The paramedic looked apologetic as he wheeled by. I understood why. A quick glance at the patient, a young man, intubated, with CPR being performed by an EMT, was long past CPR.
The family hustled into the ER right behind, tears and fear and resignation on their faces, but just a glimmer of hope as they caught my eyes. I tried not to raise that hope.
It was a familiar story. The young man might have had a bright future, but the familiar stuff (needle, syringe, candle, spoon, tourniquet) was there, at his bedside when the family got no response to the increasingly frantic knocks on his door.
He was not responsive, nor breathing, when they broke down the door, and a frantic call to 911, would bring the paramedics, but not for a while because they lived far out in the country. By the time the medic arrived, it had been a long time without breathing, and the obligatory line, intubation and naloxone got no response.
The staff shuffled the family off to do paperwork. We drew the curtain around and attached monitor leads more as a formality, but confirming a flat line, the only squiggles in the line when the sweaty EMT compressed the chest. I confirmed a stop was OK, and noted the time. The talk with the family, who had already accepted the sad truth, told a familiar story.
A new law has been passed that allows friends, family members, first responders, and law enforcement officers to be directly dispensed, prescribed or given standing orders for naloxone. The physician who does so in good faith is not subject to any liability or professional disciplinary action.
Allowing us to give family members, friends and first responders access to naloxone may save many lives. At least in the states where such laws have been passed, it seems to be true. Making naloxone available to drug addicts, friends, family and first responders seems to be a good step.
Fears that it will embolden addicts because an “easy” rescue is at hand don’t seem to bear out. The addiction is denied, they “know what they’re doing.”
But they do fear death. A young woman, every exposed vein on her body, a mass of scars, pleaded with me to find and extract the needle she had broken off in a scar because: “It might break get loose and kill me.”
I barely contained my laughter as I asked whether she thought she might kill herself sooner by injecting herself. Her response: “I know what I’m doing.” Asking her if she wanted help with her addiction, it was her turn to laugh as she said, “I’m not addicted, I can stop anytime.”
Many of the addicts who use naloxone did so for “friends” who had overdosed, saving them, because (I suppose), it’s not for me, because, “I know what I’m doing.”
The ones we don’t see, the ones where there is no family and friends have fled the scene when they go unconscious, leaving them to be discovered long past helping by the medics, may just be helped with the availability of naloxone.
And now we may see more of them. We can only hope that this time, they may accept the help they need to control their addiction, instead of being one that we don’t usually see, going straight to the morgue.
