Naloxone saves lives, but lack of follow up care can lead to death.
I have written a few blogs on this life saving medication that is an absolute requirement for emergency responders and anybody frequently around those suffering from an opioid addiction and at risk of overdose.
Nalaxone, or NARCAN as it’s commonly referred to, is an opioid antagonist that upon administration can reverse respiratory depression and revive individuals. As the opioid epidemic has grown in this country, thankfully access to Nalaxone has increased. However, there is not nearly enough follow up addiction treatment being provided to this highly at risk population.
According to an October 30, 2017 CNN article, a new study regarding the effectiveness of Nalaxone has just been reported from Brigham and Women’s hospital in Boston. Researchers reviewed more than 12,000 dosages of Nalaxone administered through emergency medical services in Massachusetts between July 1, 2013 and December 31, 2015.
The data showed that nalaxone was highly successful in reversing overdose in 93% of those administered the medication. Upon longitudinal examination it was also determined that 84.3% of those saved with Nalaxone survived one year later. This is positive in that making Nalaxone widely available has saved countless lives.
However, it also indicates that 1 in 10 individuals administered the drug died within a year.
Emergency availability and use of Nalaxone is not enough for Americans to overcome the opioid epidemic. I have spoken to many first responders throughout Florida that have reported saving the same individual’s life with Nalaxone multiple times in one day. Having available opioid overdose medications is a necessary harm reduction tool due to the masses that are currently addicted in this country, but it does very little to ensure that the individual overcomes their addiction and goes on to live a meaningful life.
The administration of Nalaxone should be considered a powerful consequence of one’s addiction and utilized in conjunction with an immediate recommendation to follow up treatment in order to save one’s life long-term. Administer, stabilize, and release should not be the pattern of hospital emergency rooms any longer. Not only does this not treat the problem, but Nalaxone itself can trigger severe opioid withdrawal. Therefore, without treatment, upon release from the hospital, an individual may have an even greater compulsion to use opioids simply to feel better.
Every hospital in this country should have access to assessment and treatment referrals. Nalaxone is simply not treatment and should be obtained to save lives in emergency overdose situations, but not provided as an alternative. Hospitalization can be an excellent time to intervene with an individual in need during a crucial window when he or she may be willing to get help.
An optimal course to save the lives of the one in ten who are at risk of dying within a year of overdose would be a referral and direct transfer to detox and treatment. Once stable and progressing in substance use treatment there are other beneficial Medication Assistance Treatment’s (MATs) that can be utilized to further improve long term prognosis in overcoming an opioid addiction. MAT includes Methadone, Suboxone (Buprenorphine and Nalaxone) and Naltrexone (or the injectible version, Vivitrol).
At Evolutions Treatment Center we occasionally recommend (and have available) Nalaxone for those leaving treatment who may remain at great risk due to a premature discharge.
However, we prefer to recommend Vivitrol, which we also have available, as a safe evidenced based Medication Assisted Therapy (MAT) for those who have made treatment progress and wish to have another tool to reduce the risk of relapse in early recovery.
Vivitrol is a 30 day extended release form of naltrexone hydrochloride, which is used to block all euphoric effects of opioids while reducing cravings for the drug. It is non-abusable, does not lead to dependency, (such as the case with other forms of MAT) and has been shown to be effective in increasing abstinence from opioids.