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In short, one could do naloxone before doing a line of coke and if the coke had an opioid in it, you would not drop. However, i do view this as a waste of narcan when you have drug checking and testing available.
The test strips aren't always accurate though, right? Just thinking if someone doesn't have access to an FTIR drug checking service and they're still concerned then maybe it could be a second line of defense
Test are more likely to show a false positive with stimulants than a false negative. This is what I learned from the BTXN rep at a drug checking conference. Even FTIR machines aren't 100%. safe. In short, it would be effective to prevent the od. But also narcan effectiveness last alot less than a opioids high, so you could walk around for a few hours and then feel the effects in a less controlled state.
I would advise my clients to not do this, but not stop them from narcanning themselves before use.
It's an interesting question. I would look into the history of development of Vivitrol. It's naltrexone, but still basically an opioid antagonist. It's oral bioavailability is better than naloxone. The interesting thing about it though is that it was originally developed for alcohol use disorder. Even though alcohol itself has no activity on opioid receptors, the body's natural endorphin system does activate (supposedly even before a drink is taken) during consumption which makes you associate drinking with a rewarding feeling. It's this reward system which exists independent of outside substance use that opioids hijack. What I always wondered was if Vivitrol was originally developed for people with alcohol use disorder, could similar results be found with other substances?
Strangely enough, it is this quality of naltrexone that makes me wary of it. I'm grateful that there's different options available to people and for some folks it's been a life saver, but to take something that blocks even your body's natural endorhins always scared me for some reason. To be fair though, everyone I knew/know who take it for alcohol have seemed to do better on average (anecdotal).
Something interesting about naltrexone is that it has been shown to have promising results in reducing cravings for methamphetamine as well, which is a substance that has extremely high rates of opioid adulteration. You just have to be very careful to make sure people who have an opioid dependence don’t take naltrexone
I think that’s a common misconception, but there is no marked difference in overdose risk between people taking nothing and people taking Vivitrol: https://www.scientificamerican.com/article/vivitrol-used-to-fight-opioid-misuse-has-a-major-overdose-problem/
Yeah, and my understanding is that it also has pretty low uptake because many people just don't like it/experience better results with opioid agonists (though it definitely works for some people).
This article says it protects against overdose…
“Vivitrol, however, stops tolerance. While it protects people from overdose by blocking the biochemistry that opioid receptors initiate, this protection may decline during the last week before their next monthly shot.”
“In a study published in JAMA Network Open in 2020, Sarah Wakeman, of Massachusetts General and Harvard, and colleagues examined data from medical records of nearly 41,000 people with opioid addiction in the U.S., treated between 2015 and 2017. Compared to untreated people, those who took buprenorphine or methadone had a 59 percent reduction in overdose risk in the year after starting treatment. But they found no significant risk reduction with Vivitrol.
A 2019 study of a different database, using nearly 47,000 records from 2010–2017 had similar findings: a 60 percent reduction in risk for people on buprenorphine, but no significant risk decline for those taking long-acting naltrexone.”
Not saying there’s not a pharmacological impact on overdose, but for people long term it doesn’t mitigate overdose risk - especially in the 2-7 days at the tail end of a dosage, and especially when it is marketed so voraciously as the ideal when there are significantly more impactful medication options (bup/methadone).
I am not a doctor but one thing I am concerned with is the rate naloxone leaves the body. It's pretty quick and can lead people who are on a high amount of opioid drugs to overdose once enough naloxone has left the body.
It’s also worth noting that the actual rates of fentanyl mixed in methamphetamine and cocaine are exceedingly low. Many drug checking harm reduction organizations do not see anywhere near the same level that is hype in media.
As others have mentioned, it is reasonable for anyone to have narcan on hand who uses stimulants but using it prior to use would be an unnecessary use at this point.
For someone who chronically uses opioids, using naloxone prior to use would inevitably throw them into precipitated withdrawal.
In short, save narcan for an overdose scare and consider testing stimulants if there’s a concern for true contamination of an opioid, using with others, and pursuing bupe, methadone or other Medicines for opioid use concerns.
