1. Running head: AVAILABILITY OF NARCAN 1
Broad Availability of Narcan
Edward J Draper
Siena Heights University

2. AVAILABILITY OF NARCAN 2
Broad Availability of Narcan
Introduction
You and your friend are using heroin. He says he is going to party big tonight and
suggests that he will be taking an extra big dose of it. You give him a look of apprehension, as
you are worried that the dose will be too much. “It is no big deal”, he says. The two of you have
been using it for a year, your tolerance is increased, and just in case, he shows you that his
physician had prescribed him Narcan, as he is aware of his history of heroin use and previous
overdoses. Your friend tells you, “If I overdose, just give me this.” and pulls out his Narcan kit.
You reluctantly oblige and he sticks the needle into his arm. Minutes later, you notice
that his breathing has become extremely shallow. You administer the Narcan and you find that
his breathing has picked back up, though he remains unconscious. After the typical 8 minute
half-life of the heroin (Addiction Blog, 2012) your friend remains unconscious. You notice at
about 30 minutes after you had administered the Narcan that his breathing had slowed again.
Little did you know your friend took heroin laced with a benzodiazepine, what users know as
doing “bars”. Now comes the turning point. If you dial 9-1-1, law enforcement is likely to get
involved and you will be charged for your part in the day’s events. If you do not, your friend
will surely die.
This situation described above is unfortunately a reality. The State of Michigan
Legislature passed a series of bills, which, in part, allowed for the use of Narcan by people other
than physicians, mid-level practitioners, nurses and paramedics (Gray, 2014). Governor Snyder
signed them into law in November of 2014 (MCL § 333.17744b, 2014), It requires the training
and carrying of the medication by all first responders as well as allows friends or family

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members of a patient, whose physician had written a prescription for the drug, to administer the
drug without fear of prosecution.
Most would say that broadened availability of the drug is a good thing; it truly can save
someone’s life. Others are concerned about the side effects and lack of education with general
pharmacology as well as administration of Narcan itself. In the following paragraphs, I will
discuss the arguments for the broad distribution of the drug, analyze these arguments, and finally
why I believe professionals should only use the drug.
Opposing Arguments
One of the benefits of Narcan is its ease of administration. It can be administered in the
same manner as an EpiPen®, subcutaneously or intramuscular, or it can be given intranasal via
an atomizer. Either application is very easy to learn. Sheriff Ted Schendel of the Benzie County
Sheriff’s Office, one of the big advocates of the initiative, touts the ease of administration of
Narcan, suggesting it is nice because “it is administered through the nose” (Troutman, 2014).
The education for the program consisted of approximately an hour of lecture and a short practical
session taught by Craig Johnson, the Benzie County Emergency Medical Services Director. The
program that Sheriff Schendel initiated is to be used at the federal level by a work group who is
drafting a model law to increase the availability of Narcan, as well as protecting the individuals
who give it (Troutman, 2014).
There is no disputing the fact that there truly is an increase in opioid-related deaths in
recent years, more specifically in heroin overdoses. In Ottawa County Michigan, there has been
nearly double the heroin-related deaths in 2014 than in each of two previous years (Thoms,
2015). As Lieutenant Andy Fias points out, with the decrease in the availability of other opiates,

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many users have switched to heroin. Furthermore, at times the people manufacturing the heroin
cut it with Fentanyl, a very potent opiate, with a half-life that can exceed that of Narcan. Having
Narcan readily available could keep the patient alive until EMS arrives (Troutman, 2014).
William Morrone, a Bay County Michigan deputy medical examiner, conveys that in
other countries Narcan is an over-the-counter medication (Heroin antidote, 2014). This shows
that this problem is more than a local problem and other areas are dealing with this same tragedy.
He feels that we need to take a more worldly view and consider these standpoints. Families are
losing loved ones and with this statement, he infers that broader access to Narcan will give these
families another chance at saving their loved one’s lives.
Analysis
When analyzing the arguments for broadly disseminating the Narcan for use by not only
emergency responders, but also the friends and families of known users, each of the arguments
have valid points, however the idea comes down to a cost benefit scenario.
In order to accept this new ideology, one must first look at it logically (McRae & Hutson,
2011). Logically, people are more apt to use knowledge and a skill if it is easy to use; therefore,
the fact that administering Narcan to a suspected opiate overdose is easy to use, more individuals
will be likely to do so. Additionally, many people have the fear of being prosecuted for their
actions. The law alleviates this worry as it protects the individual administering it from liability;
therefore, logically, people are more likely to administer the drug to someone they believe is in
need. After analyzing the principles of this argument, I believe this to be true, without a
distortion of the truth or major bias.

