Opioid

How to Obtain and Use Naloxone, the Drug That Can Reverse an Opioid Overdose

Welcome to another one of those posts you hope you never need to use. Today we’ll be talking about how to use naloxone (including brand names Narcan and Evzio) to help somebody who has overdosed on opioids like heroin or prescription painkillers.

What Is Naloxone?

Naloxone is a drug that can reverse an opioid overdose. You can give it as a shot in the thigh, or a puff up the nose. In about two minutes it can take a person from unconscious and barely breathing to sitting up and talking to you.

It works by blocking the brain’s receptors for opioids. (Opioids include heroin, fentanyl, morphine, codeine, and prescription painkillers like Oxycontin.) Opioids stimulate these receptors on the brain, and when there’s enough of an opioid in somebody’s system, they can overwhelm the part of the brain that’s responsible for breathing.

Naloxone crowds the opioid out of the brain’s receptors, but it doesn’t depress breathing or create a high. If you find somebody unresponsive and you’re not sure if they were taking opioids, that’s totally fine: naloxone is still safe to give them.

Who Can Use It?

If you think you might ever witness somebody overdosing, you should know how to use naloxone and you should consider obtaining some. Using naloxone is something a bystander can do, just like first aid or CPR.

So maybe you have a friend or family member who uses opioids. Or maybe you’re putting together emergency plans for an event or organization. (For example, music festivals in Ottowa can’t get a permit unless they show that they’re prepared to administer naloxone.) You can get your own supply of naloxone, and keep it around in case you ever need it.

How Do You Get It?

Naloxone would normally be a prescription drug, but all 50 states have some kind of law to make it easier to obtain. These laws typically let you walk into a pharmacy and either the pharmacist can prescribe it, or there is a standing order that acts like a prescription anyone can fill.

In some states, community organizations can pass out naloxone to people at risk. Use this tool to find an overdose prevention group near you, or check with your local health department.

If you think you’re at risk of overdosing, you can get naloxone for yourself, and then make sure your friends and family members know how to use it. (You should also take other steps to reduce your risk of overdose, including seeking treatment. But yes, get naloxone too.)

You can also get naloxone in your name, with the understanding that it’s not for you. So you don’t have to ask for “some naloxone for my sister who has a problem,” you just get it for yourself and you’re free to use it on your sister, or on her friend who passes out in your living room, or on the guy who overdoses next to you on the bus.

How Much Does It Cost?

Sometimes you can get naloxone for free through an…

Pill Bottle Timers Could Put a Lid on Opioid Abuse

These innovative caps for prescription pill bottles could help curb opioid addiction and abuse amongst seniors and adolescents alike.

The TimerCap is a medication lid featuring a built-in timer that reads when the bottle was last opened. Every time the bottle is closed, the timer resets to when it is supposed to be opened next.

In the midst of an opioid epidemic, these lids could deter young adults from stealing their parents’ prescription drugs for abusive purposes; or, it could help seniors to remember when they last took their medication.

The lids can also be…

Opioids Don’t Treat Depression, Yet People Turn to Them Anyway

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A man makes his way home from work on a bus as darkness falls on October 10, 2005 in Glasgow, Scotland. Photo by Christopher Furlong/Getty Images

Much of modern medicine does not consider emotions as a root cause of physical pain. It’s as if humans can divide bodies into psychology and neurology, handled by those respective disciplines, and turn to gastrointestinal specialists, cardiologists, and orthopaedic surgeons for fleshly concerns. While sometimes warranted this persistent division of mind and body is unfortunate.

While the cause of pain is not always apparent it’s also easy to misidentify the problem. Sometimes multiple issues converge in your body, each influencing the others. Instead of implementing a holistic yet scientifically credible approach to healing we remain caught in a hamster wheel of specialization. General physicians purposely overbook to maximize profits while minimizing time with each patient, sending them off to doctors who only treat one specific problem or, worse, whipping out a prescription pad before a proper diagnosis is rendered.

And now, with the promise of smart phone apps removing yet another layer of actual communication with doctors, self-prescription is becoming more prevalent. Since we’re not always adept at diagnosing our problems—“you’re your own best doctor” plays more like an excuse than medicine—and since we’re accustomed to a five minute chat before driving to the pharmacy, it turns out many people are treating emotional pain with opioids. As Olga Khazan reports at the Atlantic,

People with depression show abnormalities in the body’s release of its own, endogenous, opioid chemicals. Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery.

Relief offered by a temporary decrease in physical pain might lead to chronic problems, such as addiction and deeper depression, as some opioids have antidepressant properties, Khazan writes. On top of the initial problem a whole slew of tragic reactions begin to occur.