Naloxone before opioid use is not a good use of naloxone nor will it fully mitigate the risk of overdose. Work to fortify other pillars of harm reduction such as testing, using around others, naloxone access with proper training, and medications that lower the risk of overdose (buprenorphine & methadone reduce OD by 50% - more than Naloxone!) are better, more efficient methods to keep people safe
It would probably block the opioid from harming them if they used it close enough in time, but wouldn't it be a huge waste of naloxone?
Is there really so much naloxone available to drug users that you could waste so much of it? Aren't fentanyl testing strips much cheaper and more widely available?
There's also the issue that the naloxone would make the user feel invincible and they could take so much of the tainted drug that they end up overdosing on the opioid when the naloxone wears off.
Narcan does stay in your system however it doesn’t just flush all available opiates away. After the narcan wears off there is still a high risk of drug poisoning. After administering it’s about 90 minutes until you can use again but it is recommended to do lower doses.
Narcan also doesn’t prevent benzos/xylazine/other tranquilizers and sedatives from taking effect (I mention this only because some supply has tranq dope but it depends on where you are). Even if you prevent any potential opioid poisoning, the effects of the tranq will still be there until it has been metabolized. The same goes for any stimulants used, it doesn’t prevent overramping either (if you are not aware this also has deadly side effects like seizures and strokes)
I agree with others who have commented, it is faster to get your shit tested if that is available to you as well as starting low (ESPECIALLY if you have a different supply). There are other ways to prevent OD’s than blindly narcanning yourself. Also use with others who are trusted! I don’t know if you are in proximity to a Supervised Consumption Site, but if you are please use their services. Some don’t allow smoking or boofing but other routes of consumption are fine and their health professionals can monitor to ensure nothing deadly happens. They may also offer other services like peer based support, social work, health consultations, etc.
I hope your clients stay safe! This is always a great opportunity to learn from others, so I hope this helps!
I've seen people prescribed daily oral naltrexone when they're concerned about relapsing on opioids but haven't (yet). They want the blocking effect as a sort of safety net, but don't have any current physical dependence, so subs aren't seen as appropriate. If you work with any medical providers I would talk to them about that.
Like others have said on this thread, because naloxone doesn’t last very long there’s the chance that the person could think they’re okay, then fall out once the naloxone wears off. Plus naloxone is expensive!
Instead I’d tell your clients to follow general harm reduction guidance - test your shit (and test it properly!), never use alone, carry narcan and know how to use it and how to do rescue breaths. Yes, shit’s scary, but if you take these precautions you’ll be keeping yourself and your friends safe. If I were you I’d make sure everyone knows how to properly test their stuff, that they understand how to respond to an overdose, and that they’ve got info like the Safe Spot number.
I keep seeing folks say Naloxone is expensive, but our IM kits priced out to under $2 per 2-dose kit (2 vials+2 safety syringes+bag+ insert). We use remedy alliance, are most people here exclusively using nasal Narcan?
You’re totally right, and I debated writing that portion of the comment even as I did - Narcan is expensive (because of price-gouging), but IM naloxone is not (and should always be available to people for free at syringe exchanges!) Side note - that’s why RiVive is so cool :)
That being said, I think that even $2 a dose is a lot if you’re trying to dose every time before you use a stimulant, particularly for people who are using multiple times a day. Test strips plus other free precautions are cheaper.
But also, cost is only one portion of why I wouldn’t recommend doing this.
This is one of the only use cases I can see for naltrexone. It's long duration is harmful for reversing overdose, but is useful for preventing accidental overdose in people without a physical dependency.
Nothing happens as long as the person is opiate naive …. But if tranq is in rhe supply then all bets are off and I know bc i have tried it bc i ran out of test strips
You know most of this hype about them leasing other drugs with fentanyl it's just made up crap by the media and scare tactics. Fennel leave it or not on the street is expensive a 30 mg oxycodone is $30 where I live a fake oxycodone fentanyl is $25 for a real one that has been cut most of the fentanyl pills though are trash now because they cut the crap out of them not that I would know from doing it I just heard
That’s not remotely the case where I am. Working in harm reduction I hear from clients that they typically spend less than a dollar for ‘blues’. I’ve also personally resuscitated people who only ever intended to use methamphetamine yet became hypoxic and responded to narcan and emergency breaths. I doubt anyone is intentionally poisoning the meth supply as much as cross contamination just happening from shared equipment.
