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Apparent overdose victim falls on Red Line tracks at Kendall Square, is revived with Narcan
By adamg on Wed, 06/07/2017 - 10:36am
Cambridge Police report an incident at the Kendall Square involving a man who'd fallen on the Red Line tracks ended with him revived and on the way to the hospital after two Cambridge officers administered Narcan, which counteracts the deadly effects of opioids.
According to police, the man, 37, fell on the tracks around 8 a.m. yesterday:
When the MIT Police arrived, the male was located on the platform and officers carried him up to the street level outside of the T station. Cambridge Police arrived and were informed that the male was overdosing. One of the Cambridge Police officers immediately began life saving measures and prepared Narcan, while another officer successfully administered it.
Following the administration of Narcan, the male regained a pulse and began breathing on his own. Paramedics from Pro EMS arrived on scene and transported the male to a local hospital for further treatment and evaluation.
Cambridge Police began equipping officers with Narcan in January. Police say officers have saved "multiple lives" with the drug.
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Comments
Addicts should keep a legal
Addicts should keep a legal document on their person that they sign stating whether they either want Narcan or DNR. Like some terminally ill patients who know nothing but suffering, pain and depression, they may not want anyone to keep them alive. They hate their lives. Hospitals and other health officials should extend this protocol to addicts not just other DNR cases with other incurable terminal diseases. If an addict wants to die, let him. No cure for opiate addiction, no matter what you try or spend money on. Sorry, but that's a cold, hard fact.
Oh right
...cause heroin addicts are in the right state of mind to make life-or-death decisions and keep track of legal documents. That's frankly nonsensical.
Also, no cure for opiate addiction? David Gahan seems pretty freakin' cured to me. People like you would have let Depeche Mode die! And a lot of other less famous, less wealthy people who need that help even more.
http://www.nme.com/news/music/depeche-mode-10-1258930
Btw, totally in favor of DNR considerations generally, but not in these scenarios.
Re: Addicts should keep a legal document
Interesting concept but a bracelet or something easily visible would be better, yet still dubious. There's no time to look for a DNR. If the person is unconscious and alone, no first responder is going to take time to search pockets or a wallet for a DNR. Even a bracelet would be questionable as they could be swapped. The liability would be huge. Maybe something like the "organ donor" stamp on a license, although many addicts don't have one.
Are you guys serious with
Are you guys serious with this bullshit?
They can't be cured (at least
They can't be cured (at least, not yet), but the addiction can be successfully managed or treated.
Just curious- are you also in favor of anyone with depression being able to kill themselves/DNR? Depression is also sometimes not "curable", but can definitely be managed.
No, it's not.
"No cure for opiate addiction, no matter what you try or spend money on. Sorry, but that's a cold, hard fact."
No, it's not.
You would be more correct if you were speaking about meth addiction. I can't quote recidivism rates, but opiate addiction is beatable with willpower and help.
Also, the DNR has to be 1. An original, no xerox copies allowed, 2. Up to date, and 3. Signed by a physician.
Oh, I could add 4. legible.
If it's carried by a druggie, it will be folded up and probably showing serious signs of 'pocket wear'. In any case, someone that needs Narcan probably is in no shape to reach into a pocket for their DNR and no sane first responder will reach into a pocket anyway...
What are the statistics of
What are the statistics of heroin addicts who tried to quit, got help from their families (if their family was still talking to them), were lucky enough to find long term inpatient care at a detox program with no health insurance, got out of treatment, and stayed off heroin and other opiates without relapsing again? I am over 40 and have been a functioning addict since the 80s. It sucks. I've been to so many detoxes so many I can't even count. I have no sympathy for these junkie zombies. I know what they are going through and there is no cure. Society has to stop enabling them and treating them like babies. Now that the epidemic hit white suburbia,all of a sudden health careofficials want to help them. Remember the 80s crack epidemic? The black community still feels the effects today.
This is an irresponsible and
This is an irresponsible and hateful comment. There is no "cure" for many chronic diseases, but we have evidence-based practices to manage them and to improve the lives of our friends, family, and neighbors who suffer from them-- including addiction.
MOLST is used outside the
MOLST is used outside the hospital to help first responders decide what to provide someone. It's unfortunate there continues to be such bias against a brain illness such as addiction. If we let all the people with diabetes die that would save more money than writing off people with substance problems, there's just more people with diabetes after all. Or perhaps that's repugnant to people but since substance use is just the moral failings of someone it's ok.
