OTC treatment for opiate overdose?

[Sentience]

Not an urgent question fortunately. Just curious. What medicines or remedies might be found in a persons medicine cabinet that can be used to help someone who accidentally overdosed on opiates? I was thinking caffeine would fight the nod and increase heart rate and breathing but then I remembered that it increased the activity of opiates. Is it a beneficial trade off or not? Assuming someone is having respiratory depression and slowed heart rate. What else can be used?

This is of course not a replacement for calling 9-11, just something you can do in the meantime when help is a ways away.

 

[djsim]

This is of course not a replacement for calling 9-11, just something you can do in the meantime when help is a ways away.

You answered your own Q
There is no substitute for professional medical help (ie paramedics, ER), other than perhaps vials of naloxone, which are only distributed in a few parts of the world to IDUs.

Caffeine won't do a fucking thing when you consider a lot of BLers would be able to snort a line of speed then take a nap before a Thanksgiving dinner. I can see what you're asking, but your efforts are misguided; it reminds me of this girl who died a few yrs ago here in Melbourne from a GHB overdose in the carpark of a techno club (PHD for those curious melbournites) b/c the people with her thought they could revive her by rubbing speed in her nose and making her chew ecstasy pills (erm, ppl, how's she gonna swallow em? 8))

CPR is the 2nd best thing to do; naloxone im is the best option, but only when you have vials suitable for IM injection (ie don't grind up suboxone). Also it should be IM b/c looking for a vein is going to waste time.

 

[Sentience]

I admit I am completely ignorant here and dont claim otherwise. If I sound naive its because I am, but I am here to remedy that. So there isnt anything at all that can help fight off an OD even before the person looses consciousness? An amphetamine or stimulant wont help?

It sounds like Nalexone is a good thing to have on hand....


Oh yeah, I have a prescription for Low Dose Naltrexone....take 20 of those and you have a real dose. I forgot I even had those. I bet those could be effective IF the person was awake enough to swallow them...Choking hazard?

 

[Cane2theLeft]

Naltrexone will rip opiates off the receptors like naloxone but it lasts FAR longer and that's why it isn't used in emergency settings when naloxone is available.

I read a report a while ago here on bluelight of an opiate addict whose father was a physician and knew about his previous use of opiates. Instead of giving him a random piss test at one point, he gave him a naltrexone pill (I want to say 50mg but don't quote me) which sent him into godawful precipitated withdrawal for quite some time and there was basically nothing he could do about it.

They also use naltrexone in ultra-rapid detox and of course there is a reason they knock the patient out while the naltrexone is being administered. So, if it came down to it, I believe it could help someone who is overdosing but it would probably be pretty torturous if that person is physically dependent at least.

I don't know a whole lot about this subject, so if I am incorrect at all here please someone correct me.

I've also heard about some locations training people to be able to administer intranasal naloxone... can anyone comment about that? (sorry to hi-jack)

 

[jd0t]

.

/snip

I can see what you're asking, but your efforts are misguided; it reminds me of this girl who died a few yrs ago here in Melbourne from a GHB overdose in the carpark of a techno club (PHD for those curious melbournites) b/c the people with her thought they could revive her by rubbing speed in her nose and making her chew ecstasy pills (erm, ppl, how's she gonna swallow em? 8))

/snip

...Wow. And people wonder why I hate a majority of people. That is just... I don't even know what to think of that. But, out of curiosity, was anybody charged with anything for the... negligence?

/sorry to go off topic.

 

[djsim]

...Wow. And people wonder why I hate a majority of people. That is just... I don't even know what to think of that. But, out of curiosity, was anybody charged with anything for the... negligence?

/sorry to go off topic.

She was a nurse IIRC and her parents said something to the effect of "she wasn't involved in drugs", but honestly, anyone who is clubbing on a Sunday morning/afternoon at Pure Hard Dance (PHD is one of those hard house clubs that caters to people who aren't ready to stop partying by Sunday) then there's no chance you're there sober. No chance. Think trance clubs circa 1999 where people were hanging off the rafters grinning w/ pacifiers... so yeh, she wasn't "at the wwrong place at the wrong time" as her parents made out (poor people ).

