Sawbones: A Marital Tour of Misguided Medicine - Naloxone

Episode Date: July 20, 2021

Naloxone is known as the “life-saving drug,” since it can bring someone back from an opiate overdose. Dr. Sydnee goes through the history of this hero drug, how it works, and the recent struggle of keeping it accessible in some communities. Check out the Free Naloxone Day Fundraiser: Bit.ly/SawbonesNaloxoneMusic: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. Hello everybody and welcome to Saw Bones, a marital tour of

Miscited Medicine. I'm your co-host, Justin Macaroy. And I'm Sydney Macaroy. Well, Sid, here we are again. Justin, I'm really excited to do this week's episode. Oh, yeah. Yeah. It's a, it was a really interesting thing

for meter research and learn about and I think it's a really interesting thing for meter research and learn about. And I think it's a really important thing and something I'm really passionate about. And I'm really excited to share it. You've been talking about this stuff a lot lately. That's right. So I'm interested to learn, get a little bit more insights,

more trivia that I can use to impress you with. Although if you tell me it on this show, I probably won't be able to do that. You can impress other people. Well, other people who aren't me, because I told you, and also who don't. You don't mean the information. Also, who don't listen to the podcast,

because then they will have heard it directly from me. So they'll know that I told you. But there are probably some people who would listen to you and don't listen to them. Anyway, I have been thinking about how it's really interesting that I feel like, and I don't know, I imagine this is true outside of the US as well, although because in the US we have direct to consumer advertising of medications, maybe this is a little more

common, I don't know, but I do feel like certain drugs, medications, certain prescription medications, or over-the- the counter, I guess, can develop almost like personalities, like cultural connotations. Yes. Right? Yes. Some of them, I have realized, as I was trying to think about different ones, some of them are probably unique to those of us who are in the medical world.

Because you guys are interacting with them a lot more. And yes. And so like, I started thinking like, sort of like, Cumin dinner, war friend, you may know it as, which is a lot more. And yes, and so like I started thinking like, sort of like cumiden or warfriend, you may know it as, which is a blood thinner. And it's like the old trustee annoying standard for treating clots or clotting disorders. It's been around forever, you can count on it, it works, but it's sort of like a grumpy uncle

that you don't enjoy dealing with, because you got to do all these levels, and it can be really tricky, and if you eat too much spinach, it messes with it, and so like, you don't enjoy it, but you would really hate to lose it, because for the longest time it was the only thing we had. Or like, I think I always think of Doxycycline as the most adventurous antibiotic. It's kind of a... It can get you out of a lot of tight spots. Yeah. Yeah, right.

Is it adventurous? You've got just, you know, regular olcellulitis or a COPD flare or maybe you have an exotic tick-borne infection. Doxycycline's got your back. So I always think it's very adventurous or like chlorothaladone is HCTZ's less cool, more clumsily named underappreciated sibling. These might just be things that are in my head. But there's some like, like if I buy stingers at the flying J, people assume just because

I'm buying piles of trucker speed that I'm going to need to drive all night and get cranked on stingers. Is it just caffeine? I don't know. I mean, it's gotta just be caffeine. I mean, like these days, if it's over the counter, it must. You wanna do an episode or something?

Let's do an episode on traffic speed because I would love to know that in three overlord. I would love to. Have you ever seen three overlord? No. I'll make sure for you to show you three overlord. You can find. Oh my goodness. It's two different street manufacturers having sex.

It's a, it says exceed Viagra and Seattle. And people think just if I'm taking ED pills that I, you know, maybe I just want to see what else is out. You know what I mean? Right. Okay. This is an exactly what I meant. But maybe I just like the way trucker speed helps me parent my kids. Is it called that?

Is that the brand name? Or is that the brand name of it? Trucker speed? Yeah. No, I think they're called stingers. Okay. There's lots of different ways. I don't think I'm just gonna, on behalf of you,

I'm gonna apologize to our truck driving listeners who perhaps would not like it, that this, whatever this if you should supplement is I'm I guarantee you truckers shall we out if you see a bunch of a fedron HCl tablets at the at the uh they can't just sell that over the counter I'm telling you it's truck speed maybe it's illegal now you can't sell that You can't just sell that to people. Okay. Most of these only can exist in the confines of the medical world, obviously, not this thing.

I'm sorry, my sister is history. That you're interested in. That's right. But I think that the drug I want to talk about, the medication I want to talk about today, Naloxone is an exception because I think it is taken on a cultural connotation that is bigger than just like, here's a medicine that does something in your body, right?

