Naloxone for home use

[rph3664]

I saw something about this on NBC News tonight. In short, it's intended for friends and family members to use if they see someone in the midst of an opiate overdose, presumably heroin. Am I the only person who thinks this is not as good an idea as many laypeople may think it is?

On top of it, it's designed to be injectable THROUGH CLOTHING. I can't see anything good resulting from that.

Anyone else?

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[radio frequency]

Do you have a better idea?

If they aren't breathing, by the time the medics get there, they could be brain dead.

Sure, it's not ideal...but neither is ODing and dying.

 

[rxlea]

If they are trained to administer it, why not?

 

[njac]

On top of it, it's designed to be injectable THROUGH CLOTHING. I can't see anything good resulting from that.

Anyone else?

So are epi pens.

The thought is that it buys time to call 9-1-1. These programs are usually in areas that have laws that will keep people from being charged with a crime if they call to report an overdose.

 

[confettiflyer]

I can't think of any logical reasons why this would be a bad idea.

 

[owlegrad]

I can't think of any logical reasons why this would be a bad idea.

Because it might save a heroin addicts life I guess? And because it goes through clothing?

 

[All4MyDaughter]

I don't see the issue.

 

[farmadiazepine]

first of all..

who is getting the Rx? The junkie? great. Can they even afford this Rx?

Just let them die.

 

[Digsbe]

Are they wanting this to be OTC or to just make a practice of prescribing Naloxone for home use in the event that someone abusing opioids overdoses?

 

[gtpederson]

Coming 2015 from Mylan, the NarciPen 2pk, and the NarciPenJr!

 

[Dred Pirate]

I saw something about this on NBC News tonight. In short, it's intended for friends and family members to use if they see someone in the midst of an opiate overdose, presumably heroin. Am I the only person who thinks this is not as good an idea as many laypeople may think it is?

On top of it, it's designed to be injectable THROUGH CLOTHING. I can't see anything good resulting from that.

Anyone else?

after personally witnessing several overdose deaths in our ED this year - I think it is a good idea - many of these situations are young kids (kids to me) that have made a bad decision - how many bad decisions have all of us made that luckily we rebounded from?

I would think it would be more likely to be available in an intranasal form (that is what our EMS guys use - I don't think IM would be fast enough in many of these situations).

 

[radio frequency]

first of all..

who is getting the Rx? The junkie? great. Can they even afford this Rx?

Just let them die.

It's not up to pharmacists to dictate morality. Moreover, this is a straight up coldhearted thing to say. Until you've known people who have struggled with addiction, perhaps it's difficult to volunteer some empathy, but at least give it a shot.

 

[Dred Pirate]

It's not up to pharmacists to dictate morality. Moreover, this is a straight up coldhearted thing to say. Until you've known people who have struggled with addiction, perhaps it's difficult to volunteer some empathy, but at least give it a shot.

agree 1000% - kinda like the argument should not sell needles? going around sharing dirty needles is a hell of a lot more of an issue that drug use.

 

[WierdScience]

first of all..

who is getting the Rx? The junkie? great. Can they even afford this Rx?

Just let them die.

This is one of the most asinine and unempathetic things I have heard in a while on SDN. How did you make it as a pharmacist? You lack the heart that it takes to work in a medical services industry, I would never hire you. I don't care to hear a story of how you became so jaded, either.

 

[npage148]

Farma's comment is probably the opinion of 50%+ of the US populations right now. Screw the junkies, let them die

 

[Dred Pirate]

Farma's comment is probably the opinion of 50%+ of the US populations right now. Screw the junkies, let them die

difference between a junkie and a 19 year old who gets mixed up with the wrong person and dies the first time he tries it (saw that last month)

 

[confettiflyer]

Am I the only one who sees this as a money issue, too?

It costs us less to save the "junkie," rehabilitate him/her, and return them to society so they can generate taxes.

If it's some 25 year old and you bury them, you just wasted X # of tax dollars putting them through school and your ROI is ZERO.

OTC/home use naloxone is just one piece of the puzzle, gotta have effective rehab in place.

