The United States has 5 percent of the world’s population, and yet we consumer 80 percent of the world’s opioid medications.
The No. 1 cause of accidental death in the U.S. states is now prescription drug abuse, which now surpasses motor vehicle accidents. According to Maine Attorney General Janet Mills, drug overdose related deaths here in Maine surged 31 percent in 2015, with a record of 272 fatalities; the majority of these deaths were caused by heroin, fentanyl, and prescribed opioids.
The Maine Legislature overrode Gov. Paul LePage’s veto and passed a bill last week that will allow for naloxone or Narcan to be available from pharmacies in Maine without the need for a prescription. Narcan can be used to help reverse the life-impairing effects of opioids, namely slowing of the respiratory system and impaired oxygenation to the brain. In only a few minutes after taking an overdose of opioids (depending on how the opioid is administered), the brain can begin to suffer the effects of impaired oxygenation. Narcan when administered in the community setting usually works effectively within a few minutes, and it brings the person out of risk of overdosing and death by blocking the opioid receptors in the brain.
Narcan is available as a nasal spray, and it should be administered when the opioid user is found to be difficult to arouse (unusual sleepiness, lack of response to loud voices and pressure applied to the sternal area of the chest or sternum); very slow or shallow breathing is noted (normal respirations are 12-20 breaths/ minute); and/ or the pupils of the non-arousable person are pinpoint or very small. The emergency response system should be activated immediately. Signs of overdose can return even after Narcan has been administered, so it can be administered again with a new nasal cartridge after 2-3 minutes have passed from initial administration and CPR can be given while waiting for the medication to work and emergency help to arrive.
After administration of Narcan, the person may awaken feeling angry, confused, and/or suffering from opioid withdrawal because of the blocking of the brain’s opioid receptors. Meanwhile, the person may also gradually become aware that there life was at risk, and that they have been given a gift of not overdosing and avoiding death. With this knowledge may come a renewed desire to address the addiction issue (most addicts do not want to be addicts, but their bio-physiological-neurological dependence creates great suffering that stands in the way of their ability to disengage with consumption).
As controversial as this might sound, it should be acknowledged that about 23 percent of heroin users actually suffer from what might be classified as addiction; while this number is high compared to other addictive substances (nicotine is actually more addictive then heroin), perhaps as a culture we need to start considering issues around safe access to addictive medications, as well as ways to reduce harm from addiction.
As Maine considers ways to reduce harm around opioid use and support recovery from addiction, we are fortunate to have the presence of Dr. Dustin Sulak, Maine’s own internationally recognized cannabis doctor. He will be presenting on May 10 at University of Southern Maine on how medical use of cannabis can help treat opiate addiction. This presentation is free and open to the public, though advanced registration is encouraged.
Carey Clark is committed to supporting the growth of caring-healing capacity of health care providers, and the healing of the patients they serve. She is an assistant professor of nursing in the University of Maine at Augusta’s RN-BSN Program, where she has been teaching since 2010.
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