Resident's Question Continued: What Happens to an Addict After Being Revived with NARCAN?

In continuing our investigation into the ongoing heroin epidemic, I was contacted by Jonathan Berube, a former EMT (not of Lebanon Rescue) who currently works as a Alcohol and Substance Abuse Counselor. His generous offer of explaining addiction and the use of NARCAN a bit further was so kind!!
While we had former reports of NARCAN taking up to 20 or 40 minutes to work, Berube says that if it's taking that long, the patient is not overdosing on opiates.
According to Mr. Berube, when a patient is overdosing on opiates and NARCAN is administered intravenously or intramuscularly (IV or Injection), by medical responders, the medication should have an effect on an overdosing opiate user almost immediately. If the patient is known to be overdosing, and the first dosage does not take effect by 3 or 4 minutes, another dose is administered. in fact, doses can be given several times, 3-4 minutes apart.
The drug puts an opiate overdose patient into instant withdrawals by targeting the opiate receptors in the body and blocking the narcotic from adhering to them, thus, instantly reversing their effect.
"Often times they wake up, and then throw up," Berube stated, "and usually all over you!" He went on to add that because you have just "ruined their high", the patient will then usually become very argumentative or even combative. "It's hard to convince a combative patient to go to the hospital for treatment," Jonathan added, "but they really should go, because NARCAN is only a temporary fix." Once the NARCAN begins to wear off, depending on how much of the opiate they had used, the opiates in the patients system can begin to reattach themselves to the opiate receptors and the state of "high" or "euphoria" can return. They can even enter into another overdose situation and need a second NARCAN dose 1/2- 1 hour later when their body begins to overdose once again.
Mr. Berube says there's always a question when you come upon someone out cold in a car or elsewhere, when people aren't sure if they're in an overdose situation from herion, another opiate, or if there's another problem, such as diabetic coma or physical illness. "If we're unsure," he said, "we give what is called a "coma cocktail"." The "coma cocktail" is a mixture of drugs, including NARCAN, and dextrose (sugar). These products are designed to work on many levels toward bringing a patient back to consciousness.
But what if you give NARCAN to a patient who is unconscious and not overdosing on opiates? According to Berube, you can give NARCAN to anyone, and as long as you give it as directed, in small doses, it won't have any effect on them.
While thinking about NARCAN, it came to mind that if the patient has NARCAN and returns from overdose, but reenters overdose status after EMS responders are gone, what then?? Well, that would be why sometimes there are multiple calls to the same address over a short period of time.
There is a new drug that is being looked at in the fight against opiate overdosing, it is called Vivitrol and according to Berube, it is a longer acting version of NARCAN. Vivitrol is an injection that a opiate dependent patient gets once a month. It works the same way as NARCAN, in that it blocks the opiate receptors in the body, not allowing the opiates to attach, and therefore even if a patient were to take opiate medications, they would not experience a high from the drugs. On the outside looking in, Vivitrol sounds like an opiate addict family's dream drug, however, Mr. Berube says it can quickly turn into a nightmare if the opiate dependent addict is injured, as the Vivitrol would also block the effect of pain relieving drugs administered at a hospital or for surgical reasons. Also if the opiate addict were to use, they wouldn't feel the "euphoria" they are seeking and they may overdose themselves trying to get past the effects of the Vivitrol. Mr. Berube suggested that if a patient were on Vivitrol, it would help a lot if they were to wear a "Medic Alert" bracelet, much like those worn by diabetics or hemophiliacs, telling that they use Vivitrol so that Emergency responders would have some understanding on how to treat the patient.
Jonathan and I had a discussion regarding why the offenders are not arrested by police who attend overdosing events. "Addiction is not an easy thing," he answered, "It's a lifelong struggle, the police are trying to help, not put everyone in jail. They want people to call 911 and get help if they're overdosing. If you keep trying to punish people, they will just stop calling, that's not what we want to see happen."
We also talked about Governor LePage's recent conversations with Maine law enforcement, health and welfare, and public health officials. "The Governor's plan for hiring more police officers is not going to work," said Jonathan. "The drug problem in Maine is much more complicated than NARCAN or more police is going to fix."
Thank you to Mr. Jonathan Berube for taking the time to speak to me and fill in some more of the blanks on heroin and opiate addiction and the use of NARCAN.