Cuz damn it, I want my tax dollars coming back.

 

[farmadiazepine]

So whose getting the Rx? Your telling me some kid who got mixed up with the wrong crowd who wanted to try out heroin for the first time? So every white suburbia household will now have one of these? Well at least they can afford it right. That Medco insurance the parents got with the $50 copay that the parents can afford.

Then there's the people who actually need it. You know, the ones who don't have homes. They're homeless. They love heroin. They suck d*** for $20 to buy dope. They steal shi* to buy dope. They are dirty and buy dope.

There's a disconnect here with a product and the population it intends to treat.

I just want to know, who are doctors going to write this for?

Or is this some thing that should just be in every first aid kit?

And yea, I'm an a** because I think its stupid.

 

[zelman]

What about a biphasic depo formulation? Would that change anyone's mind?

 

[xiphoid2010]

Farm"s argument is logical. It's not logical to think teenagers who ocassionally get in trouble messing around would have a script and prepared for an OD. Would people who never had allergies before have epipens on them? This is only for the habitual junkies.

Where would money for this come from? What about children/elderly who lack care due to shortage of funding? Does increase the life expectancy of junkies produce a net societal benefit? Where is personal responsibility in all this?

 

[WierdScience]

Would there not be programs to bring this prescription to the places that need it most? Especially in the early years during it's promotion, the company making it may give it for free to certain demographics and maybe homeless shelters should have a few.

 

[radio frequency]

This is only for the habitual junkies.

Where would money for this come from? What about children/elderly who lack care due to shortage of funding? Does increase the life expectancy of junkies produce a net societal benefit? Where is personal responsibility in all this?

Maybe you don't have any loved ones who've gotten clean before. I'll share a very brief narrative, as I do. They weren't using opioids, but alcohol. They've been clean for years now, and somehow managed to contribute to society at a high level the entire time as they were a very high functioning alcoholic. A junkie and an alcoholic are both addicts though. How do you know what somebody else will do with their life if they're able to get clean?

 

[Digsbe]

As a prescription I have no problem with this being done for people going through rehab. Relapse is just a reality of rehab and I think it's not a bad thing to have an emergency prep of naloxone on hand just in case. I wouldn't say it's endorsing drug use.

Also, all life should be valued. Junkies, rich, poor and the irresponsible. I don't advocate having no consequences for poor choices or other enabling people to make them through handouts and coddling the behavior, but life is precious.

 

[xiphoid2010]

Maybe you don't have any loved ones who've gotten clean before. I'll share a very brief narrative, as I do. They weren't using opioids, but alcohol. They've been clean for years now, and somehow managed to contribute to society at a high level the entire time as they were a very high functioning alcoholic. A junkie and an alcoholic are both addicts though. How do you know what somebody else will do with their life if they're able to get clean?

There are probably a few proverbial "***** with a heart of gold" out there, but c'mon, nobody is going to mistake the group for model citizens.

Diverting money to junkies means some poor kids have to live with under funded education, or some more olderly are homeless even though they worked their whole life, or tax payers have to hand over even more of their honest labor.

As adults, we are responsible for our choices. I donate to Free Lunch for Children in china precisely because these kids really didn't have a choice. On the other hand, junkies are adults who chose to doing self destructive acts (and committing crimes), excuse me if they are not on my list.

 

[Ackj]

I'm confused about the logistics. Who writes the rx, and when? I don't think most junkies have regular 6 month checkups, so not sure when they would get it. Is this something you get discharged with after you are sent to the ER from your first OD? Seems a little late there. Also, I can't see them wanting to spend money on a copay, so there's another issue with access.

A case I can see it get used reasonably is for Grandma and her maintenance oxy rx. If she accidentally takes too many or has some kind of mixup, this could save her.

Maybe this product is just inherently geared toward legitimate opioid use.

 

[confettiflyer]

Diverting money to junkies means some poor kids have to live with under funded education, or some more olderly are homeless even though they worked their whole life, or tax payers have to hand over even more of their honest labor.

