First question: Should “everyday citizens” – however that term is defined – be given access to potentially harmful medications, including antidotes to dangerous narcotics? Well, perhaps. Second question: What if the medication also saves lives? Now the answer is a much more emphatic “perhaps”. The Commonwealth of Massachusetts is working hard to come up with a more definitive answer.
According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 100 people throughout the United States die from narcotics overdose every single day. This grim reality may be largely due to a climbing rate of prescription medication overdoses – a problem that requires a major public-policy, public-health, and public-safety decision.
On the patient-by-patient level, there is a ready solution – the use of Narcan (Alexon), which is the usual antidote to such narcotics as oxycodone, methadone, and heroine. For decades, Narcan has been carried by paramedic units, and almost always is given as an injection – by a trained professional. Thanks to the recent introduction of a spray version, the possibility of administration by nonmedical professionals has moved Narcan a somewhat-controversial step closer to the narcotics user.
In Massachusetts, a pilot project is already underway that allows the distribution – to persons other than emergency responders – of Narcan in a form that can be sprayed up the patient’s nose, where it is absorbed through the mucous membranes. Massachusetts’ state law currently allows the “ultimate user” of a medication to possess the medication. The novelty of this pilot program is that a new of responder is being created to possess medications specifically intended for possible treatment of another person.
These responders may in fact be any person who is considered likely to encounter a narcotics overdose. Such persons can obtain the medication simply by requesting it through any participating public health or medical agency. Moreover, they can receive, along with the Narcan, training on not only the use of that medication, and recognition of an overdose, but also other lifesaving steps that should be taken – e.g., calling 9-1-1, and the administration of rescue-breathing techniques and equipment.
The Massachusetts program includes a protocol that gives the legal authority to possess the medication in much the same way a prescription would be, with directions for use. After the medication is used, there is a debriefing process required so that, when the user requests a replacement Narcan kit, the program organizers can collect the data needed to evaluate the program more fully and more effectively.
A Clear Focus on the Primary Job: Saving Lives
Whether they will be carrying the medication themselves or simply have the potential of encountering it in the community, responders should receive the training available. Because EMS staff members are already familiar with Narcan, such “education” may simply mean a brief notification about the spray version being available to the public. Emergency responders who have Narcan entrusted to their care for the first time should also participate in more formal training sessions.
Recently, one large Massachusetts city, Gloucester, announced that their police and fire staffs both will be carrying the spray version of Narcan. That announcement represents the culmination of a cooperative effort by the city’s management to overcome a number of hurdles common to the introduction of new programs within the overall civil-service community. Fire and police responders already are required to participate in such training – for example, with overtime costs being paid through the Board of Health.
It should be noted that these programs already have been successful in saving many people who would likely have died from overdose. Moreover, the same events offer an opportunity for entry into addiction treatment at a time when the patient has the most persuasive motivation possible: surviving a near-death experience. The bottom line, though, is that Spray Narcan distribution does not directly address the root cause of addiction or the ballooning abuse of prescription pain killers. As Gloucester Fire Chief Philip Dench points out, “Our job is saving lives” – and this program does that, without a doubt.
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For additional information on: CDC Statistics, visit https://www.kff.org/wp-content/uploads/sites/2/2011/04/poison-issue-brief.pdf
Narcan programs, visit https://stopoverdose.org/find-naloxone-near-me-washington-state/
https://harmreduction.org/resource-center/harm-reduction-near-you/
Joseph Cahill
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.
