State allows stronger Narcan doses
Bureaucratic admission that they have “lost control” of the Acetyl Fentanyl/Heroin being sold on the street and causing people to OD ?
BOSTON — Police officers, firefighters and other first-responders in Massachusetts will be allowed to carry more potent doses of the life-saving overdose antidote naloxone under new state guidelines.
The changes, approved by the state Office of Emergency Medical Services, authorize emergency personnel to carry doses up to 4 milligrams of naloxone nasal spray, sold under the brand name Narcan. Under previous policy, they were limited to 2 milligram doses.
Naloxone can reverse overdoses from heroin and other opioids, but first responders say stronger or multiple doses are often needed to revive patients who have used substances laced with fentanyl, because of its higher potency.
“Sometimes they have to administer Narcan four or five times because the drugs are so powerful,” said Lt. Edward Guy, a spokesman for the Andover Police Department.
Massachusetts is one of a handful of states that limited naloxone dosages — a cap that has prevented police and fire departments from accepting some donations of Narcan from pharmaceutical companies.
In July, the Police Assisted Addiction and Recovery Initiative, founded by former Gloucester police Chief Leonard Campanello and Gloucester resident and businessman John Rosenthal, received a donation of 10,000 doses of Narcan from its manufacturer, Adapt Pharma.
The nonprofit group had to divert the 4-milligram doses, which were too high, to fire and police departments in other states.
“With stronger and more dangerous drugs like fentanyl claiming more and more lives each day, stronger, more potent doses of Narcan allow first-responders to save more lives,” Rosenthal said in a statement.
“We cannot save a dead person. Every life saved with Narcan is an opportunity for a person suffering from the disease of addiction to reclaim their life,” he said.
The state’s decision to increase the allowed dosages of nasal spray follows a recommendation by a U.S. Food and Drug Administration advisory committee to increase the minimum amount for an injectable dose of naloxone, which is now 0.4 milligrams.
Narcan counteracts the effects of heroin, OxyContin and other painkillers by blocking certain receptors in the brain.
But recent studies have suggested that higher doses may increase the chances of acute opioid withdrawal syndrome, which can make patients aggressive and even violent. Because of that, some first-responders may be reluctant to administer repeat or future doses, according to the FDA.
Other studies have recommended treating children and young adults — who may accidentally overdose after coming in contact with heroin or other opioids in their homes — with a higher dose because they tend to metabolize naloxone more quickly than adults.
Barbara Herbert, a physician and president of the Massachusetts chapter of the American Society of Addiction Medicine, supports the state’s decision to increase the maximum Narcan dosage.
She said lower doses aren’t as effective with fentanyl overdoses.
“It’s a good idea, as long as we track what happens,” she said. “If we find that it makes people more uncomfortable or difficult for our first responders, then we’ll have to pull back. But there haven’t been any reports of that happening yet, even anecdotally.”
The state’s medical community has debated naloxone doses over the years, Herbert said. During a heroin epidemic in the 1990s, some emergency rooms lowered the injected dosage to 0.2 milligrams to lessen withdrawal symptoms.
“But we’re dealing with stronger heroin, often laced with fentanyl, so we need to respond with a stronger medicine,” she said.
Sander Schultz, Gloucester’s emergency medical services coordinator, said the city’s fire department responds to several calls for accidental overdoses each month, and first responders often administer more than one 2-milligram dose of naloxone to revive patients.
For patients with strong addictions, a strong naloxone dose can also intensify withdrawal symptoms.
“So that person whose life you just saved will be in a lot of discomfort,” Schultz said. “They’re going to vomit and become agitated.”
Like most states, Massachusetts has experienced a surge of fatal, opioid-related overdoses. Health officials said preliminary estimates show more than 984 deaths from opioid overdoses in the first six months of 2016 — a number expected to rise as more data becomes available.
Last year, overdoses claimed an estimated 1,659 lives statewide, including 223 in Essex County.
The state has been stockpiling naloxone for cities and towns amid concerns about skyrocketing prices of the drug.
Attorney General Maura Healey reached a deal last August with naloxone manufacturer Amphastar Pharmaceuticals that provided $325,000 for a bulk-purchasing program to acquire and distribute the medicine at reduced prices, averaging about $20 per dose.
In addition to law enforcement, naloxone is made available to the public by pharmacies as an injectable product and nasal spray. School districts across the state have also stocked up on the overdose-reversing drug. Those doses range from 0.4 milligrams for injections to 4 milligrams for the nasal spray.
What’s unclear is whether the state’s decision to increase naloxone dosages will drive up costs for cities and towns.
“Even if the cost doubles, it will still be less than what police departments were paying a few years ago,” said Mark Leahy, executive director of the Massachusetts Association of Police Chiefs. “Overall, this will be far a more efficient way to administer Narcan.”
Christian Wade covers the Massachusetts Statehouse for the North of Boston Media Group’s newspapers and websites, including the Times.
Filed under: General Problems
Everyone will love this 1,,my freind who takes care of elderly in their homes,usually,,Lost 1 of her 20 year patients to a assisted living center,,well,,this women is 87 years,,ABSOLUTELY NO HISTORY OF EVER ABUSING ANYTHING,, well,,they tried to wake up this women at the ,”living,” center,,on their time,,,6 am,,she never got up at 6 am,,she was a 9;30 rizer for 87 years,,,,she would not wake,,Sooo the call a ambulance,which will only go to 1 hospital,,the same one that literally almost killed me,2ce,,sooo these brilliant e.r. staff ,,ohh and the fact..once they started lifting this elderly women,SHE awoke,,but was still drowzy,,,they determined in this e.r.,,that this elderly patient of 87,,,O.D… AND GAVE HER NARCON,,,, the poor women further awoke in complete hallucination,,screaminmg etc,,,,,,,NO BLOOD WORK WAS EVER TAKEN,,THE WOMEN WHO MEDS ARE REGULATED BY THE STAFF AT ASSISTANT LIVING ,, is allowed 2 tramadol a day,,,at the lowest dose available,,,,,,This poor soul was allowed to continue to hallucinated ,scream etc for 24 hours of complete distress because the staff at this god aweful hospital refused to call her primary,,stating once she was admitted to THEIR hospital,,they are her primary!!!!!!..There never was no o.d.,,,they just wanted the funding from the federal government for treating this ,”heroin epidemic,”’,,,,,,this is how corrupt it is people!!!!!!!!!!!!!MARY
While this is good start if there is no affordable treatment for those addicts to go to right then and there the addict will be out the door using again. Especially if they are released in a middle of a withdrawal. If we really want to deal with addiction it cannot done by half ass efforts. There needs to be education about the disease of addiction ( it is not just about drugs) there needs to be affordable treatment and there need to a big change in attidude especially among all doctor’s and politicians to start seeing addiction as a disease and not a moral issue that should be shunned. I doubt American”s are really ready to spend the money a disease that is so misunderstood and that many feel (including doctors) that the addict asked for it.