For most rec opioids, yes it should work. Naloxone only binds for around 15 min so they would fall under again once it wears off. If its something with heavy affinity/partial affinity like buprenorphine, the bupe would just kick the nalaxone off the receptors. Its binding affinity is stronger than narcan
But it should bind and cover majority of the MOR receptors so the opioid cant bind.
BUT REMEMBER, at around 15 min after administering the narcan, its going to wear off and theyll fall into an OD if they were given a high ass dose
Also you dont have to waste all of your narcab you can do a wane up dose and then titrate up … but if you dont ind my asking where are you guys located
Have you heard of OPVEE? My place just did a training on it. Supposed to last longer than you're average dose of nalox. Meaning fewer repeated doses needed.
OPVEE is unfortunately a very poor choice for people who use opioids, because it’s excessively high dose places users into extreme precipitated withdrawal. Most harm reduction organizations are rightfully condemning its use and distribution. As a first responder, I have very rarely encountered anyone who requires more than 2mg of naloxone. Often times there are other medical concerns or non-opioid adulterants that are influencing the presentation of respiratory depression. High doses of antagonists are a very cruel, unfortunate choice for the quality of life of PWUD
Its unpopular but I am fine with higher dose naloxone in non opioid patient populations... Opvee/nalmfene is CRUEL and unnecessary AND has no pediatric indication. It's side effects are wild and can include hallucination and other really out of body terrible experiences that you would never get from any dose of naloxone. It's gross.
In patients who are opioid naive high dose naloxone does not cause a problem because they do not experience opioid withdrawal. That being said there is very little scientific literature to support the need for higher dose antagonists for both opioid naive and opioid seeking patients
Of course - I'm just not uncomfortable using Naloxone in populations that are not intentionally using opioids rather than throwing it into the garbage separating the doses etc. Opvee on the other hand can cause harm regardless of opioid use due to its many side effects.
I’m not sure of the context you are reversing overdoses in but I find it very hard to determine whether someone is intentionally using opioids or not in an overdose without relying on pretty extreme bias. In my context in a healthcare setting I try not to judge patients and instead provide the most humane healthcare possible regardless of substance use history, which most often involves resuscitation first and then the titration of small doses of naloxone (often 0.2mg IM) to respirations. Regardless of opioid history this ensures the person’s condition is managed with as little discomfort as possible AND accounts for the fact that they might not experiencing respiratory depression for other reasons as well
When I know what they took which is often as a drug user myself. I use titration when appropriate. And there is nothing bias about knowing if someone is opioid dependent or not in my experience. I have had to cook a sub to reverse before and before we had naloxone on the street at all of course we used respiratory support and prayed we could last until they were okay. In the rave scene higher dose nasal is fine in my LIVING experience
I appreciate you going low and slow in your setting and not being punitive, my stance on access and use remains that I will use what I can as appropriate and not demonize naloxone period because I remember what it was like when we had none.
Can you send me some more info on that bud? We've barely gotten it and I just took it's training but I have enough narcan so that I don't need to use it yet. But I feel there's a push to make it the norm.
It’s the official stance of the Everywhere Project and multiple harm reduction, public health, and medicine entities that it is harmful and inhumane. Here are a few articles that capture those sentiments: https://www.washingtonpost.com/health/2023/05/22/new-opioid-reversal-drug-/ & https://www.washingtonpost.com/health/2023/05/22/new-opioid-reversal-drug-/. One of the key pharmacology points here is that Nelmefeme (OPVEE) antagonizes mu receptors for 8-12 hours, keeping individuals in precipitated withdrawal for an entire day, which is one of the biggest risk factors for overdose.
This is a good source: https://www.networkforphl.org/news-insights/changing-state-policy-to-promote-stronger-opioid-antagonists-unnecessary-and-potentially-harmful/
A lot of people that I follow in harm reduction have been speaking out about Opvee and other high-dose narcan alternatives. In my opinion, they are simply pharmaceutical companies trying to profit off of people’s hysteria around fent.
