IV push is the best, though SQ and IM are pretty good. IM and SQ are slow acting. You have to slowly bring the patient up. The important thing is to titrate dosage to rate and depth of breathing and slowly bring the patient up. If you push a large dose and suddenly rip the patient out of their warm, fuzzy cloud, into a world of hurt, they will often come up swinging.
You can breathe for a patient with artificial respiration for as long as needed, there is no rush to slam the Narcan in quickly. In fact, the protocols I ran under said nothing about bringing an OD patient back to consciousness, only to ensure adequate air exchange.
Also, talk to the patient with soothing, caring tones. Even though they are not responding, they can still hear you, increasingly so as the Narcan takes effect.
I never had a patient swing at me after administering Narcan once learning technique from a master that had administered literally gallons of the stuff over his career.
Some of the more jaded EMTs will purposely slam an OD patient with Narcan to punish them for using. This is just wrong.
Now I could see it not working as well if they aren’t breathing since it will likely be distributed over a smaller surface area.
Preventing ODs is easy if you have a pure product of an exact known strength and an accurate scale, but these conditions aren't often true in the real world.
Addicts often dont do it since the test dosage is wasted and its extra injection. It becomes especially problematic when money is tight and you buy individual bubbles. But that is the inherent risk you take with street drugs and the care and effort you have to invest to not OD. Its like never sharing anything that goes into your veins. Neither an OD nor catching HIV or Hep-C are cases of just bad luck, they are the result of being reckless and skipping an important and necessary step.
As unfortunate as it is, but normally people who OD are those that no longer care if they do. There are freak exceptions of course, like tainted or mixed up batches where even a allergy test can kill you, but those arent happening regularly to individual users.
People are just risking it, and its a very human thing to do. You can see the same behavior with the failure to use protection during sex. People should know better, but some people still risk it and are then faced with the unfortunate consequences.
edit: Dont get me wrong this isnt about victim blaming, but not promoting the myth that these things are just out of peoples control like the weather. You can be a heroin addict without catching HIV or Hep-C and with a reasonable level of care you are not going to end up needing Narcan regularly. You already fucked up by becoming an addict, there is no reason to also OD or catch something. Telling people that these are just inherent side effects to being an addict just makes it easier on people to excuse themselves for forgoing basic safety precautions. ODing regularly is not something normal, even for an addict. Its the result of being reckless.
You can talk about what people should do all you want, it doesn’t change anything.
My main point is that, as a health problem, drug addiction doesn’t look that much different from a lot of other health problems. Personal choices greatly influence your chances of acquiring it, your ability to beat it, and your odds of dying from it. This applies to many other medical conditions as well, but attitudes toward addicts are vastly different.
And if you are an adult chances are you know better and those arent unfortunate sideffects either. Its precautions you have to take or risk the consequences. If you get a sunburn you are not a poor victim of the sun but an idiot who skipped the necessary step of using sunscreen. As a result you are risking skin cancer. If you dont brush your teeth you get caries. It is similarly absurd to say that caries are the unfortunate sideeffects of eating. They are the reaction to your behavior of not brushing your teeth as you should. Wearing your belt in a car isnt optional either just because you have airbags. The human race, and with them you, know of what precautions you have to take to avoid certain fates. The higher the risk, the less optional they become. You might spend a day in the sun without sunscreen, the increased risk of skincancer might however be minimal if its not a regular occurrence. The risk of sharing a needle or the same watercup during cooking however is just to grave for being stupid.
Your point seems to be, that people make mistakes. I agree, but they dont have to make mistakes where they know better. There is a difference between an "ups" mistake and just a stupidly destructive choice. Unless there is a severe lack of information they chose to do something stupid for little to none benefit. Thats no mistake, thats action and reaction where you decided to no longer care for the reaction. It is people making the unfortunate decision to go from seeing themselves as addicts to seeing themselves as junkies where the tomorrow doesnt matter anymore. Sure, you can argue that there are clean people with a similar disregard for their future. Just pick people who actually live after the motto "live fast and die young". Or who are eating or drinking themselves to death. They however are making a problematic choice too.
>My main point is that, as a health problem, drug addiction doesn’t look that much different from a lot of other health problems.
I kind of agree. However different to being an addict, being a junkie is a separate kind of problem stemming from deeply destructive choices you make consciously or unconsciously. You can become an addict, there arent however good reasons and rarely good excuses for becoming a junkie. I think a vastly different approach has to be taken to help addicts then ro help people who see themselves as junkies. If you are ODing regularly, changes are you should be treated as a suicide risk who lost your will of self preservation. I dont disagree that there are other people who dont use illegal drugs where the same applies, but thats why we as a society run mental health emergency wards. Differently put, if you are ODing regularly or no longer care that you share syringes you are having a second much more dangerous problem next to your deeply unhealthy habit of injecting unknown illegal drugcocktails to escape whatever. You are having a death wish.
But is it more expensive than what we're currently doing?
(USA viewpoint)
A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
I'll point out that people rescued from the brink of death are usually grateful for it, whereas these poor individuals, as noted in the article, often take a swing at their rescuers. I think that pretty much answers the question of whether they cost more than they contribute.
> A person who eats poorly and doesn’t exercise can easily rack up millions of dollars in treatments for heart attacks and strokes. Yet they don’t seem to get anything like the same derision. Why?
What makes you think people don't? Have you never observed someone or even yourself doing something unhealthy and thought glumly "Yep, eating/drinking this is going to put him/her/me one step closer to death by a lifestyle disease. Foolish of him/her/me."
What makes me think people don’t? The fact that you begrudge $50 to save an addict’s life, while your theoretical reaction to someone eating themselves to death is “foolish of him” seems to back that up pretty strongly.
To be frank, and I say this having addicted family members, sometimes it’s rather hard to care about a junkie.
I’m not exactly in the “fuck ‘em” camp, as a society we should have a better answer than leaving them a nuisance, but the idea that we should give up at a certain point is scarcely exotic.
It’s fast and potent, but only lasts a few minutes. For a really bad OD, you might go through several doses.
Where I am Narcan is $50+ per dose, a small price to save a life but kinda crazy when you meet the same patients again and again.