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Too Many Die From Heroin
You know me Little Miss Skeptical.
I would never give a baby a loaded gun to play with, and I would
never give non-medically trained
civilians syringes full of drugs with the intent of having them
stab somebody directly in the heartand push the plunger.
You probably know what Im talking about if you saw the moviePulp
Fictionapparently about
four people in the world have not.
If you are not one of those four, you probably remember the
scene where John Travolta finds Uma
Thurman comatose on the floor from an overdose of heroin. In a
great dramatic moment (I seem
to remember music playing)he plunges the syringe with an
antidote right through her breast-bone
and pierces the heart,pumping the life-saving chemical into her.
Fortunately, she responds and
seems none-the-worse for her ordeal.
In this movie, Mr. Travolta did NOT portray a doctor. As I
recall, he played a hit man.
In my experience, the patients of some doctors have about the
same survival rate as victims of
professional hit-men, but that is another blog post.
Back to real life When I first learned that a certain county in
California wanted to teach people
to use Travolta-method emergency kits with syringes to treat
overdoses of heroin presumably
with naloxone, the only drug I know of available that is a
potentially lifesaving opioid antagonist
I was skeptical. My first thought was that things could go wrong
with injectables in the hands of
civilians without adequate monitoring (i.e. an MD or nurse).
Maybe, this idea was part of a continuing attempt to clip the
wings of doctors who are perceived
as over-trained and overpaid (by admittedly under-paid
staff).
Only once in my life did I administer lifesaving naloxone to a
patient who clearly needed it. It was
the smallest emergency room I have ever worked in in northern
France and I was a green-if-
gutsy medical student. The man was a known heroin user and I
could not do a decent job of
rousing him from a coma.
I remember hitching him up to a monitor. That is me take the
precautions, conservative in all
ways known to me when human life is concerned. I still think our
life is the most precious thing
we have.
I reported the vitals to a supervisor, who had no trouble
authorizing the Narcan (le Narcan). Yearslater I would prescribe it
orally to patients who still had a decent liver, to help them get
off
alcohol. But back then, I just hustled wand monitored and gave
the injection as quickly as I
could.
It only took a few seconds for the patient to awaken violently
and punch me in the face. Nothing
was broken I guess I have a pretty good startle reaction and
withdrew quickly. He lived, looked
http://www.rottentomatoes.com/m/pulp_fiction/http://www.rottentomatoes.com/m/pulp_fiction/http://www.rottentomatoes.com/m/pulp_fiction/https://www.youtube.com/watch?v=ZOoJoTAXDPkhttps://www.youtube.com/watch?v=ZOoJoTAXDPkhttps://www.youtube.com/watch?v=ZOoJoTAXDPkhttps://www.youtube.com/watch?v=ZOoJoTAXDPkhttps://www.youtube.com/watch?v=ZOoJoTAXDPkhttps://www.youtube.com/watch?v=ZOoJoTAXDPkhttp://www.rottentomatoes.com/m/pulp_fiction/
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stable. He was a laborer type about thirty and we got him into
come kind of rehab and me into
the on call room where I didnt do much sleeping.
I hurt in the face but did not want any kind of pain pills.
And to answer the question that I know you are thinking No I had
not yet seen Pulp Fiction.
This was years earlier when Mr. Travolta was still
aSweathog.
Those who know me know I am about as tender and loving as a
doctor can be, so I dont get
attacked very much. As a neurosurgical resident, a guy over 80
for whom I had ordered a
benzodiazepine sleeping pill when a nurse had so requested over
the phone took a swing at me in
the morning. A psychotic woman decked me when I first started
seeing psychiatric patients.
Maybe I should have taken boxing lessons as a minor in
college.
Curiously enough, nobody ever tried to deck me in all the time I
worked in a prison setting,
although my (by then, former) supervisor got a punch in the eye
that caused him to lose that eye.
However, he was a more provocative type than I and I know some
people supervised claimed that
they had the same thoughts cross their minds.
So when I heard about this plan to arm the untrained staff with
Travolta Needles I did what I
always do when I hear something new relative to my profession. I
checked it out on the internet.
According to the most recent and accurate statistics I can find,
an average ofover 100 patients a
day die from opiate (heroin and related drug) overdosein these
United States. Naloxone has a
pretty safe profile. It makes a lot of sense to make it
available to people who actually come in
contact with opioid patients. I dont care whether these ODs are
from legal prescription drugs or
illegal street drugs they all kill and thats all a doctor should
worry about.
I have no personal knowledge or experience of the training that
goes with using lifesavingemergency kits, so I cannot offer
specific endorsements. I hope it consists of more than simply
screening the first scene of Pulp Fiction. The state of
Wisconsinis currently working to legalize
the usage of this antidote by untrained civilians. But even
without formal training, I am all for
keeping people alive. The risk of death with naloxone is
negligible. The risk of death from
overdose if someone is slumbering into a coma and there is
reason to believe that opioid overdose
is the cause is well, humongous.
Somewhere since Noahs flood, when I was in training, opioids
were fairly hard to get. Since then,
it seems like multiple federal government and state initiatives
have urged doctors to be liberal in
their treatments of those suffering from pain. Statistics about
deaths from this class of drugs only
climb.
Usually a celebrity drug overdose is followed by a crackdown on
the purveyors of the illegal drugs.
Reacting to an event like the recent death of acclaimed
actorPhilip Seymour Hoffmanin this way
makes more sense to me.
There are lots of ways to help folks who need it.
http://www.usatoday.com/picture-gallery/life/people/2014/02/18/from-sweathog-to-movie-star-happy-60th-birthday-john-travolta/5579843/http://www.usatoday.com/picture-gallery/life/people/2014/02/18/from-sweathog-to-movie-star-happy-60th-birthday-john-travolta/5579843/http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.wisn.com/news/health/bill-passed-by-state-senate-could-make-narcan-use-legal-for-individuals/24570518http://www.wisn.com/news/health/bill-passed-by-state-senate-could-make-narcan-use-legal-for-individuals/24570518http://www.cnn.com/2014/02/04/opinion/newman-nadelmann-overdose-prevention/index.html?iid=article_sidebarhttp://www.cnn.com/2014/02/04/opinion/newman-nadelmann-overdose-prevention/index.html?iid=article_sidebarhttp://www.cnn.com/2014/02/04/opinion/newman-nadelmann-overdose-prevention/index.html?iid=article_sidebarhttp://www.cnn.com/2014/02/04/opinion/newman-nadelmann-overdose-prevention/index.html?iid=article_sidebarhttp://www.wisn.com/news/health/bill-passed-by-state-senate-could-make-narcan-use-legal-for-individuals/24570518http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlhttp://www.usatoday.com/picture-gallery/life/people/2014/02/18/from-sweathog-to-movie-star-happy-60th-birthday-john-travolta/5579843/
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To give a shock, or a twist ending to this essay I am coming
down firmly on the side of giving
the staffers in a clinic (who already have some type of
training)these emergency kitsfor OD
victims. I think Wisconsin is on the right track. Lets save
folks in California, too and all the
other states.
An OD will kill somebody so if a stab in the heart with an
antidote has a chance of saving them,we will worry later about the
propriety of licensing and certification of the practitioner.
Lets just save lives!
THE END
http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/
