Intra nasal naloxone
Myron Yaster MD
A day does not go by without a news story about opioid overdoses and record breaking opioid related deaths. In 2023 as in 2022, 2021, and 2020, the primary culprit is illegal fentanyl often disguised or mixed with other recreational drugs or in counterfeit looking legal opioids like oxycodone. Why fentanyl? It’s a lot easier to make and distribute than heroin. Indeed, I always wondered why it didn’t happen sooner. No poppy fields to cultivate, no clandestine manufacturing facilities, much easier to transport, and much much cheaper to produce.
In the 1980s I worked a lot with fentanyl in its powder, pre-dilution form in experiments to demonstrate its ability to produce “anesthesia” in newborns. It didn’t produce unconsciousness but if one defines MAC as immobility to surgical spramaximal painful stimulation it did…but at ver high doses. I asked the late Dr. Ted Stanley about this and he explained that it was in fact very difficult to kill mammals with opioids. They would continue to breath at very low rates and would often ‘look” dead because of rigidity. Hence carfentanil is the drug used when darting big game. Indeed, he also speculated that rigidity was a survival response…if an animal released endogenous opioids and became rigid, predators would not eat them!
Obviously, as we’ve learned all too well, fentanyl can kill humans. As readers of the PAAD know, I’ve been advocating for more widespread use, distribution, and availability of intranasal Naloxone. I think we should be coprescribing it with outpatient opioid prescriptions particularly in high risk patient groups like patients with sleep disordered breathing, teenagers, teenagers in the household etc. Additionally, I think we should ALL be carrying Intranasal Naloxone kits in our daily lives to resuscitate people we encounter outside of the hospital who have overdosed. Indeed, at the upcoming SPA MEETING we will have a booth to distribute Naloxone (and combat tourniquets) to all of the attendees. Further, in many locations Naloxone no longer requires a prescription. Many of you may want to know what you can do NOW. Dr. Bonnie Milas sent me this announcement that I am sharing with all of you. Myron Yaster MD
On the heels of a Philadelphia area accidental opioid OD in a 6-month-old infant, Dr. Kevin Osterhoudt will be speaking to local hospital staff. Dr. Osterhoudt is the medical director of The Poison Control Center and the section of clinical toxicology at CHOP. The link below can be used to register for this virtual presentation:
Thank you for registering for our "Recognizing and Treating Pediatric Opioid Overdose" webinar on February 14, 2023 at 8:00 am. Please use the information provided below to join the event.
Topic: Recognizing and Treating Pediatric Opioid Overdose
Time: Feb 14, 2023 08:00 AM Eastern Time (US and Canada)
Join Zoom Meeting
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Meeting ID: 857 7905 1123
Passcode: 051296
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You may also find the link below to Dr. Osterhoudt's prior discussion on the pediatric impact of the opioid crisis to be of interest.
https://open.chop.edu/courses/the-pediatric-impact-of-the-opioid-crisis-session-1/
The Pediatric Impact of the Opioid Crisis: Session 1 - CHOP OPEN
The Poison Control Center’s Opioid Assistance Resource (OAR) line is organizing a 4-part virtual webinar series focusing on prescribing, family and pediatric approaches to opioid use disorder (OUD) care, and the landscape of substance and opioid treatment in Philadelphia.
I hope this is helpful,
Bonnie Milas, MD