I think it is like, it's the hero of drug. Carrying the lock zone is making a statement. I mean, it is a practical necessity. It is an important thing to do. It's like learning basic life saving, you know? It's an important thing to do as a's like learning basic life saving, you know, it's an important thing to do as a member of a community. And it says something about you, you care about people. You care about people, even if they're engaging in behavior that might harm them, you know,

even if they are acting in a way which puts them in danger, you care about their life despite that and we'll do what is necessary to help them out. That's sort of the message it sends, right? Like, you carry an eloxone, you save a life, that's like a rallying cry for harm reduction. It's important. It is a meaningful act and it's a medication. And so I started thinking about, like how did an eloxone evolve into that? Where did it come from? Who

invented it? What's the story of it? And how did we get to a point where like people where, you know, hats and t-shirts and shoulder bags and these days masks that say, on my heroes carrying a lot of like, where did that come from? So I wanted to look into that story. Before you tell the story of Naloxone, you kind of have to, there's a precursor drug that sets the stage for it. And this takes us all the way back to 1944.

There was an article published in the Journal of Pharmacology and Experimental Therapeutics, which sounds really exciting, but probably isn't. Do you think it sounds exciting? Experimental therapeutics. Yeah. I mean, yeah, it does. I guess it is exciting in a sense, yeah.

Heart and Macaulay published an article called The Pharmacology of Inalno Morphine, as compared with morphine. And basically, what they had done is taken morphine, the molecule that is morphine. They'd taken one piece off of it called an in-methyl group and they had put on an in-allial group. All you need to know is they started with the molecule morphine and made one little switch. Okay? That's the point.

And basically then they gave it to rats and stuff and saw like, how is this? What does this do? There's so much of the wrap. We broke this molecule. We'll see what it does now. Now we're going to give it to you. Basically, what they found is that if you messed around with morphine to make this compound, you got something that still helped with pain some but less. So that seems not as effective, right? Like we made it, we made it less good for hurting,

but it had the opposite effect on respiration. So as we're morphine, if you take a lot of it, can slow down your respiration, your breathing, and way too much cause respiratory depression, meaning you stop breathing. This seemed to stimulate respiration, at least temporarily, making breathe more, make you breathe faster. It also caused the opposite effect on the gut. Whereas morphine,

most opiates can cause constipation, just did the opposite of that. Generally, it seemed to antagonize a lot of what the morphine did. What morphine was doing, it was stopping. They published this was doing it was stopping. So it was so they published this article and it was like, fascinating. Interesting. Good job, Wes. Good science. And then like a decade past. Okay. Because nobody, nobody, I mean, a lot of the time, that's what's really cool. We talk a lot about basic science on this show that doesn't necessarily like what, what are

you going to do with that information. And I think that's the really interesting part about it is that by exploring these things in the world, sometimes you don't see the direct clinical application, the translation of this research. But then a decade later, you do. And that was what happened with this specific compound, which they introduced as nalorefine branded nalline. And though it was at the time this compound, which again is like the precursor to naloxone, this is not naloxone, it was found to have some disturbing side effects.

In addition to these sort of good things it could do, it also can cause some confusion, some hallucinations, some anxiety, some general feelings of, like, unhappiness and unwell. But it had found a niche. It had found a place to exist. I mean, because if a drug is going to be branded and sold, it's got to do something that we needed to do. And this initial compound didn't really well nowling

Had been worked with by some doctors in Lexington. They were working with the United States public health service Giving it to people giving this nowling to people who had Addiction to opioids and they observed that it caused immediate withdrawal symptoms Okay, so someone comes in they're chronically using some sort of opiate heroin or morphine or whatever. They give them this medication and it immediately puts them in withdrawal. How on earth would that... Well, how on earth would you run that out? You give it to somebody. Okay, got it. I mean, that's it.

Thank you, Simon. They give it to someone. That well, based on this paper though, because I mean, as I said, like it increased respiration, it reversed constipation, like you could see where somebody went, well, maybe it will undo the effect of the opiate, which it did. Um, and there was a thought, well, this could reverse an overdose. That's pretty cool. Yeah. But that really wasn't its primary function. Because before doctors saw widespread use for it, the police did, specifically the police in Oakland found a great use for it. Well, great as debatable.

