Monday, October 28, 2013

Saving Lives with Narcan

Saving Lives with Narcan
By Tessie Castillo

No one wants to be in a situation where the life of a friend is at risk. Unfortunately, for many people who use opiates such as heroin or prescription painkillers, this scenario is not uncommon. Louise, a drug user in central North Carolina, has been called on to save lives over more than 100 times.

Drug overdose is the leading cause of accidental death nationwide, surpassing even auto fatalities. The majority of these deaths are caused by opiates, which slow a person’s respiratory system to the point where he or she stops breathing. As Louise can attest, seeing someone overdose on opiates can be scary – blue lips, shallow, gargled breathing, clammy skin – but many people simply look asleep. These are the most dangerous overdoses, because the warning signs may come too late.

Calling 911 is the best response to an overdose. Unfortunately, studies it’s not the most common. Studies report that due to fear of law enforcement, witnesses to an overdose call for help less than half the time. , and instead they try “home fixes,” such as rescue breathing, which helps, or putting ice or cold water on the person, which does not.

“We read in the news that most police officers are not making arrests at the scene of an overdose, but that is not our truth,” says Louise. “I have never once heard of an overdose [in my area] where police treated it as a medication situation instead of a criminal one. This is a major problem for drug users. Their lives are devastated by the legal system. With a criminal record they can’t get jobs, housing, scholarships; the justice system invades every aspect of life. So they won’t call for help. It’s not that we don’t care about our friends [who overdose]. But nobody wants to be the person who called 911 and sent everyone to jail.”

Due to fear of police, many drug users they may try “home fixes” in the event of an overdose, such as placing ice on the person’s groin, putting them in a cold shower, injecting them with milk or salt water, or a number of other remedies that don’t actually work. The best way to help someone experiencing an overdose is to do rescue breathing (not CPR) and to administer naloxone, an antidote that reverses the effects of opiate overdose.

In April 2013 North Carolina passed a new law, the 911 Good Samaritan/ Naloxone Access law, to help save lives from overdose. The first part of the law grants limited immunity for possession of small amounts of drugs to anyone who experiences a drug overdose or calls 911 for help. The second part of the law removes liability from doctors who prescribe naloxone to patients and bystanders who administer the antidote to someone experiencing an overdose. It also allows community organizations such as the North Carolina Harm Reduction Coalition to distribute naloxone to people at risk for opiate overdose and their loved ones under the standing orders of a medical provider.

Changing state law by granting limited immunity from drug or paraphernalia charges to witnesses who call for help can go long way towards encouraging people to do the right thing. In the past two years, 10 states have passed 911 Good Samaritan laws that do just that. This year, 12 more are moving similar bills, including North Carolina.

“We read in the news that most police officers are not making arrests at the scene of an overdose, but that is not our truth,” says Louise. “I have never once heard of an overdose [in my area] where police treated it as a medication situation instead of a criminal one. This is a major problem for drug users. Their lives are devastated by the legal system. With a criminal record they can’t get jobs, housing, scholarships; the justice system invades every aspect of life. So they won’t call for help. It’s not that we don’t care about our friends [who overdose]. But nobody wants to be the person who called 911 and sent everyone to jail.”

The 911 Good Samaritan laws encourage people to call for help, but there is another option to reduce premature deaths from overdose. Narcan, or naloxone, is an antidote that reverses the effects of opioid overdose. Similar to the EpiPen for allergies naloxone, Narcan is simple to use, effective, and safe enough to be administered by people with no medical trainingnonmedical personnel. Paramedics have used it for years, but particularly in rural areas where emergency response may come too late, Narcan is becoming available to drug users and their loved ones. Louise has personally reversed over 30 overdoses.

“The first reversal was the scariest,” she said. “I got a call in the middle of the night from someone in a panic. I told her to call 911, but she wouldn’t because of police. I explained over the phone how to do rescue breathing while I drove to the house with Narcan. When I got there I found the guy [who had overdosed] lying on the floor, bluish and naked. They had put him in a cold shower to try and wake him up. I didn’t even know what drugs he had taken, and no one could explain it to me because they were all freaking out. I gave him a dose of Narcan and he started breathing again, but raspy, so I gave him more. Then we called 911 and I left. I found out later that he had woken up soon after. He really appreciated what I’d done for him.”

Nationwide, over 10,000 lives have been saved through distributing Narcan directly to people most affected and training them on how to recognize and respond to an overdose. Yet the practice is not without dissent. Opponents argue that if drug users have the antidote to an overdose, they will use more drugs. Fortunately, scientific facts and eyewitness accounts prove these claims false. Narcan puts a drug user into acute withdrawal. The experience is so unpleasant that no user would deliberately increase use because Narcan was close at hand. Giving stomach pumps to alcoholics won’t cause them to drink more, because no one wants his or her stomach pumped. No one wants to self-administer Narcan either.

“People don’t set out to overdose,” says Louise. “Having narcan makes no difference in whether you overdose, but it makes a huge difference in whether you live.”
NCHRC   //  PO BOX 13761, Durham, NC, 27709  //  336-543-8050   //

Cotton Fever by Dr. Jana Burson

I can only copy what is best that I see, and Dr. Jana Burson do not stay behind.

