Narcan® and the New York City streets

It appears that the fentanyl epidemic has gotten so bad in New York City that the authorities have requested that all resident carry Narcan® (generic name naloxone) to treat overdose victims in the street.  Naloxone is a “opioid antagonist” that can reverse life-threatening effect of overdoses.  The city Health Dept is offering training to people on how to use the drug, which is now over-the-counter.  One health official opined that Narcan® should be in everyone’s first-aid kit and even available at subway stations.

The catalyst for what would once have been considered at outlandish request was the death of a two-year-old boy who died after exposure to fentanyl. That’s not all: New York City has experienced a 12% jump in overdose deaths last year (that’s more than 3.000 people) in 2022.

Why is this happening?  Failure to control our southern border has led to the importation of a whole slew of dangerous drugs by drug cartels.  It’s said the cartels are now the fifth largest employer in Mexico.  If you’re wondering who’s controlling the border, it’s not the Mexican government, and it’s certainly not us.  It’s them.

Opioids are so deadly because of their tendency to interrupt your ability to breathe, especially when taken in high doses or in combination with other recreational drugs.  You should be able to recognize the signs and symptoms of someone who’s overdosing.  Expect to see shallow, slow breathing, a slow pulse, pale and cold skin, blue lips or fingernails, and altered mental status. Unlike the dilated pupils seen with some drugs, opioids cause pupils to be pinpoint in appearance.

If you encounter someone who is unconscious, they need Narcan® immediately.  Fortunately, the drug can return normal breathing quickly within two to three minutes in many cases.  The U.S. Food and Drug Administration (FDA) has specifically approved the use of Narcan® as an over-the-counter naloxone nasal spray.  It’s effective when given correctly.

Narcan nasal spray usually comes in a package with two doses.  If the first dose is ineffective, you can give a second dose without worrying about any additional side effects.  Even if  you’re not sure that they used opioids, give them Narcan® anyway.  It doesn’t cause harm and it’s safe to take even when you don’t have opioids in your system.  It’s best to give Narcan as soon as possible; the longer you wait, the more likely it might be too late for the victim.

Someone who begins breathing again after receiving Narcan can relapse after 30-90 minutes if they have very high amounts of opioids in their system.  Because of this, it’s important that you call emergency services and stay with the person until help arrives to make sure they don’t deteriorate.  This may not be the easiest thing to do, as many victims wake up confused, agitated, and combative.

Here’s how to administer Narcan®:

• Lay the person flat on their back, making sure their mouth is clear and the airway is open.
• Open the outer package of Narcan and peel back the inner packaging of the nasal spray.
• Hold the spray container with your thumb at the bottom of the plunger and your pointer and middle fingers on either side of the nozzle.
• Tilt the person’s head back, Support the back of the neck, and insert the nozzle into a nostril.  Your index and middle fingers should touch the bottom of the nose.
• Firmly press the plunger to deliver the dose into the person’s nose; remove the device once it’s delivered.  There’s only one dose per spray device, so don’t press the plunger until you’re ready to deliver the drug.

In extreme cases, you may still need to support their breathing with CPR techniques after the first dose is given.  If the person starts breathing again and becomes responsive in short order, the Narcan worked.  You can rotate them onto their side in the CPR recovery position and monitor them.

If, in two to three minutes, the person is still unresponsive or not breathing, or if breathing difficulty returns, administer the second dose of Narcan® (each container comes with two spray devices) in the opposite nostril.

You should be able to find Narcan® at your local pharmacy; it might even be available for free.  Every state and insurance plan has their own rules, but one thing is sure: it will be an over-the-counter drug. You don’t need a prescription.

Unless things change for the better on the border, expect the opioid epidemic to continue unabated.  There’s apparently no interest in the current administration to solve our border crisis, leaving cities like New York to exhort its citizens to save overdose victims on their own.  That means 100,000 or more Americans will die every year for the foreseeable future.  It seems strange to say it, but maybe it isn’t such a bad idea to have some Narcan® around in these troubled times.

Joe Alton MD is a physician, medical preparedness advocate, and NY Times bestselling author of The Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way.

Image: Gov. Tom Wolf