Narcan in IFAK?

JimB said:

I often wonder about the use of narcan to save folks that have made an intentional choice. Same for using taxpayer money to treat diseases caused by smoking or obesity.
Then I think about losing control of my car, or my child doing the same, while traveling at a speed that was unsafe for conditions and having the EMTs standing around saying, ”well he/she made the choice…” rather than taking steps to save me/her.

Not exactly the same thing, but where to draw the line?

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No it really is the same thing. Do you treat the person with a blood sugar issue because they are obese it’s their fault? The terrible smoker with COPd? The man having a stroke from uncontrolled hypertension?

We all make choices, some good and many more bad ones often times. I would hope and pray I would get the help I need if I ever needed 911 or if my family did. We can’t pass judgment on their actions all we can do is keep them alive the best we can

Chuckman said:

Honestly I am surprised morphine is still around as much as it is; we have given so much less of it.

Besides, any narc that is made into a lollipop can't be all bad lol.

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True!!

I have given morphine 2 times in the last 2 years. One the lady had an angulated fracture of her wrist and it hurt me to look at. She refused fentanyl flat out. Said she would deal with the pain. I said will you take morphine and she agreed.

We use to give morphine out like candy once upon a time

I like fentanyl for the various routes we can give it

NCMedic said:

Help me @Chuckman .... I've been exposed to sugar... and the more potent brown sugar at that... I can feel me getting diabetes! Send insulin... I'm fading fast.

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oh now you did it. now i want oatmeal with banana and brown sugar
Should I put in a preemptive call to 911?

HMP said:

Do you mean 'former' teacher at your son's school? haha
What happened to her? Surely having drugs on property is worthy, then, of course, drug test be failed, and, well....distributing.

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Actually here’s the crazy thing. The kid didn’t eat them at the time; he went to after school care and asked for help opening the pack. The worker was like “uhhh where’d you get these?” and it unraveled from there. Cops went to her house and found more at her home and somehow she only got charged with simple possession or something along those lines. Her teaching cert was immediately and permanently yanked.

The same elementary school also had a teacher caught drinking in her classroom and an assistant principal (female) was caught having an affair with a coach from a nearby school who’s wife was a teacher at said elementary…her boss, the assistant principal, was banging her husband

Very busy year

11B CIB said:

Actually here’s the crazy thing. The kid didn’t eat them at the time; he went to after school care and asked for help opening the pack. The worker was like “uhhh where’d you get these?” and it unraveled from there. Cops went to her house and found more at her home and somehow she only got charged with simple possession or something along those lines. Her teaching cert was immediately and permanently yanked.

The same elementary school also had a teacher caught drinking in her classroom and an assistant principal (female) was caught having an affair with a coach from a nearby school who’s wife was a teacher at said elementary…her boss, the assistant principal, was banging her husband

Very busy year

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JER-RY!
JER-RY!
JER-RY!

Radar said:

True!!

I have given morphine 2 times in the last 2 years. One the lady had an angulated fracture of her wrist and it hurt me to look at. She refused fentanyl flat out. Said she would deal with the pain. I said will you take morphine and she agreed.

We use to give morphine out like candy once upon a time

I like fentanyl for the various routes we can give it

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IV Morphine will barely take the edge off when I get severe back spasms and pain (and you can forget morphine HCL immediate release…it’s like Tylenol to me). Normally the only thing that’ll knock it down to a 3-4 from “please shoot me” level is IV dilaudid and Valium at the same time. Last ER trip I had, was getting morphine every 30 minutes until they finally decided to listen to me and bust out the big guns. Surprise it worked. Almost like I’ve had it happen before

Radar said:

No it really is the same thing. Do you treat the person with a blood sugar issue because they are obese it’s their fault? The terrible smoker with COPd? The man having a stroke from uncontrolled hypertension?

We all make choices, some good and many more bad ones often times. I would hope and pray I would get the help I need if I ever needed 911 or if my family did. We can’t pass judgment on their actions all we can do is keep them alive the best we can

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This is an interesting argument and I find myself agreeing. And I understand why Doctors and others in the medical profession might feel that way.

