What is Naloxone? And why should every American have access to it?
There was a time when Automatic External Defibrillators (AED) devices … the boxes that talk to you to shock someone’s heart back to a normal rhythm … were not in the places we find them today: airports, hotels, fast food restaurants. It was not because the technology was unavailable. AEDs were in doctor’s offices and hospitals all over the world. They were not in commercial spaces, because there was a concern that untrained people would not know how to properly use them. In 2002 the New England Journal of Medicine published a paper showing the AEDs saved lives in various Chicago airports (http://www.nejm.org/doi/full/10.1056/NEJMoa020932). This study showed that not only having AED devices publicly available was a life-saving intervention but also that untrained people were very capable of saving others’ lives. The fact that this study had to happen sounds ridiculous today. We take for granted that these devices are all over our public spaces. In 2011, a study in the American Heart Association’s journal Circulation, estimated that out of hospital AED devices save over 1000 lives a year.
Today, we find ourselves in the middle of an opioid crisis that has lowered US life expectancy for the second year in a row. This dip in life expectancy has not been seen since the early 1960s, and it is due to unintentional overdoses from opioids, mainly fentanyl. One of the main ways to combat overdose deaths is to use naloxone, the antidote to opioid overdose. The surgeon general Dr. Jerome Adams MD, MPH recently issued the first advisory from his office since 2005 encouraging more Americans to have naloxone accessible to prevent overdose fatalities. (https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/index.html)
Naloxone reverses opioid overdose. It works by essentially knocking out whatever opioid has taken over the brain so that the overdose temporarily goes away. It can be injected into someone’s arm or leg muscle or squirted into someone’s nostril if that person is not responding nor not breathing and opioid overdose is the suspected culprit. It is only temporary because most opioids will stay in the body for a number of hours while the naloxone will be active for 30–60 minutes. It is important not just to give naloxone in overdose but also to ensure that the person who received it gets rescue breaths if necessary and then immediate medical attention. Because the naloxone temporarily reverses the overdose, a person on whom naloxone has been used may be very alert and state they do not need medical attention, but this is untrue. The overdose can return and will cause the person to not breathe on their own once the naloxone wears off. Naloxone can cause little harm if used incorrectly. If you use naloxone on someone that has overdosed on something else, like sleeping pills, it will not work but neither will it hurt the person significantly. It does not cause a high nor can it be abused. It can be used on the young and the elderly irrespective of medical condition because the alternative of not using it is death.
Alex Walley and his colleagues at Boston Medical Center conducted a study that suggested when whole communities, not just individual patients, are trained in overdose prevention and have access to naloxone through public distribution, opioid overdose deaths may be prevented. (https://www.bmj.com/content/346/bmj.f174) This study looked at communities across Massachusetts that received overdose prevention education training along with naloxone distribution as compared to those that do not, and found that educating not just patients and their family members but also community members at large about overdose prevention and arming them with naloxone were associated with lower death rates in those communities.
Any physician can prescribe naloxone and should co-prescribe it whenever writing a prescription for opioid based medication. In some states, naloxone is over-the-counter. In Georgia, there are two great resources for free naloxone and training on overdose prevention. In the city of Atlanta, there is the Atlanta Harm Reduction Coalition. (www.atlantaharmreduction.org) Across Georgia, the volunteers of the Georgia Overdose Prevention (www.georgiaoverdoseprevention.org) also distribute naloxone and train individuals and communities about overdose prevention.
If you are in need of a prescription for naloxone or training on overdose prevention, please do not hesitate to make an appointment for yourself or someone you love at Whole and Healthy You. You cannot control whether someone else chooses to use drugs, but you can prepare your home, your family, and your community to prevent overdose and save lives.
