Overdose by Benjamin Perrin

Author:Benjamin Perrin [Perrin, Benjamin]
Language: eng
Format: epub
Publisher: Penguin Canada
Published: 2020-03-30T00:00:00+00:00

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Naloxone is a miracle drug that saves lives during an overdose emergency, but it’s not a silver bullet for singlehandedly solving the opioid crisis. There are four reasons why.

First, giving someone who’s overdosed an excessive quantity of naloxone puts them into withdrawal. And as we’ve seen, avoiding withdrawal is one of the primary drivers of opioid use by people with opioid use disorder. The naloxone that has saved their life can simultaneously compel them to quickly use again, even though they just about died. It may be hard to understand, but some people who are revived from an overdose can be angry because the naloxone has abruptly ended the pain-relieving effects of opioids that their body craves and that they’ve spent their scant money for. This need to stave off withdrawal symptoms, even at the risk of their own life, blatantly reinforces the fact that opioid use disorder is a relentless condition that effectively robs many users of their autonomy.

“It’s one of the hardest things when we treat someone. In essence, you reverse their overdose with the naloxone, but they don’t want to go anywhere,” said Vancouver Fire Chief Reid. “They don’t want to go to the hospital. It’s exceptionally hard to have the same person overdose three times in a day and die on the fourth.”

“That’s happened?” I asked, finding it hard to believe.

“Yeah. And it’s really frustrating,” said Reid, referring to the strain on front-line firefighters who live the opioid crisis day in and day out. “They develop relationships, too. They have regulars.”

Second, once someone has had a non-fatal overdose, they’re at greater risk of overdosing again and dying. “I think a huge number of lives have been saved by take-home naloxone,” said Dr. Evan Wood, executive director of the BC Centre on Substance Use. “Though that’s resuscitating people in the moment. But if you don’t offer other things, then obviously they remain at high risk of a subsequent fatal overdose. Actually, there’s literature to show that individuals who have had a non-fatal overdose are at extremely high risk of subsequent fatal overdose.”

Third, people may simply administer naloxone without other necessary medical interventions, such as rescue breathing. Unless an overdose victim receives sufficient oxygen to their brain during the time it takes naloxone to begin working, they can suffer permanent brain damage even if they’re revived.

“Naloxone is unfortunately all too commonly considered just this panacea for the opioid crisis,” said Staff Sergeant King. “In an acute situation, it should have been used together with rescue breathing and supportive CPR and all those other factors. Even our own police officers think, ‘Oh, just administer naloxone and let it do its stuff.’ People can suffer brain damage and other really terrible medical side effects.”

As Dr. Bonnie Henry told me, “Opioids, artificial or natural, are respiratory depressants. People stop breathing, which is why we teach rescue breathing when we’re teaching the use of naloxone. Until somebody comes back up with the naloxone, you want to make sure their brain is still getting oxygen.

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