See my original post, this logic assumes that there is a 100% recidivism rate after saving said junkie. We know this isn't true (the truth is somewhere between 0-100), and at some point, the CBA becomes such that redirecting funds to junkies becomes a financial net gain for society at large. I'm all for personal responsibility and letting people live (or die) by their choices, but if there exists an option that saves money, I'd rather do that.


(since I like numbers)
It costs the government (state, federal, local), on average, $10,615 per year to educate a child in this country. Dependent exemption given by the federal government is like $3900/yr (2013). Not counting anything else (assume this child didn't get any SNAP benefits, parents didn't take any further tax credits available, etc...), and assuming a parent in the 25% tax bracket:

[(13 yrs (K-12) x $10,615)+ (18 yrs x (25% x $3900))] = $155,545 in government support through age 18 (education + tax support for parents)

I don't have the answer as to whether flipping allowing Narcan to go effectively OTC (sort of) is truly cost effective, but if the above referenced "junkie" dies at 18, there is a 0% chance of their corpse reanimating and suddenly paying taxes.

 

[xiphoid2010]

See my original post, this logic assumes that there is a 100% recidivism rate after saving said junkie. We know this isn't true (the truth is somewhere between 0-100), and at some point, the CBA becomes such that redirecting funds to junkies becomes a financial net gain for society at large. I'm all for personal responsibility and letting people live (or die) by their choices, but if there exists an option that saves money, I'd rather do that.


(since I like numbers)
It costs the government (state, federal, local), on average, $10,615 per year to educate a child in this country. Dependent exemption given by the federal government is like $3900/yr (2013). Not counting anything else (assume this child didn't get any SNAP benefits, parents didn't take any further tax credits available, etc...), and assuming a parent in the 25% tax bracket:

[(13 yrs (K-12) x $10,615)+ (18 yrs x (25% x $3900))] = $155,545 in government support through age 18 (education + tax support for parents)

I don't have the answer as to whether flipping allowing Narcan to go effectively OTC (sort of) is truly cost effective, but if the above referenced "junkie" dies at 18, there is a 0% chance of their corpse reanimating and suddenly paying taxes.

You are forgetting that is a sunk cost. Junkie or superman, that cost is already sunk gone. Like you invest in 100 differrent investments, 90 became profitable, 10 turn out to be money pits. You can't go back and "recover" the money already spent on those 10, that's sunk.

The logic is to make a decision whether throw more good money in after the bad investments hoping they would change or do you cut your losses, and direct that money towards new productive investments. I donate to starving kids partly because they are are far better investment for society. Habitual junkies + tax payer funded narcan will likely just keep ODing, commit more crimes, use up more healthcare, and just die later and sucked up more resources that the more deserving needed.

 

[confettiflyer]

You are forgetting that is a sunk cost. Junkie or superman, that cost is already sunk gone. Like you invest in 100 differrent investments, 90 became profitable, 10 turn out to be money pits. You can't go back and "recover" the money already spent on those 10, that's sunk.

The logic is to make a decision whether throw more good money in after the bad investments hoping they would change or do you cut your losses, and direct that money towards new productive investments. I donate to starving kids partly because they are are far better investment for society. Habitual junkies + tax payer funded narcan will likely just keep ODing, commit more crimes, use up more healthcare, and just die later and sucked up more resources that the more deserving needed.

I get that it's a sunk cost, but what I'm getting at is that at some inflection point your non-performing asset base may start to produce gains once more. The only problem with your stock market analogy is that you're approaching it as a common shareholder.

Reality is a bit more like if you're Carl Ichann with preferred shares and you start to influence the operations of the company. Appropriate detox & rehabilitation is akin to a management and operations change. If 9/10 in your example continue to falter under taxpayer support and fail (die) by year 10 while 1/10 thrives and goes on to produce 40+ years of net return, is it worth it?



Besides, why you sending money to China? We already send all our money there, no need to pile on.

 

[xiphoid2010]

I get that it's a sunk cost, but what I'm getting at is that at some inflection point your non-performing asset base may start to produce gains once more. The only problem with your stock market analogy is that you're approaching it as a common shareholder.

