-practice protocols prohibit naloxone administration by basic EMTs. Reducing this unnecessary barrier could help prevent thousands of drug overdose deaths annually and there are many who support suggestions for more widespread use of intranasal naloxone by non-advanced life support providers (Faul et al., 2015, p. e30). Intranasal administration of naloxone has multiple benefits compared to intravenous routes, including no required medical intravenous venipuncture skills, and it eliminates the risks of needle-stick injuries and blood-borne diseases. People without professional medical backgrounds have demonstrated competence in basic first aid, rescue breathing, and cardiopulmonary resuscitation (CPR) as first responders to an emergency, and nearly every business establishment in the United States these days has an automated external defibrillator (AED) which can be used by non-medical personnel to revive a person in cardiac arrest. Bazazi, Zaller, Fu, & Rich (2010, p. 1110) state that it makes sense for drug users and others to have an accessible tool to reverse opiate overdose that works well, is easy to use and is not harmful. Overall, these facts portray that anyone with a little initiative and the ability to follow easy instructions can save the life of someone who overdoses on opioids, whether by intent or by accident.

Whereas widespread distribution of naloxone may seem good on its face, there are many critics who believe that it could lead to further complications, such as possible accidental overdoses, perpetuating addiction or increase in drug use. There are obvious concerns that narcotics abusers may develop a false sense of security that having access to naloxone may make them safe from an overdose. These users may then increase their drug dosages due to this bravado or simply increase their overall intake to off-set any withdrawal effects. In a poll of injectable drug users who voluntarily participated in a study, nearly 15% believed easy availability of naloxone to be a bad idea and several reported that they might increase their heroin dosage as a result (Strang et al., 1999, p. 202). Some of the participants in one take-home naloxone study group stated that if someone administered naloxone to them, they would then have to use more opiates to counteract the discomfort from withdrawal symptoms (Breedvelt, Tracey, Dickenson & Dean, 2015, p. 72). While having naloxone for treatments at home may be a quick remedy for a heroin or opioid overdose, a major benefit for receiving treatment from a professional doctor at a medical facility is the opportunities offered to attend sobriety or intervention programs to eliminate the addict’s drug using and seeking behaviors and to ensure safe treatment. Naloxone distribution does not address the core problem which is the actual addiction. Participants from other studies reported that they would be reluctant to administer naloxone, even if witnessing an overdose in person, due to the police or other paperwork that may be required or because giving the medication to a patient requires constant medical surveillance and monitoring until they are fully revived or until a higher echelon of medical care arrives. Distributing naloxone may be a good gesture, but the risks of increased drug use, accidental overdoses and masking the core problem of addiction outweigh the benefits.

Regardless of the possible complications discussed in the previous paragraphs, I believe that naloxone distribution and administration would be a great concept to continue to develop. There are a plethora of widespread distribution organizations throughout the world that offer supplies, education, and training, and it would be a less risky idea to build upon the foundations already established. For example, in 2005 the United Kingdom deemed that naloxone was a safe injectable drug and allowed naloxone administration by anyone, even those without any medical training, in order to save a life in case of an overdose emergency. It seems foolish to think that in the United States, EMTs are not even allowed to perform such a simple and easy life-saving measure. Law enforcement officers are now being equipped with naloxone injectors and distribution programs have been showing documented success for several years. If research does show that the production cost of naloxone is fairly cheap, then it is absurd to completely dismiss this idea when the potential for what it could do is considered. For those with ethical qualms about providing clean needles and syringes to the community, their objections can be resolved by the use of intranasal naloxone medication rather than intravenous or intramuscular routes of administration. Simply put, the benefits greatly do outweigh the risks here, and having been a former first responder to an overdose call before, and having administered two rounds of 0.4 mg of Narcan intravenously before resuscitating a heavily sedated patient, I can say that the medication is definitely effective and I stand by its use, if used correctly and for the right purposes.

References

Bazazi, A. R., Zaller, N. D., Fu, J. J., & Rich, J.D. (2010). Preventing opiate overdose deaths: Examining objections to take-home naloxone. Journal of Health Care for the Poor and Underserved, 21(4), 1108-13. Retrieved from

https://nuls.idm.oclc.org/login?url=http://search.proquest.com.nuls.idm.oclc.org/docview/ 816192333?accountid=25320

Breedvelt, J. J. F., Tracey, D. K., Dickenson, E. C., & Dean, L. V. (2015). "Take home" naloxone: What does the evidence base tell us? Drugs and Alcohol Today, 15 (2), 67-75. Retrieved from

https://nuls.idm.oclc.org/login?url=http://search.proquest.com.nuls.idm.oclc.org/docview/ 1700641589?accountid=25320

Enteen, L., Bauer, J., Mclean, R., Wheeler, E., Huriaux, E., Kral, A. H., & Bamberger, J. D.

(2010). Overdose prevention and naloxone prescription for opioid users in San Francisco. Journal of Urban Health, 87(6), 931-41.

doi: http://dx.doi.org.nuls.idm.oclc.org/10.1007/s11524 - 010 - 9495 - 8

Faul, M., Dailey, M. W., Sugerman, D. E., Sasser, S. M., Levy, B., & Paulozzi, L. J. (2015). Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in US rural communities. American Journal of Public Health, 105, E26E32. Retrieved from

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Lankenau, S. E., Wagner, K. D., Silva, K., Kecojevic, A., Iverson, E., Mcneely, M., & Kral, A. H. (2013). Injection drug users trained by overdose prevention programs: Responses to witnessed overdoses. Journal of Community Health, 38(1), 133-41.

doi: http://dx.doi.org.nuls.idm.oclc.org/10.1007/s10900 - 012 - 9591 - 7

Strang, J., Powis, B., Best, D., Vingoe, L., Griffiths P, Taylor C, Welch S, & Gossop M. (1999). Preventing opiate overdose fatalities with take-home naloxone: Pre-launch study of possible impact and acceptability. Addiction, 94(2), 199-204. Retrieved from

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