Too Many Die From Heroin

You know me – Little Miss Skeptical.

I would never give a baby a loaded gun to play with, and I would never give non-medically trained civilians syringes full of drugs with the intent of having them stab somebody directly in the heart and push the plunger.

You probably know what I’m talking about if you saw the movie “Pulp Fiction” – apparently about four people in the world have not.

If you are not one of those four, you probably remember the scene where John Travolta finds Uma Thurman comatose on the floor from an overdose of heroin.  In a great dramatic moment (I seem to remember music playing) he plunges the syringe with an antidote right through her breast-bone and pierces the heart, pumping the life-saving chemical into her.  Fortunately, she responds and seems none-the-worse for her ordeal.

In this movie, Mr. Travolta did NOT portray a doctor.  As I recall, he played a hit man.

In my experience, the patients of some doctors have about the same survival rate as victims of professional hit-men, but that is another blog post.

Back to real life — When I first learned that a certain county in California wanted to teach people to use Travolta-method “emergency kits” with syringes to treat overdoses of heroin — presumably with naloxone, the only drug I know of available that is a potentially lifesaving opioid antagonist — I was skeptical.  My first thought was that things could go wrong with injectables in the hands of civilians without adequate monitoring (i.e. – an MD or nurse).

Maybe, this idea was part of a continuing attempt to clip the wings of doctors who are perceived as over-trained and overpaid (by admittedly under-paid staff).

Only once in my life did I administer lifesaving naloxone to a patient who clearly needed it.  It was the smallest emergency room I have ever worked in — in northern France — and I was a green-if-gutsy medical student.  The man was a known heroin user and I could not do a decent job of rousing him from a coma.

I remember hitching him up to a monitor.  That is me — take the precautions, conservative in all ways known to me when human life is concerned.  I still think our life is the most precious thing we have.

I reported the vitals to a supervisor, who had no trouble authorizing the Narcan (le Narcan).  Years later I would prescribe it orally to patients who still had a decent liver, to help them get off alcohol.  But back then, I just hustled wand monitored and gave the injection as quickly as I could.

It only took a few seconds for the patient to awaken violently and punch me in the face.  Nothing was broken — I guess I have a pretty good startle reaction and withdrew quickly.  He lived, looked stable.  He was a laborer type about thirty and we got him into come kind of rehab and me into the on call room where I didn’t do much sleeping.

I hurt in the face but did not want any kind of pain pills.

And to answer the question that I know you are thinking – No – I had not yet seen “Pulp Fiction.”  This was years earlier when Mr. Travolta was still a “Sweathog.”

Those who know me know I am about as tender and loving as a doctor can be, so I don’t get attacked very much.  As a neurosurgical resident, a guy over 80 for whom I had ordered a benzodiazepine sleeping pill when a nurse had so requested over the phone took a swing at me in the morning.  A psychotic woman decked me when I first started seeing psychiatric patients.

Maybe I should have taken boxing lessons as a minor in college.

Curiously enough, nobody ever tried to deck me in all the time I worked in a prison setting, although my (by then, former) supervisor got a punch in the eye that caused him to lose that eye.  However, he was a more provocative type than I and I know some people supervised claimed that they had the same thoughts cross their minds.

So when I heard about this plan to arm the untrained staff with “Travolta Needles” I did what I always do when I hear something new relative to my profession.  I checked it out on the internet.

According to the most recent and accurate statistics I can find, an average of over 100 patients a day die from opiate (heroin and related drug) overdose in these United States.  Naloxone has a pretty safe profile.  It makes a lot of sense to make it available to people who actually come in contact with opioid patients.  I don’t care whether these ODs are from legal prescription drugs or illegal street drugs — they all kill and that’s all a doctor should worry about.

I have no personal knowledge or experience of the “training” that goes with using lifesaving emergency kits, so I cannot offer specific endorsements.  I hope it consists of more than simply screening the first scene of “Pulp Fiction.”  The state of Wisconsin is currently working to legalize the usage of this antidote by untrained civilians. But even without formal training, I am all for keeping people alive.  The risk of death with naloxone is negligible.  The risk of death from overdose if someone is slumbering into a coma and there is reason to believe that opioid overdose is the cause is — well, humongous.

Somewhere since Noah’s flood, when I was in training, opioids were fairly hard to get.  Since then, it seems like multiple federal government and state initiatives have urged doctors to be liberal in their treatments of those suffering from pain.  Statistics about deaths from this class of drugs only climb.

Usually a celebrity drug overdose is followed by a crackdown on the purveyors of the illegal drugs.

Reacting to an event like the recent death of acclaimed actor Philip Seymour Hoffman in this way makes more sense to me.

There are lots of ways to help folks who need it.

To give a shock, or a “twist ending” to this essay – I am coming down firmly on the side of giving the staffers in a clinic (who already have some type of training) these emergency kits for OD victims. I think Wisconsin is on the right track.  Let’s save folks in California, too – and all the other states.

An OD will kill somebody – so if a stab in the heart with an antidote has a chance of saving them, we will worry later about the propriety of licensing and certification of the practitioner.

Let’s just save lives!

THE END