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 Author: crow
PostPosted: Mon May 22, 2017 2:19 am 
"Sir, he’s dead"; "Maybe, just keep bagging the air and watch for it, its not been 2 minutes yet. See, the muscles just slighly rippled, now twitched and jerked, watch yourself he could convulse or vomit ... now hold him down ... “gasp - gasp, what the? gasp - what are you doing here? gasp” - “We saved your life and....” .. “I didn’t ask you to save me” ... “Somebody called 911 and said you were dead” ... “Get out get out” ... “You need to come to the ER for a couple of hours in case you relapse” ... “Get out...” ... “Sir?” - “Get your things, we have to go, you can drive, you need the practice”

“Sir, how did you know, no signs of drugs or pills? Um, what if he relapses?” -- “Just a hunch, the heart was struggling but hadn’t given up even though the breathing had completely stopped, he didn’t look sick, just a hunch.. the Narcan, what you call Naloxone wouldn’t have hurt him even if he hadn’t taken an opioid.”

"Sir, relapse..?” “That’s a little more complicated, opioids, weather they be pharmaceutical pain pills or heroin, attach to the opioid receptors in the brain causing relaxation of all the muscles and slow the breathing for a number of hours, so, along comes Narcan and kicks the opioids off the receptors but doesn’t antidote or change the opioids in any way. In an hour or so when the Narcan is gone the opioids will reattach to the receptors but in the mean time if the amount of opioid had decreased enough he will only get high again, if not he could hit overdose level again, we can’t know so he needed to come with us to the ER. Sometimes especially in the case of long term addicts or prescription pain meds the Narcan will cause an immediate and complete withdrawal with all the withdrawal symptoms including persistent convulsions, vomiting, violence but today we didn’t see that.”

“Sir, I’m new, do we get these calls often?” -- “Watch out for that dog, compared to total calls, not all that often and until that snoopy reporter came around we really didn’t know, so we began to look; from January 1, 2017 to mid May for all of Grant County there seems to have been 31 overdose calls, 12 of which were in Silver City. Overdoses come in waves, for example in Silver City 7 of those 12 calls were in April and none for the first half of May, this could reflect a new shipment of heroin with an unknown strength or a flood of Fentanyl on the black market or as in some areas Fentanyl mixed with inferior Heroin, we just don’t know for sure. Fentanyl is 50 times stronger than Morphine and 10 times stronger than Heroin, and often takes mutable doses of Narcan. Now we are seeing Fentanyl being made in underground labs with an unknown strength. There is another issue with our stats and that is how any given report is categorized in the database that both SCFD and the County EMS use, for example we could, even though Narcan ruled it out file this run as Respiratory Failure or any of 2 or 3 other categories but next month we all will be learning a new database, mandated by the state that is supposed have clearer categories and easier to search.”

"Sir, does anybody know how much drugs are around here?” “No, and the OD’s are no indication and the availability of pharmaceutical opioids on the streets seem to be constantly rising, it almost seems like the pharma companies have a direct distribution into the black market or still reward doctors for over prescribing with 2 local “pain” doctors getting in trouble over the ast few years for over prescribing and refusing to consider alternative meds. But always remember that alcohol is still the most heavily used and abused drug and causes way more violence, injury and death than any of the opioids. Back the ambulance into the bay, just don’t crash into anything and we’ll file our report somewhere.”

The Mandate, HB 370

During the 2017 NM Legislative Session a bill was passed and signed by the Governor, it begins "Relating To Health; Enacting New Sections Of The NMSA 1978 To Require That Certain Persons Provide Opioid Overdose Education And Naloxone To Prevent Opioid Overdose Deaths.” This Bill mandates 2 things as funding becomes available:
1. That all police from local to state carry Narcan
2. That all Jails and prisons give all inmates deemed to have a drug problem, upon release, 2 doses of Narcan and how to use it.

The Silver City PD is looking into the Nasal Spray Narcan (3-4 minutes) which is slower than an intervenes shot (1-2 minutes) but faster than an inter-muscular shot (up to 5 minute) and very much more expensive as the dose required for the nasal spray is many times higher than the needled injected.

The County Sheriffs are considering the shots which, from my discussions with the County cops have many of the Deputies worried about hepatitis and HIV from needle pricks though I’m assured by the paramedics that the Narcan preloaded needles have an automatic needle sheath that retracts upon the administration then covers the needle and locks in place when the needle is withdrawn. Aside from the extra training required for needle use the Nasal Spray has 2 issues, one being a deviated septum and the other being clogged passageway from a cold, asthma or the habitual snorting of drugs obstructing absorption. Discussions and decisions are still in the early stage. Nasal spray is the most expensive since it requires a much higher dose.

