Reversing an Opioid Overdose
Should a Dental Office Have Narcan?
It’s not typical for dentists to stock Narcan (naloxone), which is used to reverse an opioid overdose. However, oral surgery practices and other offices that provide anesthesia/sedation procedures will carry the IV formulation to reverse any opioids used during the procedure, if needed.
I have not used opioids in many years, but I still stock this drug. In some states, when a pharmacy fills a prescription for an opioid medication, they are required to provide safety education and may even be required to ask if the patient would like to have Narcan to take home. Ultimately, it depends on the specific circumstances and policies of the dental practice and local regulations.
My personal view is that we should all carry the nasal spray in our offices.
As of July 2023, the U.S. Food and Drug Administration (FDA) has approved two, OTC naloxone nasal sprays for use without a prescription. Narcan® and RiVive™ will be available for consumers to purchase, making overdose reversal medications more widely available.
Narcan® is the approved branded 4 milligram (mg) naloxone hydrochloride (HCl) nasal spray from Emergent BioSolutions. It is a life-saving medication used to reverse an opioid overdose, including heroin, fentanyl, and prescription opioid medications. Narcan® nasal spray is now available to purchase OTC in places like drug stores, convenience stores, grocery stores and gas stations, as well as online. Many local health departments will have a self-service cabinet set up for anyone to walk up and acquire the spray.
RiVive™ is another approved, branded 3 mg naloxone HCl nasal spray from Harm Reduction Therapeutics (HRT). RiVive™ is delivered as an atomized spray for the emergency treatment of an opioid overdose.
RiVive™ is now becoming available, primarily to U.S. harm reduction organizations and state governments. HRT will be offering online ordering to anyone once production ramps up.
Even if you do not provide sedation, or even prescribe opioids, I believe that carrying Narcan (naloxone) can be potentially lifesaving, especially in situations where opioid overdose is possible.
Here are a few reasons why every healthcare provider should carry Narcan:
1. Emergency Response To Help Reverse an Opioid Overdose
Opioid overdoses can happen suddenly and unexpectedly. Carrying Narcan allows you to respond quickly in case someone experiences an overdose, providing a chance to reverse the overdose and save a life.
We can only control what we administer in our practices. We have no control over what our patients, or their family members, do before arrival. Many people have issues with dental anxiety, and it is not unheard of for a patient to “premedicate.” In my many years of practice, I have only used my crash cart once, when a patient’s spouse had a cardiac event in the waiting room.
2. Public Health Impact
Opioid overdose rates have been a significant public health concern in many places. Carrying Narcan contributes to community safety by being prepared to intervene in overdose emergencies, reducing the risk of fatalities.
The CDC advises that Narcan spray should be in every store, restaurant, school, community center, etc. Just like AED requirements, it is possible that at some point we may be mandated to carry Narcan.
3. Safety
Narcan is relatively easy to use. The CDC states that it is safe to administer to all ages. Including children who may have gotten into a parent’s medication or an older patient who may have accidentally taken too much of their prescription.
You cannot give too much. If a patient has not taken an opioid, no harm will come to them. If they have, then it may help.
4. Legal Protection
Many dentists have worries about legal repercussions. In most jurisdictions, there are legal protections for individuals who administer Narcan in good faith to someone experiencing an overdose. These laws are often known as Good Samaritan laws and are designed to encourage bystanders to intervene in emergencies without fear of legal repercussions. According to the Government Accountability Office, only Texas, Kansas and Wyoming do not have these laws. All of these states have Naloxone Access laws encouraging widespread availability.
5. Lack of Understanding
Most dentists do not have the training to recognize an opioid overdose. Recognizing the signs of an overdose can save a life.
Signs of an opioid overdose may include the following:
- Having small, constricted “pinpoint pupils;”
- Falling asleep or losing consciousness;
- Being slow, weak or not breathing;
- Choking or making gurgling sounds;
- Presenting a limp body and/or cold and/or clammy skin; and
- Showing discolored skin (especially in lips and nails).
While carrying Narcan is crucial in certain contexts, it’s also essential to receive proper training on its administration and understand when and how to use it effectively.
ALWAYS REMEMBER TO CALL 911 FIRST.
Pharmacies or healthcare providers often offer training sessions on Narcan use for individuals interested in carrying it. Also, the CDC has a YouTube video if that is your best way of learning.
By working together, sharing information about the use of opioids and providing effective alternatives, we can make a difference on the growing opioid abuse crisis in America.
Learn how to stop opioid addiction with the removal of wisdom teeth here.
As seen in Dentistry Today.