Narcan 101

I came across a video that -- while heartbreaking to watch -- is so educational that I found it important to share.  This is what it's like to work as a paramedic in America.

I warn you it's painful to watch.  His anguished screams are simple to understand.  He can't be consoled.  There is nothing to help him, I don't think even at the hospital, but time.  I'm not sure even methadone is necessarily a help.

This young man has been resuscitated with Narcan after long-term opioid addiction.  His housemates called 911.

A lot of my coworkers would surprise me with how little they understood drug users like this young man.  They often believed that the combativeness after receiving Narcan -- which is not usually this bad -- is anger at the money they had "wasted" on the high.

Because the one and only thing that Narcan does in the human body is block its ability to work with opioids, any and all of them.  So whether you took heroin, Fentanyl, Percocet, whatever, Narcan will stop all of that dead in its tracks.  And all of a sudden you'll start breathing again, which is the paramedic's goal:  Airway, Breathing, Circulation.  Hospital.

But the people who work as police, firefighters, and paramedics, are drawn from a very specific hiring pool.  They have military hiring preference.  They drug test.  So it skews heavily toward alcoholics who never touch weed or any other drugs.  And they simply don't understand the mindset or how it works, even very simple things about marijuana usage and etiquette, anything you wouldn't learn on a traffic stop.

Anyway I'm rambling.  But this poor guy comes from a completely different world.  He's not angry about money that he lost from all the drugs he bought, as my coworkers would sometimes say.  He's not mad that he's not high anymore.

Because those people -- like the functional alcoholics that many of the first responders are -- don't actually get high anymore.  They only get "not sick."  They have to take more and more just to be okay.  I know a lot of police, firefighters, and paramedics get drunk as dogs just to be basically okay.  A lot of them wouldn't pass a breathalyzer during their shifts, GTFO.  And yet they do judge.  This is an open secret everywhere.  It has become a new thing to bust teachers with it on YouTube.

Another area where I needed to push Narcan was nursing homes.  Elderly people are frequently given high-dose opioids in patches.  Those may be applied by people with inappropriate licensing, CNAs, and placed one atop the other, or simply applied to any bare area of skin, without removing the old patches.  The elderly person is already incapacitated, and then has a massive opioid overdose.  Because the patches often continue to seep medication.  They're meant to be removed and replaced.  The nurses push their work off onto untrained staff all the time.

But this poor young man.  He's clearly been having to take increasing doses of his opioid of choice for an extended time.  And today he stopped breathing, or his roommates couldn't wake him.  Maybe he was choking on his own vomit, like Jimi Hendrix, and couldn't protect his own airway, although I didn't see any puke. 

When the medics arrived, they had to get him breathing again.  The opioids had told his brain not to signal his lungs to breathe.  So that had to be blocked with Narcan.   And once that happened, all of that long-term tolerance that had our man Joseph in the video needing higher and higher doses over time, as I'm sure he did, all of that came crashing down.  All of that hit a brick wall with that one Narcan push.

Joseph is screaming that way because he's back to Day 1 of never having met an opioid after that push of Narcan.  Again, the one and only thing Narcan does in the human body is block the action of the opioid receptors.  It simply makes opioids not connect to their targets in the brain.  So his long-term relationship with them ended all at once.  Every raw nerve in his body hit that brick wall all at once.  His entire brain is on fire.  That's why he's screaming like that.  When he can eventually form words, they are "Let me die."

I really wish Joseph all the best.  I honestly don't know what happens next for him.