Narcan does not save lives. It is an inanimate substance that does nothing until a person activates it. And then the real life saving begins.
By now, most firefighters and medics have treated opioid overdose. We have learned how to measure the medication, how to administer it and how to use a bag-valve mask to keep the overdose victim oxygenated. It’s really quite simple mechanically, but the act of reviving a person who is seconds from death is far more profound.
Being the first person that a newly revived human being sees following a near-death experience is not an event to be taken lightly. The opportunity exists to be part of a person’s journey into sobriety, to be the gatekeeper between a life of misery or salvation, and to truly save a life, not just get the living dead breathing again.
Somebody whose existence was seconds away from being erased generally will not respond positively to chaos and condescending attitudes from people in uniform. The last thing they remember before seeing our faces is blissful serenity. My face will never be mistaken for anything resembling blissful, but my demeanor in the twilight between death and revival is always serene. I simply refuse to allow the magical moment when the addict rejoins the living to be wasted with ridiculous lectures, admonishments, arrogance or pity.
I have used Naloxone hundreds of times. The patients who woke up did so remorsefully; they were embarrassed and kind. Once, and only once, did the person who woke up attack me. Nobody ever threw up. Nobody complained that I took their high away. Nearly all looked to me for direction.
It wasn’t dumb luck, it was because I learned how to treat people, and I made sure I did my best to treat the person, not just the overdose.
5 ways to welcome an overdose patient back:
1. Get rid of the crowd.
Waking up from a near-death experience is traumatic enough; a dozen or more people staring down at you is a little overwhelming.
2. Lower the lights.
Bright lights hurt somebody whose eyes just opened.
3. Introduce yourself.
You are the only person who matters to the person in your care. Saying hello alleviates his or her anxiety considerably.
4. Explain exactly what happened, and what you did to reverse it.
Their high disappeared; the only thing that matters to them is getting high again. Now is the perfect time to introduce the idea of living clean as a real possibility.
5. Tell them your plan for staying clean and sober.
Don’t have a plan? Sure you do.
“We are taking you to the emergency room. It is crowded, loud and horrible. You have to stay there until medically cleared by a doctor who knows that the narcan we just gave you has a short life, and the possibility exists that you could OD again. You will probably just feel high again, but with any luck, and the right tools, that can be the last time you will want to. Tell your doctor, the nurse, the security guard, anybody who will listen the exact nature of what led you to the ER. Don’t hold back. There are people who care, and those people will do everything in their power to get you the help you need to get on with your life. And when you make the decision to get your life back, miracles will happen.”
It really is that simple. Of course it won’t work every time, or even most of the time, but what have you got to lose? An addict presents as an arrogant, self-destructive idiot more times than not, but who they really are inside is a lonely person in pain who needs somebody to talk to, and maybe understand.
It takes a while for the claws of the substances that take over the thoughts and dreams of a person to sink in, to grab hold and become the most important thing in their lives. People do not want to be addicts. They took a chance on feeling good and letting it go, but instead of a fleeting embrace of serenity find themselves overwhelmed with the need to continue ingesting the only thing that brings them peace.
Judging people who overdose, even those who do so again and again, is simply ridiculous. We as first responders have no idea what our patients have endured that has brought them to our care. Recognizing them as fellow human beings worthy of every bit of understanding, compassion and competence is just the beginning.
The overdosed patient presents us with ample opportunity to go far beyond our training, and to reach deep inside ourselves and find just how good it feels to be on the right side of the narcan.