There have been convoluted discussions regarding the utility in providing educational awareness in how to reduce the risk in risky behavior. Needle exchange programs struggled to get off the ground for years.  Proponents supported disease prevention while increasing access to unused syringes without punitive legal ramifications.  Counterpoints have viewed such options as means to increase illicit substance abuse of those already exposed and to entice others in contemplation.  Data and the tincture of time have borne out the need for ongoing support with a multifaceted approach, incorporating strategies and stop gaps, not to derail well warranted public health initiatives.  “To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. (IV Drug Users). Such an approach incorporates a range of pragmatic strategies that address both drug use and sexual risk behaviors. One of the most important of these strategies is ensuring that IDUs who cannot or will not stop injecting drugs have access to sterile syringes." Refer to the CDC National Center for HIV, STD and TB Prevention Pharmacy Sales of Sterile Syringes December 2005.

Recently, there has been increasing urgency to make naloxone easier to obtain for the lay public.  To allow nonprescription pharmacy distribution, partnering with physician prescribing practices, and to be recognized as an imminent must-have, that will be a lifesaver for many.  This past fall, California Gov. Jerry Brown signed AB 1535, a naloxone bill drafted by Assemblyman Richard Bloom, D-Santa Monica, that is in effect as of Jan. 1, 2015, with like agreements in neighboring states, New York and Vermont.  “AB 1535 will have an immediate impact on reducing overdose deaths in California and will empower families throughout the state to access this lifesaving drug,” Assemblyman Bloom said. “The bill has received overwhelming support from my colleagues on both sides of the aisle. [Now] I am encouraged to seek out additional innovative policies aimed at ending our drug-overdose crisis.”  Refer to ACEP Now the Official Voice of Emergency Medicine, December 2014; Vol. 33, Num. 12

Several opiate overdoses, one DOA and other very poor outcomes, by only one clinician’s count since the last NHMS blog focused on this crisis just a few weeks ago, leaves no time to hesitate in making naloxone more accessible to the public.  The timeliest delivery of naloxone to a person with acute opioid overdose may be their saving grace.  Some of the more intense and refractory overdoses experienced are due to synthetic opioid analogues.  “Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is one of countless novel psychoactive substances that have emerged within the American and international drug scene within the last decade. Although some agents such as Salvia divinorum and Mitragyna speciosa are natural botanicals newly ‘discovered’ by entrepreneurs who package and market fortified versions of the plant product as a ‘legal high,’ the potentially most problematic novel psychoactive substances are newly introduced synthetic compounds such as acetyl fentanyl.” Refer to Annals of Emergency Medicine; December 2014, vol. 64, issue 6, page 637-639.  These overdoses can require 10 times or more the usual dose or a constant infusion of naloxone to achieve a sustained reversal of acetylfetanyl, particularly when there is delay in getting the patient to EMS personnel or a hospital.

Lastly, not enough providers are up to snuff on the impact or treatment of the newest and deadliest pharmaceuticals that evade FDA mandates.  Read ACEP Now The Official Voice of Emergency Medicine, December 2014; Vol. 33, Num. 12. P.4.

Spread the word, so more lives can be saved now! 


Lukas Kolm, MD, MPH

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