It’s really quite miraculous. Anyone who’s ever reversed an overdose will never forget it. People wake up - Dr. Mary Bassett, New York City health commissioner
image by: The Addict's Diary
The epidemic of heroin use has spun so rapidly out of control that many areas of the country are training everyday citizens to administer the drug that is an opioid antagonist. Narcan is the trade name for naloxone hydrochloride. Essentially Narcan blocks or reverses the effects of opioids including heroin. It competes for the same receptor sites in the body, and either blocks the body's ability to receive the heroin molecule or can drive the heroin from the site. It should be noted however, it is still not completely understood.
The Harrison Drug Act of 1914 placed drugs in a respective schedule based on whether they have currently accepted medical use in treatment in the United States, their relative abuse potential, and the likelihood of causing dependence when abused. Note that this Act was passed five years before the 18th Amendment to the Constitution.
Heroin (a schedule 1 drug) is synthesized from morphine (a schedule 2 drug) which is a naturally occurring substance in Asian opium poppy plant. When synthesized, it can appear as a tan or white powder or a sticky black substance is known as black tar heroin. Heroin can be brought into the body by several different methods. The most addictive means is by injection at which time users will feel a rush of euphoria, followed by a waning and waxing of a drowsy state. Users can also inhale, snort, sniff, or smoke the substance. All of these methods deliver the drug to the brain where it will be converted back to morphine. One of the reasons heroin kills is it binds to the brain stem which coincidentally controls your breathing. Take too much, and you stop breathing, which then causes cardiac arrest.
Heroin is an addicting drug that has a tolerance. Users will need more and more of the drug to obtain the same effects that they now need, and not want. This causes them to do things they know is wrong but do not care or appreciate the consequences of obtaining the drug. There are treatments for a heroin addict, but it is difficult and relapses are common.
Heroin may not be the right thing to do, but we can't always blame it on an individual. Some patients with pain issues are prescribed an opioid for a certain length of time while their body heals. After that, they can become dependent on the drug, but are no longer eligible for a perscription. They then turn to street drugs for the help they perciecve they need. Thus making an innocent patient with a legitimate health problem into an addict, and sometimes with a family to support. You could also infer that drug companies have a role in this epidemic as well...
Some government documents on the proliferation of heroin state that the cartels that manufacture heroin have found some bright chemists who can make the drug more potent. this means that a user who thinks they are taking x dose of heroin may actually be taking 5x of the drug and overdosing without knowing it. Also, the drug gets "cut" several times before reaching the user. this increases the profit margin for everyone in the supply chain. The problem is the substance with which the heroin is cut is sometimes unknown. Sometimes a dealer will cut it with fentanyl (a schedule 2 drug), another opioid that is 50-100 times more potent than the same dose of morphine. As you can surmise, this combination of drugs is nothing short of deadly - especially to the user who is unaware that it's hidden in his hit of heroin. Heroin can stay active in the body for 30-80 minutes. A side effect of heroin is that it is believed to kill the white matter of the brain.
Narcan is now readily available without a prescription at several pharmacies. In its inception, it was used by paramedics to treat the overdoses that occurred when the drug was not as popular as it is now. Over the last couple of years, the epidemic has grown so much in part due to its low cost, ease of availability, large distribution, and potent high, that it became necessary for EMT's and law enforcement to carry the antidote. Now the average citizen can purchase and useNarcan if they desire after taking a class on its use. Narcan is not a benign drug either as it once was thought to be. It can cause heart arrhythmias, and even cardiac arrest, and seizures. If administered to quickly or in too high of a dose, it can cause extreme vomiting that can cause choking to the victim...
Now, with the basic facts of both drugs presented to you, what do you think? Are we enabling users and their friends/families to use heroin without fear of the repercussions that accompany it? There won't be any data to support the continued use of Narcan by civilians, and the epidemic of heroin expands. The basic definition of enabling an illegal and unhealthy habit with likely permanent damage to person's brain and the accompanying actions when someone becomes and addicted and will do anything for that euphoric feeling.
As a paramedic, I took the Hippocratic oath to save and reduce illness and injury to a person, community, or given population. Narcan is certainly a life-saving drug, and can be administered by the lay person via a squirt of the drug in the nose, or by paramedics who administer it intravenously. Withdrawal symptoms are sometimes violent and unpredictable. The dichotomy of this issue is a difficult one. Ithaca just announced it was going to open places for the controlled use of the drug so people won't die. It's another approach, but we know that many users will not use this route for fear of repercussions. Heroin use transcends every socioeconomic and racial population. Everyone from the homeless to the corporate executive uses the drug.
Do we allow the unfettered use of heroin because the antidote is easily accessible? I guess it is a question for the ages, and one I do not have an answer for. but we must find a way to keep people from dying from such a preventable cause.
Source: John Spaulding, Narcan: Life saving or enabling tool, Democrat & Chronicle, March 27, 2016.