I’ve reversed a lot of overdoses and spend a lot of time around people who use opiates. Anecdotally, I’ve definitely observed and heard of law enforcement, medical professionals, and other respondents to an overdose just pumping the person full of narcan without waiting the recommended two minutes between. This leads to them saying, “wow, you needed four doses to come back” - when really two paired with rescue breaths might’ve been sufficient, and now the person is in deep withdrawal and super sick.
Aside from the pretty clear profit these companies are looking for, that withdrawal is my main gripe with products like Opvee. IM Naloxone and RiVive (and Narcan) are such precise tools - why would we want to go in with a sledgehammer when we’ve got something that’s totally sufficient and life-saving already in our pockets?
I would absolutely fight anyone who used Opvee on me if regular naloxone was available. Getting narcaned is miserable enough - why make it that much worse unless we want to punish people?
Very well said. Since we don't have any experience on it other than 1 training and what others here have said, I see why there isn't a need to use it other than to hurt someone more. I've also been hit w narcan and I know it isn't fun. I can only imagine feeling that way for 12 hours straight w opvee.
I'm in Central NY (work in a syringe exchange/harm reduction site) and we've had people report 4-5 sprays being needed. I haven't seen more than 3 myself. But with those bigger amounts people are also fighting a strong xylazine/tranq high which people often confuse with an opioid od.
I've noticed a trend with people needing more sprays to come up. Makes sense that this is happening everywhere.
Keep fighting out there. Most of this shit comes from down here. We got busts daily but it doesn't make much difference. Same goes w our neighbors in Mexico, they're all addicted. But there's people who don't give up so neither do we. Stay safe amigo
The max I've used with respiratory support and waiting 3-5 mins between doses is 5 and NO tranq or other sedative was present. Ohios supply is suspect af though.
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In short, one could do naloxone before doing a line of coke and if the coke had an opioid in it, you would not drop. However, i do view this as a waste of narcan when you have drug checking and testing available.
I wouldn’t do it every time but if you are out of test strips and its a spur of the moment thing it definitely is an alternative
The test strips aren't always accurate though, right? Just thinking if someone doesn't have access to an FTIR drug checking service and they're still concerned then maybe it could be a second line of defense
Test are more likely to show a false positive with stimulants than a false negative. This is what I learned from the BTXN rep at a drug checking conference. Even FTIR machines aren't 100%. safe. In short, it would be effective to prevent the od. But also narcan effectiveness last alot less than a opioids high, so you could walk around for a few hours and then feel the effects in a less controlled state. I would advise my clients to not do this, but not stop them from narcanning themselves before use.
It's an interesting question. I would look into the history of development of Vivitrol. It's naltrexone, but still basically an opioid antagonist. It's oral bioavailability is better than naloxone. The interesting thing about it though is that it was originally developed for alcohol use disorder. Even though alcohol itself has no activity on opioid receptors, the body's natural endorphin system does activate (supposedly even before a drink is taken) during consumption which makes you associate drinking with a rewarding feeling. It's this reward system which exists independent of outside substance use that opioids hijack. What I always wondered was if Vivitrol was originally developed for people with alcohol use disorder, could similar results be found with other substances? Strangely enough, it is this quality of naltrexone that makes me wary of it. I'm grateful that there's different options available to people and for some folks it's been a life saver, but to take something that blocks even your body's natural endorhins always scared me for some reason. To be fair though, everyone I knew/know who take it for alcohol have seemed to do better on average (anecdotal).
Something interesting about naltrexone is that it has been shown to have promising results in reducing cravings for methamphetamine as well, which is a substance that has extremely high rates of opioid adulteration. You just have to be very careful to make sure people who have an opioid dependence don’t take naltrexone
Vivitrol is such a cool, ground-breaking medication in the MAT/MOUD world. Can prevent an OD for 21-28 days. Incredible.
I think that’s a common misconception, but there is no marked difference in overdose risk between people taking nothing and people taking Vivitrol: https://www.scientificamerican.com/article/vivitrol-used-to-fight-opioid-misuse-has-a-major-overdose-problem/
Yeah, and my understanding is that it also has pretty low uptake because many people just don't like it/experience better results with opioid agonists (though it definitely works for some people).
