Written by: Greg Ellifritz
*The police department where I work recently started providing officers with intra-nasal Narcan to reverse opioid overdoses. Although we get a fair number of overdose calls, our medics are top notch and they usually arrive on the scene within a few minutes. Only a few cops have used the Narcan since it’s been issued. I got my first chance to use it on an overdose victim last week.
I wrote about my experience in a Facebook post. I got a lot of comments and feedback from the post. Quite a few folks wanted me to expand upon my thoughts and turn the post into an article here on the site. That’s what I’ve done.
This post talks about some of the issues involved in narcotic overdoses, proper first aid should you encounter an overdose victim, and my opinion about whether or not we should be issuing Narcan to police officers.
As with every other article on this site, my opinions are mine alone and do not reflect the opinions of the police agency or city I work for.
Last Thursday at work I saved a heroin overdose patient’s life by giving her Narcan.
She was as close to dead as one can be without actually dying. When I arrived on scene, she was unconscious, blue in color and had agonal breath sounds. She was only breathing one or two times per minute.
I hit her with Narcan. After a couple of minutes she began breathing more regularly. It took her about 10 minutes to regain consciousness.
After she awoke she told me what had happened. She said she was addicted to opiate pain pills. Her addiction started after she was prescribed Percocet following an ankle surgery. She liked the feeling after taking the pills and got hooked. She kept buying them on the street after the doctor stopped writing her prescription.
She said that tonight was the very first time in her life that she had tried heroin. She had taken a large dose of Xanax and then added the heroin trying to find the perfect high.
Lots of heroin addicts are liars, but in this case I believe her. She was being incredibly candid and expressing gratitude that I had saved her. I believe that it was truly the first time she had shot up with heroin. Besides the candid conversation we were having, the woman was handicapped in such a way that would make self injection of the drug incredibly difficult. I’m think it’s likely that she nearly died the very first time she used the drug.
Her boyfriend (a heroin addict who was also saved from an overdose by police about a month ago) injected her with the heroin. When he realized she wasn’t breathing and was turning blue, he didn’t immediately call 911. He first sanitized the scene by removing all traces of heroin and drug paraphernalia. He then dumped a bucket of water over the victim’s head and started repeatedly slapping her face. Obviously, that strategy didn’t work. It was only when he ran out of ideas that he decided to call 911.
He was almost too late. The paramedics arrived about five minutes after I did. She didn’t have five minutes of life left in her by the time I arrived. If I hadn’t been so close to the call when it went out, I’m convinced that she would have died.
Opiate addiction is a massive problem of epidemic proportions. You may not recognize it, but I’m certain that you have a friend, acquaintance, or family member who is addicted to either opiate pain pills or heroin. You need to know what to do if that person suffers an overdose.
The vast majority of those of you reading this have taken some type of CPR class in your life. If opiate overdoses continue to increase, soon we will be seeing more overdoses than heart attacks. You need to know first aid for an overdose just like you know how to give CPR to a heart attack victim or the Heimlich maneuver to a person who is choking.
Recognizing an Opioid Overdose- Opioids, a term that encompasses both traditional drugs derived from the opium poppy (like heroin or morphine) as well as man made chemicals (like Fentanyl or Tramadol) that act on the same opiate receptors in the body, are central nervous system depressants. They slow the functioning of body processes and eventually can depress the level of respiration until the body actually stops breathing.
Initial stages of the opioid high are euphoria, feeling exceptionally relaxed, slurred speech, and uncoordinated movement. Think about how a person might act if he is really drunk while also being exceptionally sleepy. That’s often what someone who is high on opioids looks like.
If the person takes too much of the drug, he or she will become unconscious. That will likely be your first sign that the person is suffering an overdose. Respiration rate will slow. The person will likely be making very strange noises when they try to breathe. They might be snoring loudly, gasping for breath, or making agonal breath sounds. The average adult has a resting respiration rate of between 12 and 20 breaths per minute. Someone who is overdosing will often have a respiration rate of fewer than five breaths per minute.
The person will also have pin-point tiny pupils. That’s one way to differentiate a heroin overdose from other causes of unconsciousness.
Pulse rate will initially go higher to compensate for the lack of oxygenated blood being circulated. Most of the OD victims I’ve responded to had initial pulse rates of 140-160 beat per minute. As breathing ceases, those will gradually slow and eventually stop.
The person’s skin may be very pale or bluish in color. Nail beds and lips may also be blue.
Assessing the Scene- Be very careful if you believe someone is suffering from an opioid overdose. They most often have overdosed immediately after injecting heroin. We often find victims with needles still stuck in their arms. If the needle isn’t still in their body, it’s likely close by. Scan for needles, broken glass, razor blades, or any other hazards. Getting HIV or Hepatitis from a dirty needle isn’t the outcome you are looking for.
You should also be cautious about avoiding the drug itself. Some of the synthetic opioids are very powerful and inhaling a very small quantity could cause you to suffer the same symptoms you are seeing in the overdose patient.
Scene safety first. You can’t save the overdose victim if you are dying as well.
First Aid for an Opioid Overdose- If you suspect an opioid overdose, first call 911. Get some professional help on the way.