Reality is a bit more like if you're Carl Ichann with preferred shares and you start to influence the operations of the company. Appropriate detox & rehabilitation is akin to a management and operations change. If 9/10 in your example continue to falter under taxpayer support and fail (die) by year 10 while 1/10 thrives and goes on to produce 40+ years of net return, is it worth it?

Reality is tax payers who are paying for it are common shareholders, not Carl Ichann. Also, narcan is not detox & rehab. The OD'ed addict is going to wake up, angry, in withdrawal, and want a fix to stop it. So in your example, the 9/10 of the junkies will survive more ODs, using up more healthcare, and more crime during the longer survival, more losses for the society. That offsets what the financial gains from the 1/10 that spontaneously come clean. That's throwing good money after bad.

Meanwhile the same money could be spent on providing nutritions to poor kids, better health care for them, better schools and scholarships for bright ones. Will all of them turn into superman? No. But the odds of improving their outcome is better than junkies coming clean. Not only that, they aren't responsible for their predicament.

Besides, why you sending money to China? We already send all our money there, no need to pile on.

I still got family and relatives there. Plus there are more starving kids there. Plus the same donation feeds 3x more starving kids there than here.

 

[confettiflyer]

Reality is tax payers who are paying for it are common shareholders, not Carl Ichann. Also, narcan is not detox & rehab. The OD'ed addict is going to wake up, angry, in withdrawal, and want a fix to stop it. So in your example, the 9/10 of the junkies will survive more ODs, using up more healthcare, and more crime during the longer survival, more losses for the society. That offsets what the financial gains from the 1/10 that spontaneously come clean. That's throwing good money after bad.

That's why I said narcan is one piece of the puzzle and not an all inclusive solution.

Meanwhile the same money could be spent on providing nutritions to poor kids, better health care for them, better schools and scholarships for bright ones. Will all of them turn into superman? No. But the odds of improving their outcome is better than junkies coming clean. Not only that, they aren't responsible for their predicament.

This isn't an either/or situation, even though I see your point and agree.

I still got family and relatives there. Plus there are more starving kids there. Plus the same donation feeds 3x more starving kids there than here.

Only 3? Man, you're getting ripped off!

 

[xiphoid2010]

That's why I said narcan is one piece of the puzzle and not an all inclusive solution.

I don't think an extra piece that increase the total cost is a good addition to a puzzle.

This isn't an either/or situation, even though I see your point and agree.

As resources are finite, it's always guns vs. butter one way or another. But in politics, the allocation that provides optimal outcome is not always chosen.

Only 3? Man, you're getting ripped off!

A free lunch for kids here cost $2.50. Whereas 5 yuan (80 cents) buys a kid a proper lunch at schools in China's rural interior. Actually, 3 yuan (50 cents) will buy a free lunch, but its minimalistic to the point there is no meat in it, I don't consider that to be a proper ration.

 

[rxlea]

We went from ODs to proper rations for Chinese children....

 

[owlegrad]

We went from ODs to proper rations for Chinese children....

Chinese children>People who need naloxone, obviously.

 

[npage148]

Why send money to a country who we have a tenuous relationship with while there are starving Americans. The money was earned in the US, shouldn't it stay here? Shouldn't the fox look after its own tail?

 

[confettiflyer]

We went from ODs to proper rations for Chinese children....

This thread is win.

 

[xiphoid2010]

C'mon, we all know threads that wonders off into outer space is a defining characteristic of SDN.

 

[rph3664]

first of all..

who is getting the Rx? The junkie? great. Can they even afford this Rx?

Just let them die.

Some medical ethicists have debated whether people who blow themselves up in meth lab explosions should get any treatment other than comfort care. There are hospitals that have had to close their burn units because the whole hospital was in danger of bankruptcy just from all the uninsured meth makers who did this; I heard on NatGeo that Vanderbilt University Hospital gives $300 million in charity care every year to this population alone.

As for opiate addiction, one of my classmates died from ODing on stolen Duragesic patches.