Rat Park Experiment
Read about the so-called "Rat Park Experiment", and how it relates to heroin-addicted soldiers returning from the Vietnam War. Spoiler: once soldiers got out of the Vietnam combat environment, detoxed, and came back home, the relapse rate was about 5%. Hardly what I'd call "incurable".
http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_65... (yeah it's HuffPo but it cites sources)
I don't think you know...
...how healthcare directives work in Massachusetts. It's not that simple. For your own purposes, you may wish to look into it. As for other people and what they should do, I suggest minding your own business.
Question for the people who
Question for the people who are against clinics where addicts can do drugs in a more safe manner under medical supervision: is someone falling on the T tracks, causing delays, horrifying passengers, endangering police officers etc better than the clinic situation? Obviously not. The status quo is not working.
Re: Kinopio "The status quo is not working."
I agree that the status quo is not working but as I asked before (and I'm serious), is the proposed "heroin clinic" going to be a hospital bed or clubhouse atmosphere and who is going to buy / test the heroin? How long will they stay there? You can't release them while high and once they lose the high, they will want more. Isn't that why we have methadone to wean them off?
I can't see middle or upper class adult or teen addicts going into a clinic in Boston to hang out with homeless. If they've already been to treatment and have a marriage or job on the line, will they go and admit treatment failed? I basically see a daytime homeless shelter. I believe most shelters kick them out during the day so staff can clean and make the beds, so many will just shuffle over to the heroin clinic.
There already exists an effective model
Vancouver has had such a space operating since 2003 called Insite - http://www.vch.ca/public-health/harm-reduction/supervised-injection-sites
You're allowed to stay while you're using, but you can't just hang out in there, as there is limited space. Once you've used, you have to leave within a certain amount of time so that others may use the space. It's not intended to be a place to congregate and be social, and is in fact designed to keep you from socializing as each spot is separated like school library desks.
As for your day homeless shelter statement, what's wrong with offering drop in services as well, I'm sure the Boston Public Library, various Dunkin Donuts, the Tufts, BMC, and MGH Emergency Department waiting rooms would love to stop filling that role. We need more day-time homeless shelters, and services for those that utilize them. If you disagree, you have no right to look in disgust as you drive down Melnea Cass and think, "Someone should do something about those people". They're there because where else do they have to go?
Certainly, there are other services offered by the agency that focus on health advocacy, testing, etc., but once they've used, they can't stay at that part of the agency.
Also, you can release them while they're high....why wouldn't you be able to? Bars release "high" patrons all night long up until 2am, and those folks are actually a greater health risk to themselves or the community when intoxicated than IV opioid users.
You're right, kids from Andover will likely not be heading down to hang out there, but they are also at a much lower risk of overdose death. Injection drug use is most risky when it's done alone, in a place where someone won't be found. If I am a homeless person, I'm going to find a place to hide while using (in an alley, a Dunkin Donuts bathroom, hospital bathroom etc..).
I honesty cannot think of one logical reason as to why we shouldn't embrace these types of services. It would reduce the burden on police, reduce the impact on retail owners, reduce the overdose rate and the resource drain/trauma on EMS and Hospital EDs, it would reduce the presence of active drug use on the street in view of children, would reduce the number of discarded syringes in our parks and sidewalks or thrown into city barrels and restaurant toilets, it would literally improve the lives of people who find folks with addiction to be despicable, while also improving the lives of people who live with addiction, at the same time. It would improve my life because I'd see less of my patients die, I'd have a place to collaborate with to re-engage or connect with new patients, provide education and outreach. It'd improve the day to day experiences of every cop, doctor, restaurant manager, parks service worker, landscaper, janitor, and tourist in Boston in a way that has evidence showing that it works.
It would also be one more way to remember that just because someone is in a bad place in their life, that they are a still a human, they are still worth some basic dignity, and that they matter.
Safe Spaces
Why do people assume that addicts will flock to a safe space if allocated? My guess is if an addict needs their fix and the assigned safe space is 20 minutes away, or they can go to the part or "T" station across the street - they are going to go to the closest option.
Also, if we allocate "safe spaces" will there be added enforcement or jail time for the addicts that still leave needles in playgrounds, restrooms or public spaces in general?