Personally I have an issue with all of it to a degree.

We’ve made great strides in medicine over the years. So much so that the healthcare system is burdened with people who have made poor choices.

50 years ago they would have died because of their poor choices. Can I say that society as a whole is better because of it? Don’t know.

There is an opioid crisis just as there’s an obesity crisis and others. And everyone is looking for someone to blame.

The drug companies or the Drs that prescribed them.

While they take some blame the bulk, imo falls on the individuals making the decision to eat crappy food or gobble pills. It’s all an addiction and we have demolished personal responsibility with that single word. Addiction.

I’ve been prescribed tons of opioids over the years from injuries. It didn’t take a brain surgeon to realize they were addictive. So I only used about a 1/4 of them every time and threw the rest away. Taking them when the pain was unbearable and not just because the dr said to take one every 4 hours.

Same with sugar and salt. I crave the salty goodness of bacon and chocolate every single hour of the day. But I make a choice to not eat it that often.

This post kind of unraveled on me. Lol.

Bottom line if you’re a healthcare provider I can see the need for using the tools you have to save lives.

As an individual I’m not going to weep when someone destroys their own body through personal choices.

I felt the same when slayernut passed. He was diabetic, overweight and smoked a pack or more a day. I like him a lot as a person and several of us tried to get him to stop and take better care of himself. He didn’t. He died. I mourned the loss but didn’t shed a tear over it. He made his choices and refused to change.

Bigdave0924 said:

I don’t carry narcan in my ifak but I do carry it in my center console of my truck my gf keeps some in her car and purse. I was one of those worthless junkies that had my life saved by it once or twice many years ago maybe I can repay the favor and give someone else a second chance.

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congrats man. some people make the choice to get hooked, some get hooked on accident, some through physician negligence. You did what what about 100,000 people a year can't.

Chuckman said:

When I build a med bag, there are staples that never change, but there are things that are based on risk/benefit and probability/possibility.

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So i guess an ambu bag might be good if you have space. Opioids don't just magically kill you, they suppress your breathing (sigh, once upon a time i did pharmacology work ... even recorded respiratory neurons down in the me-dulla ob-long-ota). Hypoxia starts shutting down your brain before your heart has problems, so waiting for the heart to stop to do cpr might be a long time too late.
I really have been thinking about having a decent first aid kit. one of these days...

DrScaryGuy said:

congrats man. some people make the choice to get hooked, some get hooked on accident, some through physician negligence. You did what what about 100,000 people a year can't.


So i guess an ambu bag might be good if you have space. Opioids don't just magically kill you, they suppress your breathing (sigh, once upon a time i did pharmacology work ... even recorded respiratory neurons down in the me-dulla ob-long-ota). Hypoxia starts shutting down your brain before your heart has problems, so waiting for the heart to stop to do cpr might be a long time too late.
I really have been thinking about having a decent first aid kit. one of these days...

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It doesn’t have to be a Bag Valve mask but could be a simple cpr face mask. That being said I won’t get in the face of an overdose victim I seen them blow chunks when they come around way too much

Radar said:

It doesn’t have to be a Bag Valve mask but could be a simple cpr face mask. That being said I won’t get in the face of an overdose victim I seen them blow chunks when they come around way too much

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yeah, that last part was taken into account...

DrScaryGuy said:

yeah, that last part was taken into account...

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It’s from the gastric inflation from being ventilated. Air goes into the stomach as well as lungs and well yeah its not pretty

They do make face masks with a mouthpiece and one-way valve to keep the chunks from getting to you.


So you'd be blowing into it and providing about 17%-18% O2. Or, you can use an ambu bag/BVM and manually ventilate with room air and ventilate with about 21% O2.

Chuckman said:

They do make face masks with a mouthpiece and one-way valve to keep the chunks from getting to you.