 

[confettiflyer]

Some medical ethicists have debated whether people who blow themselves up in meth lab explosions should get any treatment other than comfort care. There are hospitals that have had to close their burn units because the whole hospital was in danger of bankruptcy just from all the uninsured meth makers who did this; I heard on NatGeo that Vanderbilt University Hospital gives $300 million in charity care every year to this population alone.

As for opiate addiction, one of my classmates died from ODing on stolen Duragesic patches.

Corroborating the post with this link: http://www.huffingtonpost.com/2012/01/23/methamphetamine-burns_n_1222925.html

But then you get onto this slippery slope of not treating patients for X or Y reason... I see this scenario where a whole family shows up burned from an idiot parent, I can't possibly fathom the ED physician playing judge and jury in determining who gets what care. Could you imagine the liability arising from a misjudgment or miscalculation? Not to mention the idea that a medical institution can outright refuse your wishes to be full code vs. comfort care. Under that same thought, a hospital could refuse your wishes for comfort care and keep you full code.

Also, doing so would require a reversal of the concept of presumption of innocence.

Sure, you'd save millions of dollars...but the true cost would be immeasurable. Penny wise, pound foolish.

 

[xiphoid2010]

Delete, double post.

 

[xiphoid2010]

Why send money to a country who we have a tenuous relationship with while there are starving Americans. The money was earned in the US, shouldn't it stay here? Shouldn't the fox look after its own tail?

Most first generation immigrants have strong family ties with their native land, not something a non-immigeant can relate, but try imagine how it feels like if you had dual citizenship. Everything being equal, I would feed american and chines kids the same.

However, my wife and I already pay taxes and donate to churches here to help feed american children. Meanwhile there is a greater number in needs and less resources in china for starving kids. And feeding 3 vs 1 with the same amount makes the decision easy.

 

[zelman]

As for opiate addiction, one of my classmates died from ODing on stolen Duragesic patches.

Tragic. If only they had survived and become a pharmacist. Think of all the other narcotics they could have stolen.

My sister was once a homeless heroin addict. Now she is an LCSW helping children who have parents dying of cancer. I really care about who she is now. However, I didn't give a crap about her when she was shooting up. She could have died at that time, and I wouldn't have minded as long as her POS boyfriend who got her on heroin ODed, too.

 

[owlegrad]

Tragic. If only they had survived and become a pharmacist. Think of all the other narcotics they could have stolen.

My sister was once a homeless heroin addict. Now she is an LCSW helping children who have parents dying of cancer. I really care about who she is now. However, I didn't give a crap about her when she was shooting up. She could have died at that time, and I wouldn't have minded as long as her POS boyfriend who got her on heroin ODed, too.

Stop, your love for your sister is breaking my heart.

 

[All4MyDaughter]

Stop, your love for your sister is breaking my heart.

Conditional love just warms the heart and soul, right?

 

[zelman]

Conditional love just warms the heart and soul, right?

Love doesn't always mean wanting someone to continue living by eating out of dumpsters and begging for money to get drugs.

 

[Digsbe]

Love doesn't always mean wanting someone to continue living by eating out of dumpsters and begging for money to get drugs.

Love isn't agreeing or endorsing someone's lifestyle. Part of what it is though is showing compassion for someone who has hit rock bottom like that and not turning them away despite their vices and struggles.

 

[zelman]

Love isn't agreeing or endorsing someone's lifestyle. Part of what it is though is showing compassion for someone who has hit rock bottom like that and not turning them away despite their vices and struggles.

I don't disagree. Sometimes compassion includes euthanasia.

 

[rph3664]

Tragic. If only they had survived and become a pharmacist. Think of all the other narcotics they could have stolen.

My sister was once a homeless heroin addict. Now she is an LCSW helping children who have parents dying of cancer. I really care about who she is now. However, I didn't give a crap about her when she was shooting up. She could have died at that time, and I wouldn't have minded as long as her POS boyfriend who got her on heroin ODed, too.

He was a pharmacist for about 10 years prior to his death.