Cotton Fever

An addict still using heroin recently asked me what “cotton fever” was, and how he could tell if he was sick with it.
Cotton fever is caused by bacteria commonly found on cotton plants, initially named Enterobacter agglomerans, later changed to Pantoea agglomerans. Most intravenous drug addicts filter heroin through cotton filters, to remove particles that could clog both their injection needle and their veins. Sometimes fibers of cotton break off from the filter, carrying the bacteria with it. These bacteria in the bloodstream cause fever and chills, but in a healthy person, this usually resolves on its own. It’s rare to see it cause serious infection. However, doctors still recommend addicts with cotton fever seek medical care and receive appropriate antibiotics, due to possible impairment of their immune system brought about by intravenous drug use. (1)
At least one study isolated an endotoxin produced by this Enterobacter bacteria, so it’s possible that the fever is actually caused by this toxin released from the bacteria and not from an actual infection.
Enterobacter species, while found in feces of both animals and humans, are also found in the plant world. Usually, these bacteria aren’t a particularly vicious, which is why they rarely cause sepsis (overwhelming infection) unless the individual has an impaired ability to fight infection. In the 1970’s, some medical products (blood, IV fluids) were found to be infected with this species, and caused significant infections, but this was probably due to a large amount of the bacteria infused into patients.
Cotton filters become more fragile with use, so addicts using new filters probably have a lower risk of cotton fever. After cotton filters are used, they remain moist and can become colonized with all sorts of bacteria, especially if they are kept warm, as happens when they are stored in a pocket, close to the body. These bacteria can cause infection when injected. Cotton filters can transmit hepatitis C and possibly other infections, if they are shared with other drug users. (2)
Filters also retain some of the injected drug, making them of some value in the world of intravenous addicts. It’s considered a gesture of generosity to offer another addict your “cottons” because the addict will get some small amount of the drug. (3)
Even in view of all of the above, it’s still better to use a filter than to use unfiltered heroin. A new cotton cigarette filter has been shown to remove up to 80% of particulates in heroin, and reduces the risk of thrombosis of the vein from particles. Other makeshift filters are made from clothing, cotton balls, and even tissue paper.
Syringe filters are manufactured for medical and laboratory use. They can be designed to filter particles down to 5 micrometers. Besides being more expensive and difficult to obtain, studies show these filters retain more of the drug than other makeshift filters, making them less desirable to some addicts. (2)
Cotton fever itself usually isn’t fatal. The biggest challenge is knowing if the addict has cotton fever or something worse, like sepsis. Sepsis is an infection of the blood stream, and even heart valves can become infected, causing serious and life-threatening problems.
I asked a former IV drug addict about his experience with cotton fever.
Me: What does cotton fever feel like?
Former Addict: You get a fever that kind of feels like withdrawal. You know there’s something bad wrong, and you don’t know what to do about it. I’ve laid on the floor and thought I was going to die. A lot of times people get it when they’re rinsing, and that means they’re coming down anyway. When the dope got short and I was rinsing cottons, that’s when I got it.
Me: How long does it last?
FA: It seems like it lasts a long time, but the intensity is bad maybe an hour or two. You shake, you sweat; it feels just like the flu.
Me: Ever go to the hospital with cotton fever?
FA: No, no! (said emphatically) I was usually wanted by the police. Only time I went to the hospital is with severe trauma.
Me: I don’t understand what you mean by rinsing.
FA: Rinsing’s when you squeeze that last little bit of drug out of the cotton [filter]. You rinse the spoon and cotton with a little water. I would save all my cottons. That was my rathole for when the dope ran out. I would actually load the cottons into the barrel of a syringe then draw water in to the barrel of syringe, then squeeze until they were bone dry. I squirted that on to a spoon, and used a new cotton to draw that into a syringe.
Me: Why do you use cotton filters? Do you use it with every drug you injected?
FA: I used cotton to strain any dirt that may be in the product, that might get up in the syringe. I didn’t want no dirt. Didn’t have to be cotton. [If you don’t use a filter, you] shoot a bunch of trash up in yourself, and get trash fever.
I used an itty bitty cotton. Some people would use a quarter of cigarette butt. That was wasteful to me. It got too saturated, could hold too much residue, or dope.
I didn’t have to use cotton with quarter gram morphine or Dilaudid. Not enough trash to stop it up. If there’s trash in the syringe, I used a cotton.
Thankfully, this person has been in recovery from addiction for more than fourteen years.
Recovery is the best way to avoid cotton fever. You never have to go through that again.
1. Rollinton, F; Feeney, C; Chirurgi, V; Enterobacter agglomerans-Associated Cotton Fever, Annals of Internal Medicine 1993; 153(20): 2381-2382.
2. Pates, R; McBride, A; Arnold, K; Injecting Illicit Drugs, (Oxford, UK, Blackwell Publishing, 2005) pp. 41-43.
3. Bourgois, Phillippe; Schonberg, Jeff; Righteous Dopefiend,(Berkeley, California, University of California Press, 2009) pp8-9, 83-84.