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yeah, but then you gotta get all close and stuff...
Also, just saying...
Although your GLOCK pistol has a loaded chamber indicator, it is a mechanical device, which could fail. Never rely solely on a loaded chamber indicator or your memory to determine whether your GLOCK pistol is loaded or unloaded.

It IS interesting how a simple question about a med kit addition has spun into a somewhat polarizing debate. Even though no one is forcing anyone to do anything.

It does come down to perceived risk and personal choice.

I had heard that some of the accidental contact stories were overstated. When my first wife was at home dying from cancer, I had boxes of fentanyl transdermal patches that I was administering on a continual basis, with no ill effects on my part. (I had vials of EPO too but that's another story.) So, the super-lethal touch it and die stories are hype.

But, I'll get some NARCAN anyway, since it's free and keep it around, probably in a main kit.

DrScaryGuy said:

yeah, but then you gotta get all close and stuff...
Also, just saying...
Although your GLOCK pistol has a loaded chamber indicator, it is a mechanical device, which could fail. Never rely solely on a loaded chamber indicator or your memory to determine whether your GLOCK pistol is loaded or unloaded.

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Yes, yes you do. Not for the squeamish for sure lol. Oh, I do have stories about that.... and getting upchucked on with activated charcoal during an overdose.

Well, there is Hands Only CPR with no rescue breathing. They came up with that because people were avoiding attempting CPR due to the in your face breathing part. The idea is that there is still sufficent O2 saturation in the blood to benefit if you can move it around. (For a little while.) Better than nothing.

georgel said:

Well, there is Hands Only CPR with no rescue breathing. They came up with that because people were avoiding attempting CPR due to the in your face breathing part. The idea is that there is still sufficent O2 saturation in the blood to benefit if you can move it around. (For a little while.) Better than nothing.

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Usually does absolutely nothing for the OD person. The vast majority of ODs we go to have a strong heartbeat, they just ain't breathing. Opiates act as a Respiratory depressant, takes quite awhile before the heart stops, if you are aggressive in your compressions you are probably doing more harm than good, busting ribs, cardiac and lung contusions, etc. If they have a pulse don't start compressions.
In most of our ODs nowadays we don't even Narcan them, we scoop them up, and bag them on the way to the ER. I like it that way, sometimes they wake up and are pure assholes, I'm tired of fighting mad pillheads and junkies when I stop them from dying but ruin their $10 high.
As far as accidental exposure?? I have never seen a DR/Nurse/Cop/Medic/EMT/FF OD by touching or getting drugs on them, with over 20yrs as a medic, 5yrs in the ER, and 6yrs in LE, I have never seen it. I've gotten stuff on myself before with no ill effects.
Unless I am actually working, or family/close friend is overdosing, I'm not giving Narcan to anyone. Because I hold a state medical license to practice medicine as a Paramedic, I also work under a Medical Directors license. If I am off duty and dispensing meds, I am not covered under my Directors license, even though it might be a lifeSaving Med, I can loose all my stuff for practicing without a license. I'll call 911 and offer Basic skills but no meds.
If the OP wants to carry Narcan?? Go for it.

georgel said:

Well, there is Hands Only CPR with no rescue breathing. They came up with that because people were avoiding attempting CPR due to the in your face breathing part. The idea is that there is still sufficent O2 saturation in the blood to benefit if you can move it around. (For a little while.) Better than nothing.

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Correct but the ventilation moves the Narcan into the system if it is given nasally as is now the most common route of administration

Interesting. My application of NARCAN will be somewhat selective.

The challenge--and it doesn't affect anyone here--is that IM/IV/IN admin are bridges to IV infusion. They all have different rates of effect and duration, so prehospital frequently needs more than one dose/administration. Even in the ED the first thing we do it start an infusion.

One may get them breathing, but they may not stay breathing. Either get more than one syringe, or be prepared to assist ventilations. And contrary to what one might think (because people are not breathing and this is counter-intuitive), the target for IN is actually the mu-opioid receptors in the brain, not the lungs. The lungs are blood-rich and a great conduit to get the narcan to the brain.

