Narcan in possible illegal drug use?

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Friday in the ER we had a Pt come in with an alcohol level of 499. He was unconcious and we intubated. Pupils were equal and reactive. The Dr ordered Narcan 0.4 mg IV now. I thought I remember something about not giving Narcan if it is illegal drugs the Pt is on but I cant remember. Help? (The reason he wanted the Narcan was the Pt is a known drug user, crack I think)

Jessica

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Depends more on the class of drug and the pt's condition - not necessarily a matter of legal vs. illegal. Especially in the prehospital setting, we tend to reserve Narcan for cases involving opioid (heroin, morphine, etc) overdose with respiratory depression. It can violently precipitate withdrawal in narcotic-addicted pts (or in babies of narcotic-addicted moms), whether the narcotic was legal or not.

Narcan is unlikely to help a patient on crack, but there is a possible benefit if the patient had also taken an opioid. There has been some research into its role in alcohol poisoning and, interestingly, in refractory shock as well.

Here's a link to get you started:

http://eilat.sci.brooklyn.cuny.edu/newnyc/DRUGS/Naloxone.htm

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not too long ago a nurse i knew who worked in the va er was presented with a pt everyone who was with him was scraming that he had overdosed [i don't knowwhat is was] anyway she got him converted and he was breathing with a pulse in time for etms to move him to civilian hospital

in an emergency i don't see why a legal drug would be illegal

don't know about its effect with alsohol

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Specializes in ICU, ER.

In our ER we almost always give narcan to an unconscious person. There is always a chance they OD'd on a legal or illegal opiate, and narcan rarely does any harm and often saves a life.

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Specializes in Oncology/Haemetology/HIV.

Actually, narcan is often given if they ARE on illegal drugs, if they are opiates. However, as it reverses the effects of opiates, using it to reverse crack or alcohol would not work.

Many places upon receiving a patient, unconscious from unknown cause, with any possible suspicion of drug abuse, will give narcan. Along with the usual check of blood glucose/D50W injection. Narcan is unlikely to harm (other than killing an addicts "buzz" and sending them into serious withdrawal) and may help. There are few situations where it is not indicated, but the use of illegal drugs generally would not be one of them.

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It is also a way to differentiate between a barbiturate OD vs an Opioid OD. Narcan won't reverse a barbiturate OD.

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Specializes in Emergency & Trauma/Adult ICU.

Agree with above posts - presented w/an unconscious patient, blood sugar check and administration of Narcan are the first interventions.

OP, Naxolone (Narcan) is an opioid antagonist, given when possible opioid overdose is suspected. "Overdose" effects of respiratory depression and over-sedation are essentially the same whether caused by street heroin or even properly prescribed analgesics.

Narcan has no bearing on ETOH, crack, or any other non-opiate.

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Thanks for all the great responses. So now that I know it is indicated, do you guys usually give a full 2 mg dose?

Jessica

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Generally speaking, Narcan works on opioid overdoses.

One should use extreme caution in narcotic-dependent patients as may cause severe withdrawal s/s such as sudden hypertension, tachycardia, cardiac dysrhythmias, and seizure activity.

One may find oneself in a predicament: Treat the respiratory depression and risk tachyarrhythmia or risk respiratory arrest.

Initially, one should administer 1/2 the "normal" Narcan dose; just to adequately improve respiratory status. Goal is not to suddenly precipitate withdrawal s/s. Then, repeat doses of Narcan slowly if necessary.

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Specializes in Nephrology, Cardiology, ER, ICU.

Another thing to mention is that its not like street drugs come with an ingredient label. Many times our patients take what they think is heroin only to find it laced with fentanyl with deadly results.

Narcan is usually on the protocol for altered level of concsiousness.

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Specializes in Emergency & Trauma/Adult ICU.
Thanks for all the great responses. So now that I know it is indicated, do you guys usually give a full 2 mg dose?

Jessica

I've learned to start small - usually 0.4mg at first. That amount will often be enough to produce some arousal to confirm that you are indeed dealing w/opiate overdose, without producing the fully-awake, pissed-off-that-you-ruined-their high uncontrollable patient. Or wiping out all of the analgesia from an elderly patient w/severe chronic pain who put on one too many Duragesic patches.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Give it slowly and in small doses. I start out at 0.1 mg and repeat in increments of 0.1 mg. - 0.4 mg.

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