Day 171: Narcan. Ethics Grand Rounds

Today was another Ethical presentation at my medical school. These happen every two weeks and occur during lunch on Thursdays. I enjoy them because it allows me to break away from the same medical theme that I am studying but still engages me in the medical community. Maximizing the utility of breaks.

The most recent topic: Paradigms Clash: Gender, Pain, and Social Change. The presentation was given by Nancy D. Campbell.

So what is Narcan? Thats the question that I immediately asked myself when I walked into the room. There was no article to read before entering so I was going in completely blind. If there is an article attached to the email for the rounds presentation, I will usually skim it. (Abstract, Results and last bit of the Discussion). Anyways…Narcan.
naloxonechemNarcan, or its official name, Naloxone, is a medication used to treat acute drug overdoses. It is administered two different ways: nasal spray and Intramuscular (IM) needle. There is a whole ethical question within administration of it regarding if the drug is used to allow drug users to continually engage in that behavior (since they know that they will have a safety net if they overdoes), but that was not the purpose of this presentation. Additionally, one can even question the prescribing practices of narcotics (opioids), such as OxyContin, Roxicodone and Percocet. The active drug ingredient is Oxycodone. I will probably expand on this dilemma in a later post.

The topic for the presentation revolved around the gender and geographical biases that surrounded the practice of co-prescribing naloxone with opiods. Co-prescribing has many benefits, as show in this article. White males between the ages of 20-29 were most likely to receive a co-prescription. Additionally, co-prescription habits were more common in suburban and urban regions when compared with rural areas. Because of the unequal co-prescribing habits, middle-age white women were more likely to die of a drug overdose compared to other groups. When you also look at methods of suicide, females are more likely to die via overdose than men. This statistic should encourage physicians who prescribe opioids, to be more aware of risk factors. Everyday, 91 people die from drug overdoses (with either heroin or prescription medications). People are more likely to die in their home than in a hospital setting, when it comes to drug overdosing. While the inequality of coprescribing was stressed in the presentation, I hovered over the idea of Quality Improvement. Physician prescribing practices differed between patients, and this results not only in more overdose-ER visits but also more deaths. Something that is preventable with a drug which society already has. We can delve into the healthcare rationing aspect of prescribing Narcan compared to overdose-related visits to the ER as well! It would actually be cheaper for physicians to prescribe Narcan and from an economical perspective it also makes sense.

One of the barriers that physicians still face with the prescribing practices of this medication is that they feel this can alienate their relationship to the patient.
“Hi, I am going to put you on 5mg of Oxycodone…and I am also going to prescribe Naloxone just incase you overdose”
Boom. The patient immediately feels like the physician has labeled the patient as a drug user….but this should be as far as possible from the truth. They was a physician acts and cares for the patient can completely change the statement. The Naloxone prescription can be framed as a safety net, just in case the dosage of the medication becomes too much for you handle. Framing this in a collaborative way and as a way of the medication having too much of an effect on the patient rather than the patient throwing the whole bottle back as soon as they get home to their couch, will have a better outlook for the patient.

I still have much to learn about the subject, but I am glad that I was able to attend this presentation. I feel that is important for physicians to constantly strive to improve their practicing habits so they can better serve their patients.

As always, I like to place a song that reminds me of this time in my life and, when applicable, can relate to the subject matter that I am writing about.

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