Narcan has a short half-life, so the issue is a need for repeated, small doses over a long period of time.

ok.
i have Epipens, plural.
they are very cheap at my drugstore.
i will add Narcan to my first aid kits.

so...
how exactly do i get Narcan?
just walk in the store and say i want some?
or, go to my county health department and say the same?
any paperwork, ID, questions, payment, whatever?
you know, spell it out for me, please.

turkeydance said:

ok.
i have Epipens, plural.
they are very cheap at my drugstore.
i will add Narcan to my first aid kits.

so...
how exactly do i get Narcan?
just walk in the store and say i want some?
or, go to my county health department and say the same?
any paperwork, ID, questions, payment, whatever?
you know, spell it out for me, please.

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Just depends on your location I believe it's Forsyth County jail that has it in the public lobby in a vending machine that's free. I would start by calling your local health dept and asking

thank you.

next week, i will check around.
if anyone else has some "hands on" experience,
please post here so i will have something to go on.

turkeydance said:

thank you.

next week, i will check around.
if anyone else has some "hands on" experience,
please post here so i will have something to go on.

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Check on the NC Harm Reduction Coalition website for your area or your local public health department

thanks.

so much i did not know,
obviously.

NCHRC....i had no idea
it was a "thing".

Eh…I’m not seeing it. There’s probably a better chance it’ll go past its expiration date before you’d ever use it. Wanna carry something useful/beneficial? Get a bottle of 81mg chewable aspirin. There’s a greater chance you’ll use it, either for yourself or someone else, than you ever would the Narcan.

I read the stories about folks picking up fentanyl-laced dollar bills or notes they found under their wiper blade at Walmart, getting exposed and falling over dead, but personally, I think it’s hogwash….stories like that are probably spread on the internet by the same folks claiming Fred Rogers was once one of the deadliest snipers in the U.S. military…lol.

You find a note on your windshield, open it up to find some powder, then ingest it like a Goody powder or a pixy stix? Yeah, probably not a good idea and should you choose to do that, you may get exactly what your stupidity earned you.

Truth is, you have a greater chance of doing more damage to yourself standing over a gas nozzle while you are fueling your vehicle and breathing in the vapors from Benzene, Toluene and all the other nasty stuff in automotive fuel than you will with a fentanyl exposure.

turkeydance said:

ok.
i have Epipens, plural.
they are very cheap at my drugstore.
i will add Narcan to my first aid kits.

so...
how exactly do i get Narcan?
just walk in the store and say i want some?
or, go to my county health department and say the same?
any paperwork, ID, questions, payment, whatever?
you know, spell it out for me, please.

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Epipens in kit here also. Those could LITERALLY be a lifesaver.

I think it's a good idea if nothing else for accidental od if you have anyone that might be on perscription pain killers. I know my mom when they gave her pain killer for her cancer it came with a co-perscription of narcan.

turkeydance said:

ok.
i have Epipens, plural.
they are very cheap at my drugstore.
i will add Narcan to my first aid kits.

so...
how exactly do i get Narcan?
just walk in the store and say i want some?
or, go to my county health department and say the same?
any paperwork, ID, questions, payment, whatever?
you know, spell it out for me, please.

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Wherever you go, get it for free. Every pharmacy in NC has a standing order to allow the pharmacist to dispense NARCAN without a prescription, but the big chains (CVS, Walgreens, etc) have to bill your insurance and there will probably be a copay. I steer people towards independent pharmacies, health departments, or charity pharmacies (as others have mentioned) because they usually have a grant to help dispense it to you for free. If only they would do the same thing for epipens…..

mightymorphin49 said:

Wherever you go, get it for free. Every pharmacy in NC has a standing order to allow the pharmacist to dispense NARCAN without a prescription, but the big chains (CVS, Walgreens, etc) have to bill your insurance and there will probably be a copay. I steer people towards independent pharmacies, health departments, or charity pharmacies (as others have mentioned) because they usually have a grant to help dispense it to you for free. If only they would do the same thing for epipens…..