Positive reinforcement of negative behaviors
Some addicts feel its ok to get dangerously close to over dosing because they know narcan can save them. I certainly don't think we should throw the junkies out with the bath water (for lack of a better saying) but I still don't think condoning negative behaviors benefit anyone, even Joe Shmoe commuter who would have been delayed if the worst had happened. I know this stance makes me sound incredibly insensitive, but I assure you I'm not. I just don't think helping or condoning people to hurt themselves is beneficial. I don't have the answers but then this isn't my area of expertise either.
[citation needed]
[citation needed]
And that's a big part of the
And that's a big part of the problem (actually, a big part of basically every problem). People that don't have expertise making judgments based on what they feel is right, instead of actual studies and facts.
It might feel like this is just condoning negative behaviors, but studies are showing that these centers have many positive effects, and that up to 10% of people that enter a similar site in Boston go right from there to get treatment. That's huge, and promising.
Opinions you know
This is a forum to discuss issues, I've been enlightened on this board a few times on topics I wasn't super familiar with.
What about the other 90%, what happens to them?
Also
Then, he mentioned something that I had never thought of. From his perspective, Narcan has actually increased the number of opiate over-doses nation-wide. The reason? Experts believe that heroin addicts have come to realize that they have this ‘saving grace’ out there called NARCAN.
https://heroininme.com/narcan-double-edged-sword
This isn't actually a good argument.
I am happy to have a longer discussion around this, but the logic here doesn't actually play out.
Couple of things:
1. Narcan (naloxone) being available likely has increased overdoses, but only because it has allowed people to survive an overdose and potentially overdose further times. In fact, one of the best predictor of an overdose is whether someone has overdosed previously. For some reason, once someone has had their first overdose, they begin to experience them far more frequently.
2. Narcan (naloxone) must be used by someone else - If I'm getting high, I can't just assume that my narcan will be used on me, what if I'm alone? What if someone finds me but doesn't know how to use it. If I'm overdosing, I'm unconscious, narcan does me no good.
3. Narcan (naloxone) administration is very unpleasant for an opioid dependent individual. The action of the drug causes an rapid and intense withdrawal syndrome due to the naloxone very quickly deactivating their opioid receptors (while using heroin, they are over-activated). People are often very fearful of being administered naloxone because they know it will make them feel quite ill for a couple of hours.
1. There's a first time for
1. There's a first time for everything right? I would want to know what percentage of heroin users overdose, and the average time it takes from first time user to first overdose. Obviously those statistics don't exist.
2. Methodone Mile. They get high on open city streets. I assume those are the heavier users, if there is such a thing. But they at the least should be the group most likely to overdose.
3. The high is obviously worth doing and going through things you and I wouldn't.
I'm happy to have the discussion and be educated as well. I don't have facts and don't pretend to have them. But the idea of get high clinics is broad enough to warrant discussion.
Happy to dig up some data for you
I have journal access so I did some digging, there's a bunch of research but here's a few quick hits:
(Pulled from a couple of different sources, I can send citations if you'd like)
1: Two-thirds (68%) of the sample reported having experienced an overdose with no difference in prevalence between males (68%) and females (69%).
Subjects who had overdosed re-ported a median of three overdoses (range 1-50) overall,
The prevalence of overdose in-creased with the length of heroin-using career:0-5 years (54/100, 54%), 6-10 years (49/72,68%) and more than 10 years (122/157, 78%).
The median length of time between the initiation of heroin use and first overdose was 30 months (1-228). Only 22% of initial overdoses occurred within the first 12 months of heroin use.
2: Heavier is a tough thing to quantify, and with substantial fluctuations in the concentrations of diacetylmorphine (actual Heroin) and fentanyl or fentanyl-related drugs, found in illicit "heroin" (i.e. what is being sold as heroin on the market). Certainly, we can assume that people who are struggling with homelessness and are connected in some way to the treatment or criminal justice systems that exist within the Washington-South Bay stretch of Mass Ave, probably are getting there as a result of their use having significantly more consequences.
According to SAMHSA, average length of substance use before first treatment admission is about 12 years (with some variability each year), once in treatment, people are more likely to return to treatment.
Article from NIH:
"The greater representation of older addicts in treatment is explained both by the fact that it is only after some years that the disadvantages of addiction relative to its pleasures become apparent and drive the addict to seek help, and by the fact that the first treatment episode often fails, which means that the treated population includes a large number of repeaters"
So, the longer people use, the more consequences increase, and the more likely someone is to be using services within that geographic area. Also, since these folks have less access to private spaces, they're more likely to be using in public.