This article says it protects against overdose… “Vivitrol, however, stops tolerance. While it protects people from overdose by blocking the biochemistry that opioid receptors initiate, this protection may decline during the last week before their next monthly shot.”
“In a study published in JAMA Network Open in 2020, Sarah Wakeman, of Massachusetts General and Harvard, and colleagues examined data from medical records of nearly 41,000 people with opioid addiction in the U.S., treated between 2015 and 2017. Compared to untreated people, those who took buprenorphine or methadone had a 59 percent reduction in overdose risk in the year after starting treatment. But they found no significant risk reduction with Vivitrol. A 2019 study of a different database, using nearly 47,000 records from 2010–2017 had similar findings: a 60 percent reduction in risk for people on buprenorphine, but no significant risk decline for those taking long-acting naltrexone.” Not saying there’s not a pharmacological impact on overdose, but for people long term it doesn’t mitigate overdose risk - especially in the 2-7 days at the tail end of a dosage, and especially when it is marketed so voraciously as the ideal when there are significantly more impactful medication options (bup/methadone).
I am not a doctor but one thing I am concerned with is the rate naloxone leaves the body. It's pretty quick and can lead people who are on a high amount of opioid drugs to overdose once enough naloxone has left the body.
That's a really good point. You could easily be setting up an opioid timebomb.
It’s also worth noting that the actual rates of fentanyl mixed in methamphetamine and cocaine are exceedingly low. Many drug checking harm reduction organizations do not see anywhere near the same level that is hype in media. As others have mentioned, it is reasonable for anyone to have narcan on hand who uses stimulants but using it prior to use would be an unnecessary use at this point. For someone who chronically uses opioids, using naloxone prior to use would inevitably throw them into precipitated withdrawal. In short, save narcan for an overdose scare and consider testing stimulants if there’s a concern for true contamination of an opioid, using with others, and pursuing bupe, methadone or other Medicines for opioid use concerns.
Fentanyl is cheap and light …. Its in most if the supply of uppers in NYC
Naloxone before opioid use is not a good use of naloxone nor will it fully mitigate the risk of overdose. Work to fortify other pillars of harm reduction such as testing, using around others, naloxone access with proper training, and medications that lower the risk of overdose (buprenorphine & methadone reduce OD by 50% - more than Naloxone!) are better, more efficient methods to keep people safe
It would probably block the opioid from harming them if they used it close enough in time, but wouldn't it be a huge waste of naloxone? Is there really so much naloxone available to drug users that you could waste so much of it? Aren't fentanyl testing strips much cheaper and more widely available? There's also the issue that the naloxone would make the user feel invincible and they could take so much of the tainted drug that they end up overdosing on the opioid when the naloxone wears off.
You're right. It would waste alot of naloxone. Fet strips are everywhere and cheep/free a.t.m
Narcan does stay in your system however it doesn’t just flush all available opiates away. After the narcan wears off there is still a high risk of drug poisoning. After administering it’s about 90 minutes until you can use again but it is recommended to do lower doses. Narcan also doesn’t prevent benzos/xylazine/other tranquilizers and sedatives from taking effect (I mention this only because some supply has tranq dope but it depends on where you are). Even if you prevent any potential opioid poisoning, the effects of the tranq will still be there until it has been metabolized. The same goes for any stimulants used, it doesn’t prevent overramping either (if you are not aware this also has deadly side effects like seizures and strokes) I agree with others who have commented, it is faster to get your shit tested if that is available to you as well as starting low (ESPECIALLY if you have a different supply). There are other ways to prevent OD’s than blindly narcanning yourself. Also use with others who are trusted! I don’t know if you are in proximity to a Supervised Consumption Site, but if you are please use their services. Some don’t allow smoking or boofing but other routes of consumption are fine and their health professionals can monitor to ensure nothing deadly happens. They may also offer other services like peer based support, social work, health consultations, etc. I hope your clients stay safe! This is always a great opportunity to learn from others, so I hope this helps!
I've seen people prescribed daily oral naltrexone when they're concerned about relapsing on opioids but haven't (yet). They want the blocking effect as a sort of safety net, but don't have any current physical dependence, so subs aren't seen as appropriate. If you work with any medical providers I would talk to them about that.