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Epipens just help people with filthy natural allergies, not like Narcan and it's deserving client base of degenerate, self destructive addicts with a smattering of unlucky folks.

NCLivingBrit said:

Epipens just help people with filthy natural allergies, not like Narcan and it's deserving client base of degenerate, self destructive addicts with a smattering of unlucky folks.

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Yeah, epinephrine is one hell of a drug. Especially after I’ve drawn up 20 some odd doses for the SOB in the ICU that they’ve declared dead tonight. But I digress……


The one thing I will say about having NARCAN around is it’s not always the junkie that goes and winds up needing it. Sometimes you get innocent bystanders caught up in the line of fire as well. As long as it’s free, why not have it around in your kit?

Epi has its place. Resuscitations is not one of those places. You give a rock enough epi and it'll get a heartbeat.

Chuckman said:

Epi has its place. Resuscitations is not one of those places. You give a rock enough epi and it'll get a heartbeat.

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Agreed Chuckman, or at least let me call down to pharmacy and have them bring up an Epi Drip so I don’t have to keep drawing up vials.

But for real, I wish some of the grant money for Narcan would have gone to Epipens in schools or something. Would probably have saved just as many lives if not more considering how few people take advantage/utilize the Narcan. Although I don’t think there’s THAT much grant money compared to how stupid expensive Epipens are. But that’s a different rant for a different day.

Does narcan work on edible Marijuana? It might be good to have some, at home, or in your car, just in case you are at a party and an old person eats the whole edible cake on accident!

mightymorphin49 said:

Yeah, epinephrine is one hell of a drug. Especially after I’ve drawn up 20 some odd doses for the SOB in the ICU that they’ve declared dead tonight. But I digress……

Police officer credited with saving 2-year-old who ingested a fentanyl pill while playing at Tacoma park

A 2-year-old was rushed to the hospital on Thursday after he ingested a fentanyl pill he found while playing at a Tacoma park.

www.q13fox.com

The one thing I will say about having NARCAN around is it’s not always the junkie that goes and winds up needing it. Sometimes you get innocent bystanders caught up in the line of fire as well. As long as it’s free, why not have it around in your kit?

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This is exactly why I posted this. Not for junkies, but for the incidental bystander.

Your chances of becoming involved in a gunfight are slim.

Your chances of being accidentally exposed to opiates through candy are also slim.

Your chances of being exposed to fire are considerably higher than both.

If a fire extinguisher isn't a part of your EDC, you're risking the lives of your family and loved ones. I recommend carrying one in a small sling bag at all times.

RedneckFur said:

Your chances of becoming involved in a gunfight are slim.

Your chances of being accidentally exposed to opiates through candy are also slim.

Your chances of being exposed to fire are considerably higher than both.

If a fire extinguisher isn't a part of your EDC, you're risking the lives of your family and loved ones. I recommend carrying one in a small sling bag at all times.

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Hell if you're talking probabilities you should carry a lawyer and camera crew in case you interact with a cop.

NCLivingBrit said:

Hell if you're talking probabilities you should carry a lawyer and camera crew in case you interact with a cop.

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Two body cams going at all times, along with a lawyer on speeddial, with two spare cell phones. Not a perfect solution, but its the best I'm able to do.

again, thanks for all the Narcan advice.

the local county jail gives it out free.
it is in a vending machine, just like Pinky787 posted.
i appreciate this thread so much, because otherwise
i would not know how to get free Narcan.

RedneckFur said:

Your chances of becoming involved in a gunfight are slim.

Your chances of being accidentally exposed to opiates through candy are also slim.

Your chances of being exposed to fire are considerably higher than both.

If a fire extinguisher isn't a part of your EDC, you're risking the lives of your family and loved ones. I recommend carrying one in a small sling bag at all times.

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I have one with me at all times. As I get older it needs to be drained more frequently and the size of the fire it can handle is clearly decreasing.