First aid for an opiate overdose is intra-nasal Narcan. The generic name for Narcan is naloxone. If you have a friend or family member who abuses opiates, you need to have a Narcan kit on hand at all times.
In many states (including Ohio), you can purchase Narcan at a pharmacy without a prescription. Here is a list of Ohio pharmacies that will sell you the drug. It comes as a simple syringe loaded with the drug. Instead of a needle on the end of the syringe, it has a foam atomizer. You stick the foam atomizer up the patient’s nose and depress the syringe plunger. It’s both simple and easy. It does not require a medical degree to administer.
Guidelines are constantly evolving, but currently the standard initial dose is two milligrams. That is the dose loaded into the Narcan syringes. Vigorously push the syringe plunger to properly atomize the liquid. Shoot half of it up one nostril and then spray the other half of the syringe in the other nostril.
Here is a quick video on how to administer the intra-nasal naloxone:
Watch for improvement in breathing. If the person hasn’t started breathing more regularly, give them a second dose after three to five minutes.
Narcan does not work on all overdoses. Some victims will have taken too much of the opioid drug for this relatively small dose of Narcan to counteract.
Don’t let denial allow you to avoid purchasing a Narcan kit if you have an opiate abuser in your family. If you had a kid with a severe peanut or bee sting allergy, you would have an Epi-Pen available. If your kid has an opiate addiction, you should have Narcan available to counteract the effects of an overdose. It’s common sense.
Harm Reduction Strategies- You shouldn’t be doing heroin. It’s a hazard to your health. You know this, but that fact won’t stop everyone from using the drug. I realize the “just say no” message isn’t effective. If you or a family member abuse opioid drugs, you need to practice some harm reduction strategies to ensure that you don’t die.
– Don’t mix opiates with any other drug that may compound the side effects
– Don’t shoot up alone. You should have a sober person on scene who can call 911 in the event of an overdose.
– If you have a friend or family member who is suffering from an overdose, call 911 immediately. Don’t try to wake them by conventional means. Don’t waste time cleaning up your drug paraphernalia. Get medical help on scene as soon as possible.
– Have Narcan on hand and use it as soon as you detect a problem (unconsciousness combined with pin-point pupils, difficulty breathing, slow respiration rate, blue skin, loud snoring sounds or agonal breathing).
The heroin problem will get worse before it gets better. Millions of Americans are addicted. If you care about one of those addicts, make sure they know and practice the basic harm reduction strategies I listed above. Have a Narcan kit available and ready to use in case they accidentally overdose.
Should Cops be Carrying Narcan?- There is a lot of controversy about cops carrying Narcan to save overdose victims. The kits cost money ($60-90 each). Some people think that opioid overdose victims are not “deserving” of the care required to reverse their overdoses. Still others think that cops carrying Narcan will experience inevitable “mission creep” and will be spending more time saving addicts than fighting crime.
The fact is that heroin overdose victims make poor decisions. Those decisions negatively affect both themselves and society. There is a cost for bringing them back and it is borne by the taxpayers. I can understand the frustration. I don’t want to pay more taxes either.
As cops, we don’t only provide services to “deserving” victims. There’s no way to easily determine who deserves our help and who does not. Quite simply, we help everyone we can, regardless if their poor decisions led to the problem or not.
I don’t refuse to take a burglary report just because someone stupidly left their doors unlocked. That person’s choices led to a negative outcome. I still help them try to get their property back and try to identify and arrest the burglar.
Besides overdoses, lots of other medical conditions are caused by poor decisions. Yet we continue to treat them. Do we tell the heart attack victim, “I’m sorry, we can’t treat you. We told you to stop eating Big Macs and start an exercise program, but you refused. No AED for you.“?
Do we limit the number of times we transport diabetics to the hospital when they have blood sugar emergencies? “Sorry, grandma, we’ve already transported you three other times in the last couple years. You’ve reached your limit. Maybe you should cut back on the sugar a little bit and monitor your glucose levels more often.”
Why should opiod addiction be any different? The addicts make bad choices and suffer the consequence of potential death. The 600-pound man who eats three meals daily at McDonalds is doing the exact same thing, but we would never consider limiting his treatment.
I don’t see reviving overdose victims as being any different from giving a heart attack victim CPR.
The bottom line for me is that these heroin abusers have undoubtedly screwed up. A lot of them are real shitbags as human beings. But poor decision making isn’t a crime that is currently punishable by the death penalty. We have the relatively easy ability to save a lot of them. We should do it.
I got into this job to do good things and save lives. Narcan is a tool that allows me to do that better. I’m all in favor of cops carrying the drug.
I’ve responded to opioid overdoses as a cop both with Narcan and without it.
Before we had the drug, the only thing we cops could do was call for paramedics and hope the patient didn’t die before their arrival. Having been in that spot several times, I can tell you that it sucks. Nothing makes you feel more impotent and useless as a human being than to be forced to watch someone as they are dying without having the ability to do anything about it.
I felt a lot better last week when I was in the same situation and I knew I could do something. I was able to save a woman’s life all because of that little Narcan pouch I carry in my police cruiser. That is the greatest feeling on Earth.
Opioid addiction is no joke. As addiction rates increase into the future, I have no doubt that it will touch someone you love. It’s best to have a plan to deal with that before it occurs.