buprenorphine patients do not have a required daily check-in. The medication is taken sublingually and prevents attempts to get high through injecting medication (NIDA, 2021b). Naltrexone is an opioid antagonist, which blocks the action of opioids. This medication is not addictive or sedating and will not result in physical dependence. However, because of the nature of this medication, patients often have trouble complying with treatment, which limits the effectiveness (NIDA, 2021b). Naloxone is the gold standard to reverse the effects of heroin overdose. The drug is not new and has been used by emergency medical personnel on the streets and in hospitals for over 40 years in an injectable form. Originally approved in April 2014, naloxone was approved and released for sale by medical doctor prescription in all states and in some states by pharmacist prescribing (SAMHSA, 2021). Naloxone comes in the form of a handheld device, an injector, a nasal spray, and a sublingual tablet (the newest form). It can be injected intramuscularly or subcutaneously. Naloxone is an opioid antagonist and revives overdose victims from death because of respiratory depression (SAMHSA, 2021). New naloxone laws are expanding in regard to who can receive naloxone and who can distribute naloxone and are simplifying the process of obtaining naloxone (SAMHSA, 2021). Government and healthcare leaders are hailing the medication as a groundbreaking tool to address the epidemic of heroin overdoses across the nation. As the opioid epidemic has worsened, emergency medical services, law enforcement, and families are the first line of defense. In a study done in North Carolina, the implementation of a community -based naloxone distribution program resulted in the avoidance of 352 opioid overdose deaths between 2013 and 2016 (Naumann et al., 2019). In addition, for every dollar spent on the program, there was a $2,752 dollar benefit because of overdose deaths avoided (Naumann et al., 2019). The study suggests that a community-based naloxone program is associated with decreased opioid overdose rates and generates substantial societal benefits. Since 2010, law enforcement agencies across the United States have been training and supplying their officers to use naloxone, but not all have been included. Police generally are the first on the scene ahead of emergency medical technicians and other first responders. Because of the opioid epidemic and overdose deaths, the 2017 report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended that all law enforcement in the United States be equipped with naloxone and trained in its use (Fleming et al., 2018). The release of the drug has been controversial. Some experts believe it will give addicts a false sense of confidence that they can continue to use as much heroin as they want and that the drug will save them from death by overdose. Many also object because it will increase insurance costs. Proponents of the drug do not believe addicts will intentionally take enough of the drug to overdose just because naloxone is available, and they feel the U.S. Food and Drug Administration (FDA) has addressed a Bath salts The intake of patients in the emergency department who have abused bath salts is an emerging trend. Bath salts consist of a synthetic powder that is sold legally online and in drug paraphernalia shops. Bath salts contain manufactured stimulants called cathinones , which are similar to amphetamines. Because these substances are stimulants, they increase dopamine levels in the brain and create a sensation of euphoria. The substance comes as a white or brown powder, sometimes sold as jewelry cleaner, but it may be snorted, injected, smoked, or ingested orally or even rectally. The substance is inexpensive and is easy to acquire (NIDA, 2020d). (Box 2)
life-threatening public health crisis that has reached epidemic proportions (Fleming et al., 2018). One drawback of naloxone is that if the heroin is adulterated with fentanyl, patients will need a larger dose over a longer period to combat the longer acting drug combinations. This may cause the patient to sink back into respiratory distress once revived by naloxone and require repeated naloxone doses. Patients will also require emergency medical care or hospitalization despite receiving the drug and being revived (Fleming et al., 2018). In addition, a safety alert was published in Police and Security News ; first-line responders, police, and family members must be careful regarding giving naloxone to someone who is experiencing an overdose. In an incident in Appleton, Wisconsin, a firefighter named Mitchell Lundgaard was killed during a routine aid call to a bus stop. Police officers and firefighters responded to a bus passenger’s medical emergency in downtown Appleton (Peters & Gunta, 2019). The passenger was reported by others to be snoring oddly and seemed to be experiencing a seizure. Upon further assessment, it was determined that the passenger’s eyes were extremely dilated and his breathing inconsistent. Naloxone was administered and further aid was offered. During the pat-down, following the naloxone administration, the passenger became aggravated and unexpectedly pulled out a handgun, firing two shots that struck firefighter Lundgaard, killing him. As reported in the safety alert, when someone administers naloxone to an individual who is high, emergency medical service providers often refer to this time as “waking the dragon.” The recommendation within the article is that providers need to give small amounts of naloxone at one time while monitoring the patient’s reaction (Peters & Gunta, 2019). Self-Assessment Quiz Question #4 Nora was found unresponsive with shallow breathing. Her partner reports that she took a white powdery substance, and he couldn’t get her to wake up, so he called 911. Of the following, which would be given for first-line treatment?
a. Naltrexone. b. Naloxone. c. Buprenorphine. d. Methadone.
Self-Assessment Quiz Question #5 Jose recently had a hospitalization because of a polysubstance overdose. He really desires to get his life straightened out, but he has limited access to healthcare, and he has limited transportation. Which of the treatment options would be best for him?
a. Naltrexone. b. Naloxone. c. Buprenorphine. d. Methadone.
Box 2: Bath Salts: Common Street Names
• Ivory wave • Lunar wave • Bloom
• Bath blow • Cloud nine • Salting • Lunar wave • Scarface • Flakka • Wicked X
• Blue silk • Bubbles • Vanilla sky • White lightning
Note. NIDA, 2020d.
Page 36
Book Code: RPTTX2024
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