In the hard house scene GHB was (is??) a real scurge (IIRC one time ~30 people OD'd at a God's Kitchen night). The real issue was that anyone familiar with GHB users know that its pretty common to pass out on G and often they pull thru... I knew people who'd pass out every fucking weekend! So yeh, obviously these guys thought as OP did; stimulants would wake her.

In answer to your Q: don't remember whether someone was charged or not. I think they went to court over it, but I dont remember the outcome

 

[djsim]

She was a nurse IIRC and her parents said something to the effect of "she wasn't involved in drugs", but honestly, anyone who is clubbing on a Sunday morning/afternoon at Pure Hard Dance (PHD is one of those hard house clubs that caters to people who aren't ready to stop partying by Sunday) then there's no chance you're there sober. No chance. Think trance clubs circa 1999 where people were hanging off the rafters grinning w/ pacifiers... so yeh, she wasn't "at the wwrong place at the wrong time" as her parents made out (poor people ).

In the hard house scene GHB was (is??) a real scurge (IIRC one time ~30 people OD'd at a God's Kitchen night). The real issue was that anyone familiar with GHB users know that its pretty common to pass out on G and often they pull thru... I knew people who'd pass out every fucking weekend! So yeh, obviously these guys thought as OP did; stimulants would wake her.

In answer to your Q: don't remember whether someone was charged or not. I think they went to court over it, but I dont remember the outcome

actually, she accidentally drank from a "water" bottle in the car and OD'd, so maybe she was kind of new to the whole scene... ya know, that makes it worse now I think of it; someone ODs on your drugs by accident and then you don't call 000 (911) b/c you're worried about what..? Your own ass?! 8)

This actually brings me to a good point; can any BLer honestly say they'd understand if their friend didn't call 911 if they ODd b/c they were worried about themselves? Of course not. Play the game and you get burned -- always call 911 for an OD. In most instances police wont be involved anyway (except maybe in texas or some backwards US backwater urgh)

 

[KnowBudz]

This question is like asking for an OTC remedy for a heart attack. Its a life and death matter that demands immediate intervention. The show "Trauma, Life in the ER" on DiscoveryHealth the other night showed a guy who OD'd on fentanyl. His "friends" stuck him a bathtub full of ice water. That kind of insanity nearly cost him his life.

 

[danalprazolam]

You can run in a gas station and chug a energy drink. If your lucky enough to start odin'g infront of one. And dont pass out before you get in there.

 

[dogfood]

actually, she accidentally drank from a "water" bottle in the car and OD'd, so maybe she was kind of new to the whole scene... ya know, that makes it worse now I think of it; someone ODs on your drugs by accident and then you don't call 000 (911) b/c you're worried about what..? Your own ass?! 8)

This actually brings me to a good point; can any BLer honestly say they'd understand if their friend didn't call 911 if they ODd b/c they were worried about themselves? Of course not. Play the game and you get burned -- always call 911 for an OD. In most instances police wont be involved anyway (except maybe in texas or some backwards US backwater urgh)

also if you are worried about police just say you think they had a heart attack. heart attacks and drug overdoses are treated with the same priority, and when the paramedics get there they will figure out real quick its a drug overdose even if you don't tell them.

 

[Sentience]

This question is like asking for an OTC remedy for a heart attack. Its a life and death matter that demands immediate intervention. The show "Trauma, Life in the ER" on DiscoveryHealth the other night showed a guy who OD'd on fentanyl. His "friends" stuck him a bathtub full of ice water. That kind of insanity nearly cost him his life.

Poor example. There ARE OTC remedies for a hear attack.

Please dont flame me for being clueless. Thats what I am here for. Even if there are not any OTC remedies, I think this thread has value in educating people who think there are.....and if there were, this is the place to discuss them.

What if somebody just barely overdosed, not like comatose but still bad off? Is there anything that can slightly lessen the effects?