They felt like it was a great use. Time magazine published an article about this in the Christmas Eve issue in 1956 and it's called drug detector. Okay. in the Christmas Eve issue in 1956, and it's called drug detector. The California Bureau of Narcotic Enforcement began using Nalline in what they called the Nalline test to figure out whether or not a person that they were arresting or wanted to arrest were holding was addicted to opioids. It was a drug detector. We are trying

to figure out if you have an addiction. Until then it was really hard to prove. You would ask people they may or may not tell you drugs were illegal. So, so what you would do is try to hold people long enough that they would see if they would go into withdrawal, which is terrible. And also, I mean, if we're being honest, often they didn't have a reason to hold people to like, detain them for that long. So, and that what they wanted to do is try to convict them of an narcotic related crime. So the Nalline test, which is, you can find a detailed description of this. It's, it's, you can find it for free on the internet, published by Dr. James Terry and Fred Brahmuller in the California Medical Journal of 1956.

Basically, what you would do is if you had detained somebody who was suspected of using an opiate, you would do your history and physical exam. They did do informed consent. This wasn't, and now this, that being said, you have been arrested, and you are in police custody. So I think, anytime you're talking about, yes, I think you have to allow for the possibility that you are going to be co-erced into this, but they did, in theory, obtain informed consent from everyone who received this gnarling test. And before they would give you it, they would measure your pupils, see what their diameter was. Okay. Then they

would give you three milligrams of gnarling, weight 30 minutes, and measure your pupils again. And basically, there were three possible outcomes. If your pupils got smaller, constricted, that means you don't use chronically, because we have just given you this sort of opioid antagonist, which does bind to opioid receptors, so we'll constrict your pupils. But you didn't have anything else there, so it just did the thing it does, constricted your pupils. So if you didn't use any drugs, your pupils would get smaller. If you do use drugs regularly, meaning in their mind you had addiction, then your pupils

would die late. Okay. Get bigger. And if they stayed the same, that meant that you use drugs sometimes, but not all the time. So you weren't addicted, but you still may have used some opiates. Now, didn't you say that you could have some pretty harmful side effects? Like, couldn't this be pretty messed up? Like, yes. It could.

Some different things that happened in some of the, because you can read in the article about it, a few of the examples, they give you some case studies of people receiving the test, and you might get nausea, vomiting, anxiety, sweating, somebody passed out upon receiving it. The protocol was basically to evaluate the patient's pupils and then once you had deemed

whether or not you thought that they were addicted to opiates, you were supposed to give them an opiate to reverse the effects. Giving them the opiate was based on what you gave them was based on at that point asking them what they use and how often and how much so that you could either give them morphine or hydromorphone dilated, which is even stronger enough to try to end the withdrawal symptoms basically. And it took different doses. And again, it's all detailed.

Every patient kind of got a personal experience, so to speak. This is Horde. And I'm also shocked that it ever came up with anything that would be admissible in a quarter of a block. It all seems so. The legal side of this, and that's not my area of expertise. And I really wanted to focus on the story of Naloxin. But the legal side of this, I really

want to dig into more because I don't know the answer to that. How you could measure a pupillary response and deem addiction. I mean, especially, I mean, this is it. This is the data. This is it. They were doing it collecting the data

and also saying, yes, you should arrest this person for an narcotic-related crime. Yeah, it's part of stretch. Yes. Part of the protocol was that you don't need to continue to wait to see if they like go into further withdrawal symptoms, which would have been really horrible. In part because that's terrible and in part because there was a belief that you could hide them.

In hide what? You just hide those symptoms. Patients can will the way. Oh, like with a lie detector. How you can fake that? Yeah. You can fake this. detector. How you can fake that you like fake this. But the pupils you can't fake. And then of course the side effects of Nalline made it somewhat less useful for much of anything else. This is the only place that it and when I say commonly

this was not widespread use across the United States. That's why a lot of when you hear the accounts of it being used are to this one specific part of California where it seemed to have taken hold. But not a lot of other places were excited about this. Probably because of all the side effects and it's really hard to, I would imagine to, yeah, take to before a judge. So it wouldn't be until the 1960s that the next paragraph in our Nooxone story would be written. And I want to tell you about that part, which is a happier part, I think. Oh, good. It would almost have to be. But before we do that, let's go to the billing department. Let's go.

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Have I not talked about what the law's on is for? I don't think you've talked about it that yet. Should I say that right now? No, set now it's a twist. Now it's a Paul Harvey episode. Now you're on the edge of their seats. What does this stuff do? Okay. Well, I need something, should I be taking it?

