NALOXONE (“Narcan”) IS INSUFFICIENT TREATMENT FOR OPIOID USE DISORDER

To follow up on the letter of Abigail Tapper, MPH, that appeared in the July/August issue of Hadassah Magazine, she correctly recommends the availability of injectable naloxone (“Narcan”) to those who have regular contact with opioid users who are at risk for fatal opiate overdose. Naloxone saves lives because it immediately reverses the potentially fatal respiratory depression that opioid overdose causes. This is, of course, most laudable.

Tapper does not mention, however, that after every dose of naloxone there is still more immediate work that is necessary to save the recipient. The reason is that soon after its dramatic life-saving effect, naloxone always precipitates in the chronic opioid user an acute opioid withdrawal state that is generally intolerable to the user. The just-rescued victim now craves— insists upon, actually— an immediate opioid fix to attenuate the withdrawal.

Therefore, the recommendation is that every recipient of naloxone go promptly to an emergency room to begin medication assisted treatment for opioid use disorder. The initial treatment ideally should consist of buprenorphine (“Suboxone”) or methadone in an in-patient setting, with provisions also to begin right away a program of intense psychosocial counseling combined with the maintenance medication— the real treatment regimen for opioid use disorder.

Unfortunately, many-- perhaps most opioid users-- reject this recommended transition to proper treatment, either because they have no means to pay for it or they prefer to return to their previous pattern of illicit use, regardless of the risks. (It is ironic that there are many instances of opioid overdose death within just hours of naloxone rescue.)

Naloxone is, therefore, only a temporizing measure. It plays very little role in treatment or prevention. It is not an entity that combats addiction. Other entities are; but, sadly, access to these remains woefully limited relative to the need.

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© 2016 Eli Goodman, M.D.
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