On an almost daily basis, an irrational, irritating debate seems to break out within the online EMS community. Typically it has to do with one of two topics, arming EMT and paramedics, and the debate on the ethical use of Narcan. While I would love to open two cans of worms today, there is only so much ranting that I would be willing to subject you, the reader to, so we are going to stick with the discussion on Narcan today.
It is no secret that we are giving Narcan to patients at an alarmingly high rate. Compound that with the amount that the public themselves is using, and the number gets even higher. But there are some things that the EMS community needs to concede and understand about Narcan use, addicts, and ethics when it comes to administering the medication.
Giving Narcan kills more people than it saves
A few years ago, there was somebody who I will classify at this point as an “online EMS personality” who shared his thoughts on the use of Narcan, feeling that bringing addicts back over and over again would result in them pushing themselves closer to the edge because they knew that we were going to be there to save them. I shared my thoughts on that topic then, and my feelings have no changed because the evidence has not changed. There are a lot of things that are making the opiate addiction problem in this country worse, and EMS giving patients Narcan still is not one of them. Narcan is nothing new. It has been in our toolboxes for a lot longer than most of us have been in the field. And its not going away.
“All that we are doing by making Narcan available to these people is enabling them to use heroin”
This argument always leaves me scratching my head. Recently, I gave D50 to the same patient for the 5th time in two weeks. Once conscious, I asked them “did you go see your doctor like you said that you were last week?” Their response was, “I was going to but I did not have time.” I asked if they had plans to go in the next couple of days, and they said “Maybe, we’ll see.” Me giving Narcan to a heroin addict enabling them to use more drugs is about as relevant an argument as me giving D50 to that diabetic patient is enabling them to continue to eat poorly and not take better care of themselves.
People make bad choices all of the time. If a person having an active STEMI wants to refuse care, we can fight them all that we want, but it is still their right to make a bad life decision. If someone with seven stents wants to have a Big Mac for lunch everyday, they are well within their rights to do so. That does not mean that when the STEMI patient calls back and says, “wait, I changed my mind” we don’t tell them “you should have thought of that before!” or when that guy is on his third Big Mac, we should not stand over him and say, “you should have thought about what would happen before you asked for extra cheese.”
We are there to treat people and care for them. Not to judge them.
“Who is going to pay for their care?”
Part of me wants to say, “That is not your concern” because frankly, its not. If we are going to look at their care and potential non-payment of it, should we also be looking at how we care for the under-privileged who suffer a sudden cardiac arrest? I am sure that there is not a medic out there who, while five shocks deep into a V-Fib code in state funded housing says to themselves, “If we get ROSC who is going to pay for all of their care?” We don’t care about it when we are coding them, why should it matter when we are providing other care?
More importantly, payer concerns like this one are yet another reason why health insurance reform should be such an important topic to everyone, regardless of race, creed, gender or economic status. I do not think that the alleged Affordable Care Act was the answer, and I am skeptical about what the current administration will put on the table. I also wonder about the setup and sustainability of single payer health insurance in a nation where for-profit health care dominates the industry. Regardless, we need something better than what we have now.
“They should lock these people up! Why aren’t there any consequences for their actions?!”
In a nation where allegedly non-violent drug offenders were pardoned so frequently over the last couple of years, and over-crowding in our prisons is an almost constant problem, why would we ever push to put more people there? More and more communities are decriminalizing those found to have overdosed, and rightfully so. If they focused on that, there would be very little time left over for actual police work. Repeat offenders might be a different story, eventually. We need to guide these patients to definitive treatment, as Narcan administration and resuscitation is nothing more than a short term fix. Incarceration though, I don’t think that is an answer to this problem at all.
Ultimately, paramedics and EMTs need to remember why we are here. It is not our job to pass judgment or treat our patients based solely on the poor life choices that they have made. We are there to care for them to the best of our ability and see that care through until we can ultimately hand them off to someone else. Everyone is welcome to have their opinions. Heck, I am one of the most opinionated people that you will find, but once I hit a patient’s front door, my focus turns to providing them with whatever care that they need, regardless of who they are.
Remember that. Remember why you do this job, and remind yourself why every day.