Everyone should be carrying it. I'm gonna start. I'm gonna be taking it every day with my multiple. No, you should be taking it, necessarily, but you should be carrying it. Okay, so as we've covered this, Nalline test, this Nalline medication was being used for, I mean, I would say that the ethics of this are, well, it's unethical is what I would say.

I would say that this test is problematic for a number of human rights reasons, let alone that addiction is a medical condition and a disease and not something that should be criminalized. And all of that, which I think everyone knows how I feel about that. The now-eantest was certainly not going to be very popular and medical ethics did away with that. Of course, although it existed in the literature well up into the 70s as something that you could do. It wasn't until the 1960s, Dr. Jack Fishman would bring something better along. Dr. Fishman was a cancer. It's a very 1970s name. It is. Dr. Jack Fishman sounds like,

like if you just grab a Dr. randomly in 1971, it would be like, oh me, I'm Dr. Jack Fishman obviously. I believe his full name was Jacob Fishman, but he went by Jack from all the articles I read. He was a cancer and steroid researcher who actually immigrated to the US as a child escaping the Nazis. So he was researching morphine derivatives. Again, a lot of the things with morphine were we knew this was a... And we've talked about this sort of in the history of opiates.

You have these medicines that as soon as they come on the scene, we realize, oh my gosh, we can treat pain in a way we never have been able to before, which is amazing and important. But they have all these problems, right? Like you can get addicted to them, you can take too much and you'll stop breathing. They do cause horrible constipation, which doesn't sound like a big deal until you've experienced really intense serious constipation when it's a huge deal. So he was researching this, looking for alternatives, and he discovered a compound called naloxone. And in addition to, you know, not causing constipation, which is great, even more importantly, it was excellent at reversing an overdose without all of the symptoms that nowling would cause.

It was very excellent. So if somebody has taken too much of an opiate medication and it could be something you might get in the hospital like morphine or a percussed or a norco, those weren't around back then, but you know, things today or something like heroin, whatever it was, opium, you could administer naloxone and it would increase the respirations, a person would start breathing again, and it would save their life. So reverse an overdose prevents someone from dying of it. And the way this works, in case you're curious, I don't know if you are, is our body has receptors for opiates.

Right. We have little like tendrils They're reaching out for your brain and when the opioids come in there's part of your brain. It's like oh Oh, give me give me that it's that place and I'll do some different things with it If you look at pictures in like science textbooks I always think they they sort of draw receptors like little cups Okay, and then they have the little like molecules come in and they're like little balls. And they just like, that's for me. Right in the cup.

So we have little cups ready to collect opioids. And that's because we do have endogenous opioids. Things already in our body that are like opioids that make us feel pain relief, make us happy, make us feel euphoric, like those are things in our body. And then we found chemicals out in the world that work on those receptors. That's how most things work. So, you have those. When they're filled, when all those cups are filled up with something like morphine,

some sort of opiate or heroin or whatever, you can overdose and stop breathing. So, and these are called opioid agonists because they work like those endogenous opiates. They like those receptors. They add, they bind to them. Naloxone is an opioid antagonist. It antagonizes the opiates, like knocks them off their cups. Get out of here. Get off that cup.

That's my cup. Because my cup, I'll sit here. Yeah, I'm gonna get you out of there. And then that wakes you up and you breathe. And maybe your life is saved. And that's how any antagonist, there are lots of different antagonist medications, but specifically in this case, that's how an opioid antagonist would work. Go in, knock off the opiate and keep you from, you know,

do we have anybody like this for like alcohol or weed or other drugs? We, I don't, you know, I don't know of one for marijuana for cannabis, but I mean, yes, for alcohol. I know that because there's that one episode that gets smart where he had the pill that absorbed all the alcohol. There are also medications, well, I don't want to get into this too much,

but there are medications you can take that every time you drink alcohol, you'll have a very violent reaction to it. A very, you'll get very sick. And so That's supposed to discourage you from drinking alcohol. The idea of an antagonist is well known throughout pharmaceuticals. If we have something that we need to block or stop, we create an antagonist medication, which is similar to the molecule that binds to it, but blocks it in some way,

and doesn't have all of the effects of the original molecule. So Dr. Fishman invented this in the 60s. He actually didn't patent it until 1971 and there wasn't a lot of widespread use for it initially because it was prescribed and administered by healthcare professionals in healthcare settings. So really the only place this was coming into play and it was also given intravenously IV initially. So the only place you were seeing this being used

was in an emergency room if someone who overdosed happened to get there in an up top. Which is really the use right, you've limited the use case for it because it's like you've overdosed, but also someone knows enough to get you to the hospital and can get you there in time. And then.

