“My son would not be alive today if not for the third-party prescription of naloxone. … Naloxone needs to be readily available in treatment centers and jails and in the medicine cabinet of anyone who uses opiates of any kind.”
- Posted March 18 on the National Institute of Drug Abuse Nora’s Blog under “Naloxone: A Potential Lifesaver.”
In May, the Minnesota Legislature passed a Good Samaritan law, “Steve’s Law,” to protect family, friends or others from liability in the event they need to administer naloxone to an unconscious victim. The law also allows a prescriber to write a prescription to a family member or a friend (a third party), allowing them to take home naloxone for emergency first aid. For example, if a person with cancer is discharged from the hospital on morphine pain medication, a family member could request to have a prescription filled for naloxone to be used in the event of an unexpected reaction to the morphine.
The purpose of this commentary is to educate the general public about naloxone, address misperceptions and encourage obtaining naloxone wherever there is any risk of death from opioids.
Naloxone is a prescription medication that has been around for more than 40 years and has been used frequently by emergency rooms to restore breathing after the use of too great a quantity of opioids/opiates like heroin, morphine, Oxyxontin and methadone. Naloxone is not a controlled substance and is not habit-forming. Naloxone is an antidote that temporarily blocks the opioid receptors, causing the brain to “wake up” and start breathing again. Naloxone can be administered either by injection or via nose spray (intranasal).
The only major risk of naloxone is opioid-withdrawal symptoms that can include agitation, sweating and anxiety. Opioid withdrawal is uncomfortable but not life-threatening.
In spite of the new law, misperceptions and fear may prevent wide acceptance and distribution of naloxone. These misperceptions include that someone could be identified as an “addict” for using naloxone and that its use encourages heroin abuse, which is unproven in the literature. There’s also a fear of injecting naloxone, a lack of education or training programs about naloxone and difficulty finding physicians to write prescriptions for naloxone.
Although ambulances and emergency rooms have injectable naloxone available, non-medical, or public, distribution of injectable and intranasal naloxone usually occurs through harm-reduction programs like at the AIDS Resource Center of Wisconsin-Superior. The center provides clean needles and naloxone to heroin users for preventing the spread of diseases and death from overdose.
Survey data from 1996 through 2011 from 48 naloxone distribution centers across the U.S. reported more than 10,000 overdose reversals from among 50,000 participants who received naloxone.
Based on Centers for Disease Control data from 2011, the risk of death due to opioid overdose is not confined to substance-use disorders or heroin use. Compared to substance-use disorders, cancer and acute and chronic pain diagnoses have been associated with higher risks of death due to overdose at morphine-equivalent doses greater than 20 mg per day. This data is compelling enough to recommend that people without substance-use disorders also have access to naloxone to prevent opioid-related fatalities.
Who else should consider having naloxone available? Based on opioid-related death-risk data, a family member or friend should consider having take-home naloxone if caring for a person whose pain management with opioids is at doses greater than 20 mg of morphine equivalents like oxycodone or Lortabs; who is switching to a new opioid pain medication (especially methadone) or who is increasing a dosage; who is known to have or is suspected to have a substance-use disorder with opioids or who is participating in a harm-reduction program; or who recently completed an extended opioid abstinence, following a substance-use rehabilitation program and who has returned home.
Naloxone also should be available if there’s potential for the accidental poisoning of children or adolescents with opioids; if there’s a history of respiratory disease like chronic obstructive pulmonary disease, emphysema, asthma, chronic bronchitis or sleep disorders; if opioids are being combined with other medications that reduce breathing such as benzodiazepines (examples include valium and clonazepam), sleeping medications like Ambien, and/or alcohol; or if there are chronic kidney or liver problems that may slow the breakdown and excretion of opioids from the body.
The recent legislative changes in Minnesota now allow prescribers to write prescriptions for take-home naloxone as a preventative first aid to reverse severe breathing suppression and death due to opioids. Using naloxone in conjunction with cardiac pulmonary resuscitation could save a loved one’s life. Ask your prescriber or pharmacist if you are unclear about the above opioid risks or are interested in obtaining an emergency supply of naloxone.
Mark E. Schneiderhan is a board-certified psychiatric pharmacist who sees patients in the Department of Psychiatry at the Human Development Center and is an associate professor in the University of Minnesota College of Pharmacy-Duluth. He is also a member of the Northeast Minnesota Opioid Abuse Response Strategies, or OARS. Jay (Ya-Feng) Wen is a student in the University of Minnesota College of Pharmacy-Duluth.
Go online * For more information on naloxone, go to the website for the National Institute for Drug Abuse (NIDA) at drugabuse.gov/about-nida/
noras-blog/2014/02/naloxone-potential-lifesaver
* To find family support in the Twin Ports area, go to sites.google.com/
site/resourcesagainstdrugs/home, a site for Resources Against Drugs, or R.A.D.
* A site for Al-Anon Family Groups, al-anon.alateen.org/al-anon-in-minnesota,
* To learn more about Minnesota legislative changes for prescribers and pharmacists, go to mn.gov/health-licensing-boards/images/Naloxone%2520Lagislation%2520faqs.pdf
Go to the conference What: The seventh annual Impairment Without Disability Conference
About: The conference will focus on the health care provider’s role in effectively managing workplace disability while minimizing the effect of disabling conditions by encouraging a return to work and by promoting health and productivity; former Major League Baseball star Darryl Strawberry will deliver a featured keynote presentation; there will be a special emphasis on the opiate crisis in medical practices, places of employment, and our communities
When: Oct. 2-3
Where: In Duluth at the Depot and Radisson Hotel
Sponsored by: Essentia Health and Mayo Clinic
Online: To register or for more information go to impairmentwithoutdisability.com