3.
It's interesting, heroin obviously has quite a reputation for being very pleasurable and very dangerous. Most people don't start with it, but study from the 1990s sampling the general adult population reports:
"8,098 household residents aged 15–54 were asked if they had ever used heroin even once; one percent had used, and only 23 percent of users qualified as ever dependent"
So, about a quarter of people who try it become dependent. Another study found that race and poverty can create an increase in likelihood of becoming dependent.
Often, consequence actually begins to have less of an impact on long-term users, and the reasons are complicated. Biologically, substance dependence creates a physiological state where the consequence of not having the drug creates more activation in the brain than social/economic consequences. Essentially, not having heroin becomes more terrifying than not having a home. The longer someone uses, the less traditional rewards/consequences will be valued due to physical changes in the brain.
Aside from biology, also consider that the very social consequences of using typically involve being cut out of social interactions (families pushing the user away, criminal justice involvement reducing access to jobs as well as periods of unemployment begin to compound etc.) with folks only really being welcomed by drug dealers, drug users, and treatment program staff. So, if you're slowly ostracized by society, but then not given a clear way to reestablish a connection, what do you end up doing? The impact of stigma makes it incredibly difficult to get your shit together. Even if you try, society, family, friends, all treat you with a certain degree of suspicion and expectation of failure. Humans are social beings, we bond with others by our very nature, and we bond with the groups that will accept us.
Eventually, it's not that the drug is so good, it's that there literally isn't anything else left that is. It's a really shitty place to find yourself, and we don't have enough resources for most people who try to get out. About 10% of heroin dependent individuals who attempt treatment will be abstinent after two years, most will return to use within 30 days. The rate of death from an overdose has gone from 10.5/100,000 in 2010 to 30.5/100,000 in 2016.
Sorry for the novel, this is an issue I am devoted to. I work with these folks every day, and sometimes they drive me crazy, but I would do anything I could to try to help them.
Wow
Seriously impressed with all that information you provided Daniel. Truly mean Thank You for that, it gives me something to digest over the weekend. 30 months to your first overdose is not what I would've expected, but there are so many variables to that I never gave the answer much thought.
Or
You set yourself up with a dose you've had before and it kills you because a) there's fentanyl or something else in it or b) maybe you've tried to quit and you're relapsing and your body isn't used to that amount of drug anymore or c) something else happens/goes wrong.
I'm pretty sure most addicts do not go "Hey it doesn't matter if I OD this time since someone will show up with narcan."
A dose you've had before?
No disrespect but this isn't CVS or Walgreens, so there's really no such thing as the "dose you've had before." It's Russian Roulette. It's being grown in Afghanistan, shipped and cut in Mexico and probably cut again in a garage locally, using all kinds of toxic additives. We've all heard of the "bad batch" and uptick in deaths.
The other variable (b+c in your post) are also valid, so again, who will supply the heroin to the clinic? Bring your own or city bought? This raises numerous other issues, will the city risk federal funding or knowingly violate state law for being present where heroin is kept? Is this a proposal for hospital beds or party atmosphere with music, dancing etc? Have we abandoned methadone? Gotta love the pols who imagine these ideas with no specifics.
You never know
https://heroininme.com/narcan-double-edged-sword
I AM THE 37 Year old man in this story
to whom it may concern ,
I am the 37 year old guy who feel on the tracks . this story has false information first of all I did not over dose on heroin or any obits for Narrcan to work . I will tell you I was on crystal meth . which is no better but . for the police to take credit and saying they narrcan to save my life is a complete lie and shows they give false information to the media and public so they can be seen as the hero . narrcan does not work on people on methaphine . it would have no effect . so before you write a story for your paper get your facts straight . on a happy note I have not used since this has happen and doing much better
Narcan Didn't Save Your Life, But The Police And Paramedics Did
You fell unconscious onto the subway tracks. Had you not beed rescued, you might not be alive today. It was reasonable for the police to assume heroin was involved, but administering Narcan was only one of the heroic efforts expended on you.
Even with the additional details you provided, I don't see any false information in this story. Adam said "apparent overdose victim", which you were; and the police administered Narcan, which they did. For you to lash out at people who saved your life by calling them liars is the height of ingratitude.