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

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    • Head Scratcher of a Head CT?

      Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all thoseRead more

    • Central Line Troubleshooting. Beyond the Basics.

      Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease andRead more

    • Narcan Overdose. Too Much of a Good Thing?

      What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote inRead more

    • Health Information Exchange: Quest for the Omni-Chart.

      Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vitalRead more

    • Clinical Decision Support…your daily helper.

      Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision supportRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    • Cerumen Impaction: an Update.

      The last time addressed the topic of cerumen (ear wax) impaction was in 2013. See this post:  If you’re like me, you likely believe that the world of cerumen impaction is a rather staticRead more