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The second argument talks about the increasing prevalence of opiate over-dose. How this
problem is significantly affecting communities and that, the administration of Narcan is a simple
fix. I personally see a touch of commonsensism bias. It is not always best to jump at the easy
and quick fix to a problem (Lonergan, 1997). In this case, I can agree that the distribution of
Narcan will save these people’s lives in the short-term; however, it is like putting a Band-Aid on
an arterial bleed. You are only delaying the inevitable.
Two other largely important factors are being over-looked or simply ignored. This
problem is sold as the cure-all, but the real problem is the underlying addiction and subsequent
effects of the administration of the Narcan. Take the hypothetical scenario I described before
with the two heroin users. The one user felt more comfortable using the bigger dose because he
had the safety net of Narcan. Then the overdosed experienced renarcotisation, the narcotic side
effects returning after the Narcan wore off, or further sedation by a benzodiazepine (Clarke,
S.F.J; Dargan, P.I; Jones, A.L., 2004). These unintended consequences are indeed a concern and
I do not believe that the individuals promoting the dissemination of the drug are knowingly
selling it without expressing these consequences. They are simply seeing the victims who are
surviving.
In addition to looking at the cost benefit of the administration of Narcan by individuals
other than medical professionals, we must also look at the actual financial cost benefit.
Currently, a single dose of Narcan is the same cost as an American Heart Association CPR
course, approximately $50-60. When taught CPR, rescue breathing is a skill taught for a person
who still has a pulse. This technique would effectively do the same thing as the Narcan, for as
many overdoses as the patient had, without any of the consequences. A single dose of Narcan
will only begin to treat the first overdose. As the director of an ambulance service, I can attest

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that many of my paramedics, myself included, rarely give Narcan. We place an endotracheal
tube in the patient and breath for them, just as a layperson could do with rescue breathing. This
allows for the benefits of an increased respiratory drive without the negative aspects associated
with giving Narcan.
Finally, in looking at the idea that Narcan is an over-the-counter medication in other
countries, it does not seem that there is any common bias in this statement. Marrone is simply
pointing out the fact. What I do find wrong with this statement is that it too only looks at the
short-term fix. In further scrutiny, Marrone could have a vested interest, as it is not uncommon
for physicians to be paid to promote drugs and products (Kesselheim, A.S., Wang, B., Studdert,
D.M., & Avorn, J., 2012).
Conclusion
After having done the research and evaluating the opposing sides, I am only more
convinced that lesser skilled responders or the patient’s family should not use the medication.
The evidence only further supports the idea that there are problems that can arise from the
administration of Narcan by a lesser trained individual and that there are other options available
to treat the condition. The broadened availability would reduce the number of initial deaths from
opioid overdoses; however, so would teaching rescue breathing as part of a cardiopulmonary
resuscitation training. Opioids bind to receptors in the body and respiratory depression is a side
effect, which ultimately is what is causing their death. With administration of Narcan, comes
further complications. First, as I described above, is renarcotisation. Once the effects of the
Narcan wear off, the receptors will once again become effected by the opioid (Clarke et al.,
2004). Additionally, administration of Narcan can result in pulmonary edema and violent
withdrawals. Both of which family and some responders are not equipped to deal with (Clarke et

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al., 2004). Keeping this medication only in the hands of professionals will prevent the
unintended consequences.

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References
Addiction Blog (March 2012) How long does heroin stay in your system? Addiction Blog
Retrieved from drug.addictionblog.org
Clarke, S.F.J, Dargan, P.I., Jones, A.L. (April 2004) Naloxone in opioid poisoning: walking the
tightrope. Emergency Medicine Journal Retrieved from emj.bmj.com
Gray, K. (September 2014). Senate passes 3 bills to make drug more accessible. Detroit Free
Press. Retrieved from freep.com
Heroin antidote that can save a life in minutes may become easier to get. (2014) Legal Monitor
Worldwide. Retrieved from go.galegroup.comezproxy.sienaheights.edu
Kesselheim, A.S., Wang, B., Studdert, D.M., & Avorn, J. (2012) Conflict of interest reporting by
authors involved in promotion of off-label drug use: an analysis of journal disclosures. PLoS
Medicine, 9(8). Retrieved from go.galegroup.com.ezproxy.sienaheights.edu
Lonergan, B. (1997) Insight: A study of human understanding. University of Toronto Press
Retrieved from sienaonline.org
McRae, M., Hutson, J. (2011). Critical thinking part 1: A valuable argument. Retrieved from
youtube.com

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Public Health Code Act 368 of 1978, MCL § 333.17744b (2014)
Thoms, S. (February 2015). Heroin abuse rising in ottawa county; issue is focus of town hall
meeting. Mlive. Retrieved from mlive.com
Troutman, M. (November 2014). Benzie sheriff’s anti-overdose effort noticed in D.C. Traverse
city record eagle. Retrieved from record-eagle.com