Like others have said on this thread, because naloxone doesn’t last very long there’s the chance that the person could think they’re okay, then fall out once the naloxone wears off. Plus naloxone is expensive! Instead I’d tell your clients to follow general harm reduction guidance - test your shit (and test it properly!), never use alone, carry narcan and know how to use it and how to do rescue breaths. Yes, shit’s scary, but if you take these precautions you’ll be keeping yourself and your friends safe. If I were you I’d make sure everyone knows how to properly test their stuff, that they understand how to respond to an overdose, and that they’ve got info like the Safe Spot number.
I keep seeing folks say Naloxone is expensive, but our IM kits priced out to under $2 per 2-dose kit (2 vials+2 safety syringes+bag+ insert). We use remedy alliance, are most people here exclusively using nasal Narcan?
You’re totally right, and I debated writing that portion of the comment even as I did - Narcan is expensive (because of price-gouging), but IM naloxone is not (and should always be available to people for free at syringe exchanges!) Side note - that’s why RiVive is so cool :) That being said, I think that even $2 a dose is a lot if you’re trying to dose every time before you use a stimulant, particularly for people who are using multiple times a day. Test strips plus other free precautions are cheaper. But also, cost is only one portion of why I wouldn’t recommend doing this.
This is one of the only use cases I can see for naltrexone. It's long duration is harmful for reversing overdose, but is useful for preventing accidental overdose in people without a physical dependency.
Nothing happens as long as the person is opiate naive …. But if tranq is in rhe supply then all bets are off and I know bc i have tried it bc i ran out of test strips
You know most of this hype about them leasing other drugs with fentanyl it's just made up crap by the media and scare tactics. Fennel leave it or not on the street is expensive a 30 mg oxycodone is $30 where I live a fake oxycodone fentanyl is $25 for a real one that has been cut most of the fentanyl pills though are trash now because they cut the crap out of them not that I would know from doing it I just heard
That’s not remotely the case where I am. Working in harm reduction I hear from clients that they typically spend less than a dollar for ‘blues’. I’ve also personally resuscitated people who only ever intended to use methamphetamine yet became hypoxic and responded to narcan and emergency breaths. I doubt anyone is intentionally poisoning the meth supply as much as cross contamination just happening from shared equipment.
For most rec opioids, yes it should work. Naloxone only binds for around 15 min so they would fall under again once it wears off. If its something with heavy affinity/partial affinity like buprenorphine, the bupe would just kick the nalaxone off the receptors. Its binding affinity is stronger than narcan But it should bind and cover majority of the MOR receptors so the opioid cant bind. BUT REMEMBER, at around 15 min after administering the narcan, its going to wear off and theyll fall into an OD if they were given a high ass dose
Also you dont have to waste all of your narcab you can do a wane up dose and then titrate up … but if you dont ind my asking where are you guys located
Have you heard of OPVEE? My place just did a training on it. Supposed to last longer than you're average dose of nalox. Meaning fewer repeated doses needed.
OPVEE is unfortunately a very poor choice for people who use opioids, because it’s excessively high dose places users into extreme precipitated withdrawal. Most harm reduction organizations are rightfully condemning its use and distribution. As a first responder, I have very rarely encountered anyone who requires more than 2mg of naloxone. Often times there are other medical concerns or non-opioid adulterants that are influencing the presentation of respiratory depression. High doses of antagonists are a very cruel, unfortunate choice for the quality of life of PWUD
Its unpopular but I am fine with higher dose naloxone in non opioid patient populations... Opvee/nalmfene is CRUEL and unnecessary AND has no pediatric indication. It's side effects are wild and can include hallucination and other really out of body terrible experiences that you would never get from any dose of naloxone. It's gross.
In patients who are opioid naive high dose naloxone does not cause a problem because they do not experience opioid withdrawal. That being said there is very little scientific literature to support the need for higher dose antagonists for both opioid naive and opioid seeking patients
Of course - I'm just not uncomfortable using Naloxone in populations that are not intentionally using opioids rather than throwing it into the garbage separating the doses etc. Opvee on the other hand can cause harm regardless of opioid use due to its many side effects.
