Mid November 2014, I received a Maryland State Health Alert from our Secretary of Health & Mental Hygiene, Joshua M. Sharfstein, MD titled, Prescribe Naloxone and Save Lives: An Alert for Maryland Clinicians. The body of the text stated the following:
- Anyone who has completed the Overdose Response Program;
- Anyone with a known history of intravenous drug use or misuse of prescription opioids;
- Anyone who receives high-dose opioids or receives opioids chronically;
- Anyone who used opioids with antidepressants, benzodiazepines, alcohol, or other drugs;
- Anyone who uses opioids with a history of major organ dysfunction (renal, hepatic, cardiac, pulmonary);
- Anyone using opioids with a history of mental illness; and
- Anyone receiving treatment for substance use disorder.
As you can see highlighted, there are four indicators that may directly impact people living with pain who are prescribed opioid medications as part of their pain treatment plan. These recommendations, I feel are well-thought out and a forward step in promoting safe prescribing which may help reduce unintentional overdose. Maryland’s Governor O’Malley set into motion a statewide overdose prevention plan in 2012, which every county has created. Recent state legislation has paved the way for the broad implementation of Naloxone Programs throughout the state as one strategic solution. Fred Branson from Project Lazarus has spent time with many county health departments, prescribers, and other stakeholders to help understand how to implement successful training programs. These trainings are open for healthcare providers, law enforcement, patients, families and friends. The hope is that those at higher risk for overdose will have faster access to the reversal agent for opioids and therefore prevent an unwelcomed, premature death IF opioids are the cause.
Maryland is only one state of many who are looking at this issue. I live here and have worked with my own local health department, so that people with pain will be represented and not seen as the source of the problem. Appropriate prescribing and safe use of opioid pain medications is critical, so that these pain medications are available for legitimate medical need. I applaud Maryland and other states who are trying to create realistic and balanced solutions.
Yet, what is missing here? Where is the outreach to people with pain and their caregivers about Naloxone? If my crystal ball is working, I can foresee that soon, when someone is prescribed an opioid, the prescription for its antidote will be also written. How would you react? Does this give you and/or your family comfort or raise alarm? Have you ever heard of Naloxone (aka Narcan)? Would you understand how, when and why it could be used? How much will it cost and will your insurance cover it? Will you be able to have this prescription filled at your local pharmacy? These are important questions that require clear answers. See if TPC’s Naloxone FAQ is helpful. Talk with your healthcare provider and your pharmacist for additional information. Better yet, look into how to become trained.
Whether given in the nose or in the muscle even through clothes or directly in the vein (by EMS, physician or nurse), Naloxone can save the life of someone who has overdosed from opioids. This does give promise in dire situations.
Note: Narcan will not work if opioids are not the cause of an overdose, as with sedatives, alcohol, stimulants or illegal drugs other than heroin. Giving it will not harm someone in those situations and if given may help direct emergency responders to other possible causes, when overdose is suspected.