For the County this is a much more pressing issue because of its rural nature. Example, in early May a camper at City of Rocks took a bunch of pills, 2 different kinds, one was determined to be Fentanyl of which 5 were ingested. When a cop arrived, the Ambulance was still 20 minutes out and the lady was getting worse fast so the cop loaded her into his car to meet the ambulance on the highway. During the radio conversation the cop said that if she stopped breathing he would pull over and do what he could like CPR which would be like doing nothing. Lucky for the lady a timely rendezvous was made, Narcan was administered and she lived.

List of Opioids, heroin (and some of the morphine) is the only one not produced by drug companies though "bathtub" fentanyl is gaining traction.

fentanyl - 50 times more potent than morphine. 10 more potent then heroin
Buprenorphine - see below

Graph below is national persentages from the CDC, see https://www.cdc.gov/nchs/products/databriefs/db273.htm

• Deaths from drug overdose involving heroin tripled from 8% in 2010 to 25% in 2015 (Figure 5).
• For drug overdose deaths involving natural and semisynthetic opioid analgesics, which include drugs such as oxycodone and hydrocodone, the percentage decreased from 29% in 2010 to 24% in 2015.
The percentage of drug overdose deaths involving methadone also decreased, from 12% in 2010 to 6% in 2015.
• For drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl and tramadol, the percentage increased from 8% in 2010 to 18% in 2015.
• The percentage of drug overdose deaths involving cocaine increased from 11% in 2010 to 13% in 2015.
• Drug overdose deaths involving psychostimulants with abuse potential, which include drugs such as methamphetamine, increased from 5% in 2010 to 11% in 2015.

If we add up the 3 catagories of pharnacuitical opioids and compare with herion for 2015 alone we see that pharma drugs make up 48% of the overdose deaths compared with heroin’s 25%.

The NM OMI yearly stats for 2015 do not itemize for specific drugs but list a generic "Substance intoxication" with 392 deaths and a row for "Chronic drug abuse" with 1 death, need I say that reliable stats can be ambiguous and unreliable?

Got an addiction to Opioids? We got an Opioid for that. Suboxone and Methadone.
Buprenorphine a feeble opioid (brand name Suboxone with a market share in 2012 of $1.4 Billion) is the current choice to diminish cravings for opioids during withdrawal and long term drug rehab and is mixed with Narcan, to protect against overdose but "The National Pain Report discovered that 30,135 emergency room visits in 2010 were the result of Suboxone misuse, and over 50 percent of those cases were recreational in nature.” and now we have Suboxone addiction but again up to date stats seem unavailable.

Methadone, adopted in the late 1960's as the opioid of choice for withdrawals and long term treatment of heroin addiction and has, as scene in the above chart, its own death rate from abuse.

Pain relief and control is an all time best seller, generating 100's of Billion of dollars in profits for drug companies, far exceeding the heroin trade and causes many times more addicts and twice the deaths as heroin. Hopefully through the next decades there will be a greater understanding of the role of the so called "opium receptors" and the natural body produced compounds that bind with those receptors for pain control rendering most use of opioids obsolete.

Wars have been fought, in part or solely for the control of opium to guarantee the availability for future and current war injuries. In 1937 Nazi Germany developed Methadone because they lacked a nature source, Opium Poppies, to meet there project needs for WW 2.

Another interesting CDC chart showing the states with above, below and at the national level of drug OD's in 2015: Dark Blue - Statistically higher; Gray - Statistically the same; Green - Statistically lower

 Author: hayranur
PostPosted: Mon May 22, 2017 7:48 am 
great work, Crow. thank you.

 Author: Todd
PostPosted: Mon May 22, 2017 2:14 pm 
Thank you for the insights!

 Author: mook
PostPosted: Mon May 22, 2017 2:50 pm 
What kind of kickback do you think that Susanna Martinez is getting from the manufacturers of Naloxone and Narcan for requiring all Police and Fire and Ambulances and jails and prisons in NM to carry and use their product?? Is this another unfunded mandate ?? This stuff is EXPENSIVE----Paid for by defunding the drug programs and Medicaid ?? Follow the money

 Author: Infodigger
PostPosted: Tue May 23, 2017 6:18 am 
There is a tree in SE Asia called the kratom tree. Its leaves are shredded to make a painkiller and energy booster which our government, I think the DEA, almost made illegal last year, as it does evidently have a couple of things in it that would give reason for that. But so many people wrote and said that it helps them to control their pain and that they are not addicted to it, that for now at least it is still obtainable online.


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