What’s Up Doc?: Five things to know about take-home naloxone
By Medicine Hat News on January 23, 2018.
“Nothing is impossible; the word itself says, ‘I’m possible!'” – Audrey Hepburn Naloxone is a life-saving medication when used after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription. There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), andnatural opioids (opium, morphine, codeine).Naturalopioids are from anaturalsource — opium poppy. Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery.It is also administered to alleviate severe pain associated with terminal illness like cancer. Fentanyl is a powerful drug. It is up to100-times more powerful than morphine.Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. It plays a role in the deaths of more than four people on average every day in B.C. and Alberta alone. Fentanyl poisoning results in respiratory depression, miosis (excessive constriction of the pupils) and altered level of consciousness. These three features should alert physicians to the possibility of fentanyl poisoning. An article in the Canadian Medical Association Journal (CMAJSeptember 18, 2017) titled “Five things you should know about take-home naloxone” emphasis the following points: 1. Naloxone is available without prescription in Canada In 2016, naloxone was removed from the federal Prescription Drug List. Now pharmacists can dispense it without prescription.It is available in commercial formulations, including intranasal preparations, as well as in locally prepared take-home naloxone kits, available from some pharmacies, clinics, emergency departments and community health centres. 2. Most take-home naloxone kits contain similar equipment Most take-home naloxone kits will contain two ampules of naloxone (0.4 mg per vial), two safety-engineered syringes, two ampule-opening devices, alcohol swabs, nonlatex gloves and a rescue-breathing barrier. The average cost for a take-home naloxone kit is $35. However, many sites offer them free of charge. 3. Multiple doses of naloxone may be required for overdoses related to high-potency opioids In overdoses related to fentanyl and other synthetic opioids, multiple doses may be required to restore breathing. Most take-home naloxone kits include two doses, and additional doses can safely be administered every two to five minutes if there is no response.Naloxone should be used in conjunction with basic life support principles, such as rescue breathing, cardiopulmonary resuscitation and calling 911. 4. Take-home naloxone kits may reduce overdose-related mortality Observational studies in North America, Europe and Australia, has found that take-home naloxone programs led to improved survival rates among program participants. 5. Take-home naloxone kits are not only for patients with current opioid abuse The kit can be used for other at-risk populations include individuals who are on methadone or on high doses of prescription opioids, or who frequently use recreational drugs. Naloxone can be delivered to the patients in different forms: intravenously, intramuscularly, subcutaneously, through the trachea and nose.The drug is effective in one to eight minutes after administration. Dr. Bharwani is a general surgeon, freelance writer, photographer and author of A Doctor’s Journey and Doctor B’s Eight Steps to Wellness. His latest book is available at Shoppers Drug Mart and Coles Book Store (Medicine Hat Mall), and http://www.nbharwani.com. You can discuss this article and other articles on his website: nbharwani.com and sign up for RSS feed, Twitter or get on the email list. 20-19
