Thursday, May 26, 2005

Reducing OD Deaths by Peers

A new article describes for a small pilot cohort in SF a program to train heroin dependent individuals to administer CPR and provides them with pre-filled naloxone syringes and the education to use them. The article points out that naloxone is non-"abusable," and that among the lay community CPR training has been deemed reasonable (though largely ineffective because so few folks in the community at large witness cardiac arrests). OD events were self-reported "but were corroborated by one or more witnesses. . . " In a six-month period naloxone was used by the study-population in 15 of 20 cases of observed OD; no deaths were reported, and the subjects claimed to have lessened their own use of heroin. The limitations of the study are acknowledged - but one has to wonder: what could possibly argue AGAINST such training and distribution of naloxone? One plausible reason to hesitate (not discussed in this paper) might be fear of legal liability if individuals die and blame is attributed to the training and the trainers.

Surely there's some way to deal with that issue - if medical intervention in general were to be withheld from patients in need as long as the threat of liability existed, no one would get care for anything. Article appears in J of Urban Health (Bull. of NYAM), 2005, KH Seal et al.


At 9:37 AM, Anonymous Anonymous said...

Just to clarify a side point - it's not the "C" in CPR that is the effective intervention in straight opioid overdoses - it's the "P" and the "R". The "rescue breathing" ("mouth to mouth respiration") component of CPR is what saves lives. In a true opioid overdose breathing slows over a period of time until it stops, but the heart keeps beating vigorously. Maintaining respiration for a relatively short time through rescue breathing is frequently sufficient to get the victim past the true danger zone.

So simple rescue breathing training can save many lives, but of course naloxone distribution in addition makes nothing but good sense....

At 2:24 PM, Blogger RGNewman, MD said...

right- bottom line: anything and everything that can save a life is worth doing - and teaching others to do. And anonymnous is absolutely right- it's the resp depression effect of the opiate od that kills - one can respond by reversing the pharmacological effect with narcan, or one can articially breathe "for" the individual until the opiate effect wears off - or until one can summon emergency med assistance. rnewman

At 9:10 AM, Anonymous Anonymous said...

I am currently offering naloxone to heroin users in New York City. We train the users prior to prescribing and dispensing naloxone. I find that the training has little that is new for users, rather it validates what they have observed, "connects the dots". They tend to know about mixing drugs and loss of tolerance, the majority have witnessed an overdose and understand stimulation as a tool. Many have done mouth to mouth. So the training is quite simple. I hope we can eventually see naloxone as an over the counter- particularly as intranasal administration is fairly effective.
Sharon Stancliff

At 5:36 PM, Blogger Matt said...


Thanks for this blog. I wish more doctors would get involved in understanding and treating opiate addiction.

I'm a recovering addict, currently on subutex, and I've been keeping a blog about my recovery. Please feel free to post a link -

Also, my sponsor writes a blog aimed at helping doctors better understand addicts.

Thanks again,
Santa Monica, CA


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