34 YEARS the Feds. say nothing less than measurable proof of therapeutic success would be acceptable

From "Coping with Psychiatric and Psychological Testimony", by Dr. David Faust,  and Jay Ziskin

If this was quoted in 1979 to psychologist in the monthly magazine the monitor.  Why are all
the Federal Agencies continue to promote pseudoscientifically procedures?  Patients have the
right to know, and we should cause a big fuzz and write to the directors and chiefs of this
federal agencies.  Perhaps I will make a list of emails for you all to write to them.

This Evidence Based treatment have fallen in deaf ears. In fact the first record I find is
in the Chief of what is not SAMHSA back in the 1970, for those who are interested I find the
reference..... In fact I just found it. it was a Dr. Gerald Klerman, in 1979 wrote to the American
Psychiatric Association in APA's magazine The Monitor November 1979 page 9. quoted as
saying that nothing less than measurable proof of therapeutic success would be acceptable
to the government. "One can not demonstrate the efficacy of therapy in terms of the
"INTENTION OF ITS PROPONENT... never can a therapy can be consider routine and
acceptable on the basis of testimony of authorities... it goes on.

Here is the whole article. If you want a copy of the actual "The APA Monitor this article came out in November 1979 I will be glad to do so. Please email me at

Klerman Challenges Professions To Prove Therapy Works
Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) chief Gerald Klerman, addressing the annual meeting of the American Psychological Association in September, called on the mental health professions to take on the task of psychotherapy evaluation, noting that the promise of national health insurance and the consumer movement have led to a climate which demands more than custom as justification for reimbursement. Elaborating on an earlier speech in which he underscored the need,, to circumscribe legitimate mental health activity, Klerman told APA that nothing less-.than measurable proof of therapeutic success would be acceptable given the federal government's sizable and expanding role as a third-party payer. "We can attack the problem of defining boundaries in part by returning to the practical problem that many therapeutic methods are well intended; but poorly established in terms of safety, efficacy and economy. One cannot demonstrate the efficacy of a therapy in terms of the intentions of its proponents." "Neither can a therapy be considered routine and acceptable on the basis of the testimony of authorities--that is/ because outstanding •members of the profession are of the opinion that it is useful, safe and effective. I believe that only evidence as to outcomes will suffice in the rigorous climate of consumerism and health insuranc~ coverage."
Klerman pointed to the recently established National Center for Health Care Technology as a sign of the times. The center is currently evaluating 40 treatment methods for efficacy, including aversive drug treat- ment of alcoholism. "I view this as a possible prototype," Klerman said--"a 'shadow of the future.' Next year, evaluation of the efficacy of group treatment of family distress might be requested. Or of chlorpromazine for treatment of schizophrenia. Or Librium for sleep and anxiety." "The establishment of this center within a short time of the formation of the Health Care Financing Administration to tighten the federal reimbursement purse strings, in my view, makes it especially noteworthy," Klerman added. "As the federal third-party payer, HCFA dispenses dollars in the 'megabillion' range. It thus inevitably sets a tone which other reimbursers may follow." The public no longer accepts credentialing and licensure as sufficient guarantees of effective and safe service, Klerman said. "The new consumerism demands •a  new 10ok at these protections. It demands not just good training, but good services. It demands an evaluation not just of the state of the artist, but the state of the art .... If we don't respond, i~ will be brought upon us." W.H.

Please note that this article was written in 1979, that is over 34 years ago, and clinician continue to do their own thing and call it treatment.

Advice to Mental Health Clinicians (take it will you. Your patients lives depends on them

Advice for Mental Health Clinicians

Mark Willenbring, MD at Substance Matters: Science and Addiction - 2 weeks ago
A clinician recently sent me this email: *Dr. Willenbring,* * * *I read an article in the New York Times from early this year discussing Effective Addiction Treatment that in part highlighted your comments and Alltyr's mission to be a 21st century model for addictions treatment.* * * *As a therapist in an outpatient practice not specializing in addictions treatment--but who nevertheless encounters co-morbidity with substance abuse on a pretty regular basis--it can be confusing to know how to approach the psychosocial aspects of treatment. I believe in a multimodal approach for chron... more »

I also suggest that people read Drs. Scott O. Lilienfeld William T. O'Donohue  book
"GREAT IDEAS of Clinical Science: 17 Principles that Every Mental Health Professional Should Understand"

This two guys and others have been trying (I think some times in vain  but they are making some headway, to me just do not seem to be fast enough) to convince clinicians to become scientist first and then practitioners. Suggest you follow them and if you get existed start reading the references study in the back of the books.

I got mind use and very good condition from ABebooks (I don't get a toaster for announcing them, I do not care where you get the books  from)

Another one read by Scott is 

Brainwashed: The Seductive Appeal of Mindless Neuroscience [Hardcover]


too much rubbish being written about Neuroscience and this book ought to help you to be more critical about what is being said by Professionals who are extrapolating way beyond the data available.  I don't always agree with what they have to say but scoot specially is Definitely a clear thinker.