This comes during a time when pharmaceutical companies are being sued

The Opioid Epidemic Spurs the Search for Safer Painkillers

illustration of pills
BEYOND TODAY’S OPIOIDS The need for new medicines that soothe pain without risking addiction or overdose death is urgent. Safer opioids and alternative painkillers are getting closer to human studies.

Last year, Joan Peay slipped on her garage steps and smashed her knee on the welcome mat. Peay, 77, is no stranger to pain. The Tennessee retiree has had 17 surgeries in the last 35 years — knee replacements, hip replacements, back surgery. She even survived a 2012 fungal meningitis outbreak that sickened her and hundreds of others, and killed 64. This knee injury, though, “hurt like the dickens.”

When she asked her longtime doctor for something stronger than ibuprofen to manage the pain, he treated her like a criminal, Peay says. His response was frustrating: “He’s known me for nine years, and I’ve never asked him for pain medicine other than what’s needed after surgery,” she says. She received nothing stronger than over-the-counter remedies. A year after the fall, she still lives in constant pain.

Just five years ago, Peay might have been handed a bottle of opioid painkillers for her knee. After all, opioids — including codeine, morphine and oxycodone — are some of the most powerful tools available to stop pain.

Hitting opioid receptors in the peripheral nervous system keeps pain messages from reaching the brain. But opioids can cause problems by overstimulating the brain’s reward system and binding to receptors in the brain stem and gut.

opioid side effects in the brain and gut
FILO/ISTOCKPHOTO, ADAPTED BY L. LO

But an opioid addiction epidemic spreading across the United States has soured some doctors on the drugs. Many are justifiably concerned that patients will get hooked or share their pain pills with friends and family. And even short-term users risk dangerous side effects: The drugs slow breathing and can cause constipation, nausea, and vomiting.

A newfound restraint in prescribing opioids is in many cases warranted, but it’s putting people like Peay in a tough spot: Opioids have become harder to get. Even though the drugs are far from perfect, patients have few other options.

Many drugs that have been heralded as improvements over existing opioids are just old opioids repackaged in new ways, says Nora Volkow, director of the National Institute on Drug Abuse. Companies will formulate a pill that is harder to crush, for instance, or mix in another drug that prevents an opioid pill from working if it’s crushed up and snorted for a quick high. Addicts, however, can still sidestep these safeguards. And the newly packaged drugs have the same fundamental risks as the old ones.

The need for new pain medicines is “urgent,” says Volkow.

Scientists have been searching for effective alternatives for years without success. But a better understanding of the way the brain sends and receives specific chemical messages may finally boost progress.

Scientists are designing new, more targeted molecules that might kill pain as well as today’s opioids do — with fewer side effects. Others are exploring the potential of tweaking existing opioid molecules to skip the negative effects. And some researchers are steering clear of opioids entirely, testing molecules in marijuana to ease chronic pain.

Opioid action

Humans recognized the potential power of opioids long before they understood how to control it. Ancient Sumerians cultivated opium-containing poppy plants more than 5,000 years ago, calling their crop the “joy plant.” Other civilizations followed suit, using the plant to treat aches and pains. But the addictive power of opium-derived morphine wasn’t recognized until the 1800s, and scientists have only recently begun to piece together exactly how opioids get such a stronghold on the brain.

Opioids mimic the body’s natural painkillers — molecules like endorphins. Both endorphins and opioids latch on to proteins called opioid receptors on the surface of nerve cells. When an opioid binds to a receptor in the peripheral nervous system, the nerve cells outside the brain, the receptor changes shape and sets in motion a cellular game of telephone that stops pain messages from reaching the brain.

The danger comes because opioid receptors scattered throughout the body and in crucial parts of the brain can cause far-reaching side effects when drugs latch on. For starters, many opioid receptors are located near the base of the brain — the part that controls breathing and heart rate. When a drug like morphine binds to one of these receptors in the brain stem, breathing and heart rate slow down. At low doses, the drug just makes people feel relaxed. At high doses, though, it can be deadly — most opioid overdose deaths occur when a person stops breathing. And high numbers of opioid receptors in the gut — thanks in part to all the nerve endings there — can trigger constipation and sometimes nausea.

No matter how much I say I want to avoid opioids, half of my patients will get some kind of opioid. It’s just unavoidable.

Christopher Wu

Plus, opioids are highly addictive. These drugs mess with the brain’s reward system, triggering release of dopamine at levels higher than what the brain is used to. Gradually, the opioid receptors in the brain become less sensitive to the drugs, so the body demands higher and higher doses to get the same feel-good benefit. Such tolerance can reset the system so the body’s natural opioids no longer have the same effect either. If a person tries to go without the drugs, withdrawal symptoms like intense sweating and muscle cramps kick in — the body is physically dependent on the drugs. Addiction is a more complex phenomenon than dependence, involving physical cravings so strong that a person will go to extreme lengths to get the next dose. Long-term users of prescription opioids might be dependent on the drugs, but not necessarily addicted. But dependence and addiction often go together.