 

[Captain.Heroin]

What if somebody just barely overdosed, not like comatose but still bad off? Is there anything that can slightly lessen the effects?

No. Caffeine might reduce some of the extreme sedation, but it'll do nothing to reduce how high you are and it won't lessen "all" of the effects.

There are no OTC opiate antagonists AFAIK.

 

[Dankycodone]

In my country narcan is otc as no one will call the police in case of an od because everyone will be serched drug tested and arrested so in case of an od u run to the nearest pharmacy and get narcan but i would still call an ambulence and try running.

 

[TheDankaholic]

You answered your own Q
There is no substitute for professional medical help (ie paramedics, ER), other than perhaps vials of naloxone, which are only distributed in a few parts of the world to IDUs.

Caffeine won't do a fucking thing when you consider a lot of BLers would be able to snort a line of speed then take a nap before a Thanksgiving dinner. I can see what you're asking, but your efforts are misguided; it reminds me of this girl who died a few yrs ago here in Melbourne from a GHB overdose in the carpark of a techno club (PHD for those curious melbournites) b/c the people with her thought they could revive her by rubbing speed in her nose and making her chew ecstasy pills (erm, ppl, how's she gonna swallow em? 8))

CPR is the 2nd best thing to do; naloxone im is the best option, but only when you have vials suitable for IM injection (ie don't grind up suboxone). Also it should be IM b/c looking for a vein is going to waste time.

This is ALL you need to know really. Working in an ER everyday I've seen a lot of FOOLISH simply FOOLISH attempts at at home remedies for an Opiate overdose and they all almost end up doing more damage than good. Just a week ago they brought in a gentleman who was not only OD'd but in hypothermia now because his friends put him in an Ice bath because they heard it would reverse a heroin overdose (old wise tale) & they ended up putting him into more danger because they dropped his body temperature so low he came in with hypothermia & was still passed out from his OD.

Naloxone was used and he came right out of it & we spent the next hour packing huge blankets around him & heat lamps trying to get his body temperature back up. It was a huge mistake on there part and they almost killed him because of it. He was shaking uncontrollably from it when he woke up from the Naloxone. Took well over an hour to get it under control. Scary shit! I really wasn't sure if he was going to make it when they brought him in.

Just call 911 as there is NO substitute for properly trained medical professionals when an OD occurs with opiates.

CPR is the 2nd best thing to do; naloxone im is the best option, but only when you have vials suitable for IM injection (ie don't grind up suboxone). Also it should be IM b/c looking for a vein is going to waste time.

Everyone seems to know about a month ago I was hospitalized again for about 19 days & placed on a PCA pump of Dilaudid like usual. Well everytime they refilled my PCA (which was a few times a day) they have to bring in a bottle of Naloxone to place on the counter in case of emergency as part of normal hospital rules.

Well i had a lazy nurse on day 4 & 5 and she had brought in over 9 vials of Naloxone without ever removing one at the end of the day and just left them out in the open. Being the person I am and knowing there rules I swiped 3 of them & was never even asked about them at shift change when the new nurse came in and removed the 6 vials sitting on the counter still. I know it was wrong but i knew no one was going to get in trouble for it & they basically were just going to be written off as an error.

So I actually have 3 Naloxone vials at home in case of emergency. I think they should provide them at the needle exchange anyways and don't. So being an RN & knowing the proper use and effects of administering Naloxone if someone OD'd at my house I'd gladly give them a IM Naloxone shot & then call 911 afterwords for continued treatment of the OD. I'll definitely save my friends life first and give them an IM shot though rather than wait for the ambulance while they suffocate. I'm actually really happy to have 3 Naloxone vials for an emergency.

I've even taught my fiance how to properly use them in an emergency if something were to ever happen to me even though I only IV my Dilaudid when my pains really bad. Emergencies happen & it's good to know they are at my disposal & I won't be waiting for the ambulance if I OD.

 

[Captain.Heroin]

it's good to know they are at my disposal & I won't be waiting for the ambulance if I OD.