And isn't afraid of prosecution for bringing you. And yes, all those things. And so you would have it in the hospital because sometimes when you're doing a surgery or a procedure or just when you're trying to treat pain, you get too much pain medication. Someone has an overdose in the hospital. This happens.

People have different tolerances. So you might use it in the hospital in that case. But it really wasn't something that was a tool to help stop overdose on a large scale because it wasn't in the right places. It also wasn't the best form. It's hard to administer an IV medication. Right. Go find the vein, everything.

Yeah. So over the years, two things would then happen to Naloxone that would transform it from something that was really just used occasionally in the hospital by a medical professional into this sort of wonder drug as we look at it today. The first thing is that it had to be available in other forms. So it went from just intravenous to something

that you could give as an intramuscular injection like you would get a flu shot, a tetanus shot of vaccine, I am a sub-Q injection just under the skin, like if you give insulin, that's the same kind of thing. Really? Mm-hmm. And finally, an nasal spray, as we'll get to, the easiest way I would say.

It's the easiest way to say, it's not gonna be the trickiest one, because don't you have to be able to inhale to like, go to the inhale. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test.

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It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the easiest way to get to the test. It's the little there's a little pro tip for you. You generally do not need to like snort when you squirt a nasal spray after nose. No, it is best to aim it sort of towards the outside

border, upper outer border of your nose up against the wall and squirt it. And if a little bit runs out, that's okay. If you just like sniff it, you're just going to swallow it. Well, look at that. Yeah. So it's okay. We don't need the patient who is receiving the naloxone nasally to sniff it out. Got it. As it became easier to administer, the next thought that arose is, well, I mean, wouldn't it be better if it were at the place where someone actually had the overdose? Yeah, I mean, why we need to make it easier to access. Most people who experience an overdose don't do it in a hospital, you know.

And you don't have a lot of time when someone has overdosed to get them the naloxone or get them to the hospital. And you can lose a lot of people in that interim. So even though we had this life-saving medication, it was mainly confined to hospitals. Even after 1983, the World Health Organization added it to its list of essential medicines, meaning like these are medicines that everybody needs to have access to all over the world. Nooxone has been one since the year I was born, but it took a long time

to convince people that we needed to have access to it out in the community. It really started in Italy in 1991. That was the first place where they started like giving public access. Like once you receive the training, you can have some the locksome to take with you. The next places to follow suit would be the UK in Australia. And we've talked about the history of harm reduction in some of these places, especially in the UK, and how like the idea of any positive change, any step in the right direction is worthwhile, no matter how small or, you know, how far you still are from that recovery part, it's still the right thing to do. The US would finally start in 2001, the first state, I know, the first state, so the year

I graduated from high school, my like early education. So in New Mexico in 2001, they actually began to allow people to receive training and get a prescription to carry an aloxone to have an aloxone out in the community. Is there other drugs like that where you get a prescription to carry? I use epipens.

Epipens? I can't think of a lot of other. Dean especially training for heavy pins? We just describe how to do it. If you think about it, if you give yourself insulin injections or if you give somebody in your family or your friends insulin inject, if you're responsible for that, we teach you how to do it. I taught many patients how to do it in the office or I would have, we had a pharmacist

that worked with us and she was always had to do it in the office or I would have like, we had a pharmacist that worked with us and she was always happy to do it. Somebody would teach you how to do that. But you didn't need like any sort of class or course. You know, I mean, it's a pretty, a lot of these things are pretty easy. They let people use those wild paddles. You know what I mean?

Like those are really easy. I really use those. Like, I really want those. Those are widely available. That's what, which is wild. Just to get those right work, Cooper, and get them. Just no problem. And I'll go ahead and say this,

because I did want to really make this point. Unlike, I would say a lot of these other things we just like insulin or an EpiPen, naloxone, what is really great about it is that if you think someone has overdosed, but you're wrong and you give them naloxone, it will not harm them. Oh, okay.

So it's a fairly low risk thing to attempt if someone has stopped breathing and you're trying to save their life. Naloxone is a really low risk intervention in that sense. Unlike giving someone insulin, you can really do a lot of harm if you don't do that appropriately. We'll give the right dose. