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Old 11 March 2017, 08:04 PM
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Ambulance Does Naxalone enable drug addicts?

I wasn't sure where to put this question, but this is a social issue. I'm sure you are all familiar with Naxalone and how it can reverse a heroin/opiate overdose. Who could be against saving a life? Rhetorical question. Some argue that providing this drug(?) simply enables an addict and said addict figures that he can overdose and will be saved. The way I see it, it's the humane/right thing to do. While I would hope that the addict would get into treatment, that might not always happen. But to just say, it's an addict--he'll simply use again, so why bother? strikes me beyond callous.
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Old 11 March 2017, 08:32 PM
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My brother deals with addictions as a career. He has saved well over 50 people using this product. He is very adamant in saying outright that this does not empower people to use drugs.

What it does do, however, is reduce the risk of dying from an overdose when your supplier does not know what he/she is giving you.

For example, in today's fentanyl crisis going on in North America, there is no standard measurement of fentanyl being used. So, an addict going to their dealer gets some fentanyl prepared at lab A gets the amount they are used to. That same addict goes to the same dealer who has new stuff from lab B and it is twice as strong. Wham. Overdose. Naloxone used, medical care sought, and life saved.

Unlike many soft drugs, and in a different way than heroin, fentanyl (and its derivative carfentanil) is sooooo easy to overdose on. Heroin takes some work to overdose (but people do it). Fentanyl, you can do it with one hit.

My brother is a firm believer in the product. About 5% of addicts, in his estimation, that OD and get saved by this product clean up and kick the habit. It is not a lot, but 5% is more than just a dead addict being buried.
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Old 11 March 2017, 08:32 PM
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I think it applies a degree of rational decision-making regarding drug use that actual addicts by their nature (for lack of a better word) do not possess. There are enough good reasons not to become an addict that reason is clearly out of the question. It's not just callous, it's obtuse and completely ignores how actual humans behave.

Kind of like abstinence-only sex education, actually...
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Old 11 March 2017, 09:40 PM
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Quote:
Originally Posted by DawnStorm View Post
I wasn't sure where to put this question, but this is a social issue. I'm sure you are all familiar with Naxalone and how it can reverse a heroin/opiate overdose. Who could be against saving a life? Rhetorical question. Some argue that providing this drug(?) simply enables an addict and said addict figures that he can overdose and will be saved. The way I see it, it's the humane/right thing to do. While I would hope that the addict would get into treatment, that might not always happen. But to just say, it's an addict--he'll simply use again, so why bother? strikes me beyond callous.
Not a chance. I work with opiate addicts, and while many do have access to naloxone/Narcan at home, I've never heard of any addicts being created because of it. It would be analogous to saying that seat belts cause bad driving, because hey, you won't get hurt as badly.
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Old 11 March 2017, 10:40 PM
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According to a story on NPR this past week, in Ohio (specifically mentioned in the story and maybe true in other states also) an addict who has been revived has the right to refuse further medical treatment and must be turned loose. The theory is that they still access to drugs and the need for the drug is still there so they use again. Ohio is going to try a law that charges someone who OD's with a crime so that they are taken into custody for at least long enough to come down.
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Old 11 March 2017, 11:50 PM
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Ohio is going to try a law that charges someone who OD's with a crime
Sounds like a real good way to discourage people -- including others who may be present -- from calling for help before it's too late.

Some of the OD's around here have been teenagers, high school age. Several of them have died. Teenagers try lots of idiotic things; but, while Mother Nature sometimes exacts the death penalty for doing something stupid, I don't think humans should be helping enforce it. And I really don't think we should be writing off sixteen year olds as not worth saving because they swallowed or snorted something that wasn't what they thought it was -- or even if they knew what it was but not the dose. (or, for that matter, 26 or 36 or 76 year olds; but it somehow seems even worse when it's teenagers.)

There is a big push on around here to get a lot of people trained to use naloxone and supplied with it. IMO it's a very good idea.
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Old 12 March 2017, 12:12 AM
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To be fair, you have to understand the position the states are in. The only way to provide 100% free government-sponsored medical care for someone is to lock them up or put them into the military and th military won't take an addict. To create a third option would akin to socialism and we can't have that.
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Old 12 March 2017, 12:21 AM
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Is there a way, perhance, of using "they are a danger to themselves or others" as a way of temporarily detaining them until they are out of danger, but without charging them with a crime?

Narcan only temporarily stops the effects of opioids. If a major dose was taken, then 45 minutes of narcan will only delay the fatal reaction. People need care afterwards. And I think that there must be something that can be done (without forcing a cold turky treatment on someone).
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Old 12 March 2017, 12:36 AM
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I wonder of they realise just how expensive it is going to be to forcefully detail and treat every addict. It requires pretty serious medical treatment and supervision for people detoxing from most drugs or the withdrawal can itself be fatal. I am all for giving people who want that the opportunity for it, but it will cost the state a lot of money to do well (And personally I think the money would be well worth it for those who want it - especially if it can be followed up with a long term treatment program).
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Old 12 March 2017, 01:26 AM
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Originally Posted by me, no really View Post
I wonder of they realise just how expensive it is going to be to forcefully detail and treat every addict.
You could apply the same logic to other types of legislation that are often embraced by voters and politicians. Anti-abortion legislation, tough anti-drug-user laws, and abstinence-only education are often pedaled by the same people, for instance.

Long-term social consequences never seem to occur to such people, or at least their calculus tends to be way off when it comes to outcomes. It's like they're addicts of a different sort themselves...
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Old 12 March 2017, 02:31 PM
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They seem to be going under the theory that if you just make the consequences harsh enough humans will just stop having sex and/or taking drugs.

Both historical and current evidence argues otherwise.
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Old 12 March 2017, 06:26 PM
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Originally Posted by thorny locust View Post
Sounds like a real good way to discourage people -- including others who may be present -- from calling for help before it's too late.
That was considered in Ohio according to the story. It is not a felony they are being charged with but a misdemeanor. It is only to get them at least temporarily sober. It is not a harsh punishment but an attempt to get the person to seek help.
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Old 12 March 2017, 11:58 PM
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There's been a meme going around social media along the lines of "I have to pay $500 for my kid's Epi-pens, but an overdosing addict gets a Narcan dose from the police for free." My cousin, a city police officer who deals with drug offenses on a regular basis, posted it and asked for thoughts, without commenting himself one way or the other. My response was that there were a few issues at play: the somewhat ridiculous price of the auto-injection systems to deliver what is between a $1-$5 per dose amount of medication, and the apparent injustice of an innocent family being financially punished for lifesaving measures for what was most likely inadvertent exposure to an allergen, while someone (presumably intentionally) abusing an illegal substance gets off without the financial punishment. While I don't believe in withholding lifesaving treatment from anyone, I personally can see justification for charging overdose victims for their required treatment after the fact. In cases of inability to pay, perhaps mandatory treatment would be a viable option. I don't know what various municipalities have in place now.
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Old 13 March 2017, 04:34 AM
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Quote:
Originally Posted by musicgeek View Post
There's been a meme going around social media along the lines of "I have to pay $500 for my kid's Epi-pens, but an overdosing addict gets a Narcan dose from the police for free."
I don't think giving a kid in anaphylactic shock a Narcan dose is going to do them much good. So the analogy is pretty weak. A person might as well complain that a life saving medication like an epi-pen is much more expensive than a non-life saving drug like an aspirin.
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Old 13 March 2017, 07:44 AM
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I was under the impression that emergency services in the US often bill the patient. Is that untrue?
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Old 13 March 2017, 01:10 PM
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Quote:
Originally Posted by musicgeek View Post
There's been a meme going around social media along the lines of "I have to pay $500 for my kid's Epi-pens, but an overdosing addict gets a Narcan dose from the police for free." My cousin, a city police officer who deals with drug offenses on a regular basis, posted it and asked for thoughts, without commenting himself one way or the other. My response was that there were a few issues at play: the somewhat ridiculous price of the auto-injection systems to deliver what is between a $1-$5 per dose amount of medication, and the apparent injustice of an innocent family being financially punished for lifesaving measures for what was most likely inadvertent exposure to an allergen, while someone (presumably intentionally) abusing an illegal substance gets off without the financial punishment. While I don't believe in withholding lifesaving treatment from anyone, I personally can see justification for charging overdose victims for their required treatment after the fact. In cases of inability to pay, perhaps mandatory treatment would be a viable option. I don't know what various municipalities have in place now.
Wouldn't the obvious solution be to make the epi-pen free?

Would the people making the argument from the OP do heroin if there wasn't the risk of an overdose?
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Old 13 March 2017, 02:29 PM
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Quote:
Originally Posted by ganzfeld View Post
I was under the impression that emergency services in the US often bill the patient. Is that untrue?
Depends on the emergency service and the jurisdiction. In Seattle (because that's the jurisdiction I know), you're billed for the stuff at the hospital, but the EMTs and the ambulance and 911 itself are paid for by taxes. As are the salaries of the Police and other emergency personnel.

Let's say you're hiking in the mountains, fall, and break your ankle. Whether you get charged for the rescue can depend on a lot of factors, including whether you've had to be rescued before and where you're hiking.

Seaboe
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Old 13 March 2017, 02:36 PM
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Also, billing for the services is one thing, actually getting paid is another.
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Old 13 March 2017, 03:47 PM
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From a behavioral perspective, I'd naively guess that Naxalone would function as a punisher or would make the opiods given before it less reinforcing over time. Immediacy of consequence is a crucial part of behavioral conditioning: the more immediate a consequence, the bigger the effect on behavior. Take excessive drinking, for instance. Vomiting and hangovers occur after excessive drinking but they tend to occur several hours afterwards. Because there is little immediacy, there is little punishment. But presumably with nalaxone the person ODs and there is a pretty immediate unpleasant consequence.

Physiologically, I don't know exactly how the unconsciousness brought about by an OD would impact the parts of the brain that are usually involved in learning punishment contingencies. It might be that the normal process of learning that a chain of behavior leads to a punisher is interrupted by the OD itself. And I'd also anticipate that the punishing effects of Nalaxone, if there are any, would be very sensitive to the relative reinforcing value of the opioid at a given time: you might not shoot up heroin if you'd taken some Oxy eight hours before because the Oxy is letting you 'cruise along'; but if you hadn't taken an opioid for sixteen hours, the value of the opioid might far outweigh any conditioned aversive consequences.

At any rate, I'm doubtful that drug addiction and overdosing is driven by thoughts like, 'It's fine if I OD because my friend will give me Nalaxone.' I'd guess that Nalaxone either has no impact on drug seeking behaviors or that it slightly decreases them.
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Old 14 March 2017, 02:44 PM
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Quote:
Originally Posted by musicgeek View Post
There's been a meme going around social media along the lines of "I have to pay $500 for my kid's Epi-pens, but an overdosing addict gets a Narcan dose from the police for free." .
I think if I saw that meme, my response would be: and...? Seems to me that g-you have already paid for the Narcan through your taxes.
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