I couldn't agree more. They should be at exchanges. The exchange I was going to said they were going to get naloxone, then they said that it's a prescription drug so they can refer you to a doctor for a prescription. 8)

It's a damn shame they don't give out naloxone at exchanges.

 

[dogfood]

So I actually have 3 Naloxone vials at home in case of emergency. I think they should provide them at the needle exchange anyways and don't. So being an RN & knowing the proper use and effects of administering Naloxone if someone OD'd at my house I'd gladly give them a IM Naloxone shot & then call 911 afterwords for continued treatment of the OD. I'll definitely save my friends life first and give them an IM shot though rather than wait for the ambulance while they suffocate. I'm actually really happy to have 3 Naloxone vials for an emergency.

here is a top tip: put the narcan in one of those nasal spray bottles so you don't have to fuck around with prepping a shot, you can just put it up the nose and squeeze.

 

[Captain.Heroin]

here is a top tip: put the narcan in one of those nasal spray bottles so you don't have to fuck around with prepping a shot, you can just put it up the nose and squeeze.

It's really, really easy to IM. I'm pretty sure if you couldn't IM naloxone, you couldn't inhale it either.

 

[TheDankaholic]

here is a top tip: put the narcan in one of those nasal spray bottles so you don't have to fuck around with prepping a shot, you can just put it up the nose and squeeze.

It Just won't absorb and work properly like this if someone is OD'd and passed out this just won't be effective at all & you would be wasting precious time you don't have to waste in an OD situation.

The other thing about this idea that is bad is Naloxone needs to be properly dosed & you just simply couldn't do that with a nasal spray bottle & doing it that way. It's super easy to measure out a quick IM dose in a syringe and give the injection.

I know for most people you would be worried about them giving a proper injection but I'm a RN in a busy ER & have given 1000's of injections and even have experience giving Naloxone injections for OD's. It would be no different then doing it at work except I'd use different syringes. I could even take home some from work legally if I'd like (syringes that is)

It's really, really easy to IM. I'm pretty sure if you couldn't IM naloxone, you couldn't inhale it either.

Your actually correct, as much as I'd like it to be a nasal spray type of ordeal and not mess with needles it just simply won't work properly that way nor will you get it absorbed up the nose during an OD where I'm 100% passed out or a friend is.

Plus being an RN I'm qualified to give someone an injection, i've dealt with naloxone injections before at work. I wouldn't even be nervous doing a quick IM injection on a fallen freind ya know? No big deal I'd get it handled if it happens.

I wish needle exchanges would give out Naloxone after attending like a quick 1 hour certification class on it's usage. Make people learn about how to properly administer it than give it out to them. It would save a lot of lives as well as save people from these dangerous at home attempts for reversing an OD. It's a win win situation and nobody is using Naloxone for anything besides what it's meant to be used for so there really isn't much risk in giving it out.

 

[Cane2theLeft]

I was a little surprised when I saw some people in here flat out deny that the intranasal route is a viable alternative to IV/IM for naloxone administration... a simple google search turned up 130,000 responses and below is the abstract of one of the studies on the manner.

Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting.

Barton ED, Colwell CB, Wolfe T, Fosnocht D, Gravitz C, Bryan T, Dunn W, Benson J, Bailey J.

Division of Emergency Medicine, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.

Prehospital providers are at increased risk for blood-borne exposure and disease due to the nature of their environment. The use if intranasal (i.n.) medications in high-risk populations may limit this risk of exposure. To determine the efficacy of i.n. naloxone in the treatment of suspected opiate overdose patients in the prehospital setting, a prospective, nonrandomized trial of administering i.n. naloxone by paramedics to patients with suspected opiate overdoses over a 6-month period was performed. All adult patients encountered in the prehospital setting as suspected opiate overdose (OD), found down (FD), or with altered mental status (AMS) who met the criteria for naloxone administration were included in the study. i.n. naloxone (2 mg) was administered immediately upon patient contact and before i.v. insertion and administration of i.v. naloxone (2 mg). Patients were then treated by EMS protocol. The main outcome measures were: time of i.n. naloxone administration, time of i.v. naloxone administration, time of appropriate patient response as reported by paramedics. Ninety-five patients received i.n. naloxone and were included in the study. A total of 52 patients responded to naloxone by either i.n. or i.v., with 43 ( 83% ) responding to i.n. naloxone alone. Seven patients ( 16% ) in this group required further doses of i.v. naloxone. In conclusion, i.n. naloxone is a novel alternative method for drug administration in high-risk patients in the prehospital setting with good overall effectiveness. The use of this route is further discussed in relation to efficacy of treatment and minimizing the risk of blood-borne exposures to EMS personnel.