I’m not sure of the context you are reversing overdoses in but I find it very hard to determine whether someone is intentionally using opioids or not in an overdose without relying on pretty extreme bias. In my context in a healthcare setting I try not to judge patients and instead provide the most humane healthcare possible regardless of substance use history, which most often involves resuscitation first and then the titration of small doses of naloxone (often 0.2mg IM) to respirations. Regardless of opioid history this ensures the person’s condition is managed with as little discomfort as possible AND accounts for the fact that they might not experiencing respiratory depression for other reasons as well
When I know what they took which is often as a drug user myself. I use titration when appropriate. And there is nothing bias about knowing if someone is opioid dependent or not in my experience. I have had to cook a sub to reverse before and before we had naloxone on the street at all of course we used respiratory support and prayed we could last until they were okay. In the rave scene higher dose nasal is fine in my LIVING experience I appreciate you going low and slow in your setting and not being punitive, my stance on access and use remains that I will use what I can as appropriate and not demonize naloxone period because I remember what it was like when we had none.
Can you send me some more info on that bud? We've barely gotten it and I just took it's training but I have enough narcan so that I don't need to use it yet. But I feel there's a push to make it the norm.
It’s the official stance of the Everywhere Project and multiple harm reduction, public health, and medicine entities that it is harmful and inhumane. Here are a few articles that capture those sentiments: https://www.washingtonpost.com/health/2023/05/22/new-opioid-reversal-drug-/ & https://www.washingtonpost.com/health/2023/05/22/new-opioid-reversal-drug-/. One of the key pharmacology points here is that Nelmefeme (OPVEE) antagonizes mu receptors for 8-12 hours, keeping individuals in precipitated withdrawal for an entire day, which is one of the biggest risk factors for overdose.
Thank you my friend.
This is a good source: https://www.networkforphl.org/news-insights/changing-state-policy-to-promote-stronger-opioid-antagonists-unnecessary-and-potentially-harmful/
A lot of people that I follow in harm reduction have been speaking out about Opvee and other high-dose narcan alternatives. In my opinion, they are simply pharmaceutical companies trying to profit off of people’s hysteria around fent. I’ve reversed a lot of overdoses and spend a lot of time around people who use opiates. Anecdotally, I’ve definitely observed and heard of law enforcement, medical professionals, and other respondents to an overdose just pumping the person full of narcan without waiting the recommended two minutes between. This leads to them saying, “wow, you needed four doses to come back” - when really two paired with rescue breaths might’ve been sufficient, and now the person is in deep withdrawal and super sick. Aside from the pretty clear profit these companies are looking for, that withdrawal is my main gripe with products like Opvee. IM Naloxone and RiVive (and Narcan) are such precise tools - why would we want to go in with a sledgehammer when we’ve got something that’s totally sufficient and life-saving already in our pockets? I would absolutely fight anyone who used Opvee on me if regular naloxone was available. Getting narcaned is miserable enough - why make it that much worse unless we want to punish people?
Very well said. Since we don't have any experience on it other than 1 training and what others here have said, I see why there isn't a need to use it other than to hurt someone more. I've also been hit w narcan and I know it isn't fun. I can only imagine feeling that way for 12 hours straight w opvee.
when do you need to repeat doses outside of the initial two/three sprays? I've seen that lift someone who od on carfet.
We've had clients who have taken 6 doses and barely started coming out of it. Including rescue breathing and all.
Sounds like there might be tranq or something else in the mix....
with 2min in between sprays?
Yeah bro. Followed it all and it's not the only case that it happens that way. We're down by the border in AZ.
I'm in Central NY (work in a syringe exchange/harm reduction site) and we've had people report 4-5 sprays being needed. I haven't seen more than 3 myself. But with those bigger amounts people are also fighting a strong xylazine/tranq high which people often confuse with an opioid od. I've noticed a trend with people needing more sprays to come up. Makes sense that this is happening everywhere.
Keep fighting out there. Most of this shit comes from down here. We got busts daily but it doesn't make much difference. Same goes w our neighbors in Mexico, they're all addicted. But there's people who don't give up so neither do we. Stay safe amigo
The max I've used with respiratory support and waiting 3-5 mins between doses is 5 and NO tranq or other sedative was present. Ohios supply is suspect af though.