Narcan for the road?


    Narcan for the road?

         I could bullet point plenty of statistics, but I don’t think I have to convince you: there is an opioid epidemic and it is getting worse.
          We all have treated patients for opioid overdose in the ED. We also frequently identify substance abusers who are at high risk for future overdose. Aside from referring these patients to detox centers and encouraging enrollment in methadone maintenance programs, what else can we do to potentially save a life? Should we be considering prescribing narcan for the road? In the the fall of 2015, the FDA approved the first intranasal naloxone product and narcan nasal spray is now available in pharmacies (over the counter in 14 states).
         The most common formulation administers 2mg–1mg per nostril. Data shows time to patient response is equivalent to that of IM administration. There are many advantages of intranasal naloxone, chief among them being the reduction of needle stick injury to rescue providers and the possibility of lay person delivery.
         Concerned your prescription will encourage risky behavior? Data shows it won’t. Not willing to provide a patient with Narcan–how about calling in a prescription for a loved one living with a drug abuser unbeknownst to the patient?
    I wrote my first prescription for intranasal narcan last week. I can’t say this will become my routine practice,  but it is something we should consider.
    Layperson naloxone kit
    1) Dietze, Paul & Cantwell, Kate. Intranasal naloxone soon to become part of evolving clinical practice around opioid overdose prevention. Addiction. 14 Mar 2016. Volume 111, Issue 4, pages 584-586
    2) Kerr, D., A. M. Kelly, et al. (2009). “Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose.” Addiction 104(12): 2067-74
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    • Reach for the COWS

      Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is askingRead more

    • Tis the season, summer edition

      As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergencyRead more

    • Meet the newest member of your team

      We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know wellRead more

    • In the spirit of roasts and fire-breathing dragons

      You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh.Read more

    • E-point Septal Separation in the Patient with Congestive Heart Failure

      Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%).  This isRead more

    • Lidocaine for cough?

      Whether it’s asthma, a U.R.I., or post nasal drip as the cause, cough is a common enough complaint encountered by emergency physicians everywhere. Of course you must always rule out the dangerous causes of coughRead more