What I take from this study is that it may not be as effective as IV/IM naloxone but it also cuts down on certain risks for those administering and if insufficient, can simply be supplemented by IV/IM either in the hospital or prehospital setting.

I also distinctly recall reading about a heroin user who found someone passed out in the park and upon determining it was a heroin overdose, administered some intranasal naloxone they had and subsequently likely saved their life.

I think intranasal naloxone provided with sufficient instruction could be useful, especially for people who are not medical practicioners but run a higher likelihood of coming across or being there when an overdose takes place.

_______________________

HERE is the pubmed search for intranasal naloxone and the 31 results.

Further evidence of not only the possibility of intranasal naloxone but 74 cases it was used!

Saved by the nose: bystander-administered intranasal naloxone hydrochloride for opioid overdose.

Doe-Simkins M, Walley AY, Epstein A, Moyer P.

Boston Public Health Commission AHOPE Needle Exchange program, Boston, MA, USA.

Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose.

 

[TheDankaholic]

I was a little surprised when I saw some people in here flat out deny that the intranasal route is a viable alternative to IV/IM for naloxone administration... a simple google search turned up 130,000 responses and below is the abstract of one of the studies on the manner.



What I take from this study is that it may not be as effective as IV/IM naloxone but it also cuts down on certain risks for those administering and if insufficient, can simply be supplemented by IV/IM either in the hospital or prehospital setting.

I also distinctly recall reading about a heroin user who found someone passed out in the park and upon determining it was a heroin overdose, administered some intranasal naloxone they had and subsequently likely saved their life.

I think intranasal naloxone provided with sufficient instruction could be useful, especially for people who are not medical practicioners but run a higher likelihood of coming across or being there when an overdose takes place.

_______________________

HERE is the pubmed search for intranasal naloxone and the 31 results.

Further evidence of not only the possibility of intranasal naloxone but 74 cases it was used!

Hmm I guess it's possible that it works this way I just would have no professionally experience doing it this way as all my experience is in the hospital at work giving patients IM shots. So for me naturally I'm going to go with what I know, what I've been trained on, & what I've done. It just makes more sense.

To an everyday citizen with no medical training or experience who doesn't want to have to deal with the dangers of an injection I can understand trying to go with a less invasive method of administering Naloxone. But why would I? I'd be less confident in my abilities to administer it intranasal as it's just not something I've ever done in any setting, & I have had to use Naloxone on quite a few different patients and I'm very familiar with the onset of the effects & how patients generally react.

Also my biggest concern with giving it intranasal is the ability to properly dose the Naloxone and to be sure of myself on how much I dosed & how much actually got absorbed. With a syringe I can make an EXACT dose & know the patient absorbed every last bit of it. I can be much more sure of myself and the medicine I'm administering that way.

There's a reason why under optimal conditions IM shots are used of Naloxone. The drug is meant to be IM'd and I have vials of it that are 100% meant for injection & not nasal use. Although it works obviously and I'm glad you found that and proved that it does work, it just doesn't seem optimal under the conditions I'd be working with.

When someones life is on the line I'd have to go with what I know works and what I have experience doing. That's going to be an IM shot for sure.

So if any of you guys pass out at my house, just remember TheDankoholics coming at you with IM Naloxone, you aint getting no nasal Naloxone at this dudes house if you OD. lol, you have all been warned!