Despite their risks, opioids are still widely used because they work so well, particularly for moderate to severe short-term pain.

“No matter how much I say I want to avoid opioids, half of my patients will get some kind of opioid. It’s just unavoidable,” says Christopher Wu, an anesthesiologist at Johns Hopkins Medicine.

In the late 1990s and early 2000s, more doctors began doling out the drugs for long-term pain, too. Aggressive marketing campaigns from Purdue Pharma, the maker of OxyContin, promised that the drug was safe — and doctors listened. Opioid overdoses nearly quadrupled between 2000 and 2015, with almost half of those deaths coming from opioids prescribed by a doctor, according to data from the U.S. Centers for Disease Control and Prevention.

Story continues below graph

Opioid prescriptions rose in the United States throughout the 1990s and early 2000s. Physicians have begun to back off in the last few years.

U.S. prescriptions of opioid painkillers since 1992

Source: IMS Health

Opioid prescriptions have dipped a bit since 2012, thanks in part to stricter prescription laws and prescription registration databases. U.S. doctors wrote about 30 million fewer opioid prescriptions in 2015 than in 2012, data from IMS Health show. But restricting access doesn’t make pain disappear or curb addiction. Some people have turned to more dangerous street alternatives like heroin. And those drugs are sometimes spiked with more potent opioids such as fentanyl (SN: 9/3/16, p. 14) or even carfentanil, a synthetic opioid that’s used to tranquilize elephants. Overdose deaths from fentanyl and heroin have both spiked since 2012, CDC data reveal.

A sharper target

Scientists have been searching for a drug that kills pain as successfully as opioids without the side effects for close to a hundred years, with no luck, says Sam Ananthan, a medicinal chemist at Southern Research in Birmingham, Ala. He is newly optimistic.

“Right now, we have more biological tools, more information regarding the biochemical pathways,” Ananthan says. “Even though prior efforts were not successful, we now have some rational hypotheses.”

Scientists used to think opioid receptors were simple switches: If a molecule latched on, the receptor fired off a specific message. But more recent studies suggest that the same receptor can send multiple missives to different recipients.

The quest for better opioids got a much-needed jolt in 1999, when researchers at Duke University showed that mice lacking a protein called beta-arrestin 2 got more pain relief from morphine than normal mice did. And in a follow-up study, negative effects were less likely. “If we took out beta-arrestin 2, we saw improved pain relief, but less tolerance development,” says Laura Bohn, now a pharmacologist at the Scripps Research Institute in Jupiter, Fla. Bohn and colleagues figured out…

Columbia Professor: The War on Drugs Is a War on Race

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Every 25 seconds in the US, someone is arrested for drug possession. In Manhattan, black people—just 15% of the population—are 11 times more likely to be arrested on drug possession that white people.

For centuries Europeans drank—and for some today, drink—a lot of ale. Numerous accounts of polluted water in the 13th to 18th centuries abound, which apparently forced the citizens of London and Germany to drink plenty of alcohol—one entry from St. Paul’s Cathedral allowed for one bola (gallon) per person every day. Others claim that such an amount was unsustainable on the environment, if not the liver.

Whether or not the English and Germans drank a gallon a day, it is certain that beer was an integral part of daily life, especially in monasteries. While it was common knowledge that a little alcohol elevates the spirits, it certainly was not considered a drug. At least a portion of the water sources really were contaminated. Even if widespread pollution is a myth, who wouldn’t want to believe it true if the solution meant breakfast with ale?

Our beliefs about the substances we ingest has always dictated public attitude toward them. “Drug” is a relative term. Ayahuasca has long been medicine for the soul—advocates call it “grandmother medicine,” with the grandfather being peyote. Marijuana’s history as a Schedule One substance is much shorter than its common usage in numerous cultures. Substances that alter consciousness are usually deemed sacraments, not sacrilegious. That changed roughly 50 years ago from a policy perspective.

That attitude changed for the same reason that the idea of building a wall on our Mexican border persists: racism. Carl Hart, who chairs the Department of Psychology at Columbia University, recently stated that the war on drugs is simply a war on race. This is not mere speculation. Last year an interview was published with a former aide to Richard Nixon in which he stated the war on drugs was specifically waged to put down any chance of minority revolt.

Are America’s Anti-Drug Laws Scientific? Or Are They Colonialist and Racist? Maia Szalavitz

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Are America’s Anti-Drug Laws Scientific? Or Are They Colonialist and Racist?

M_szalavitz_hs

Maia Szalavitz

Author, “Unbroken Brain: A Revolutionary New Way of Understanding Addiction”

07:31

“Drugs” are simply chemical…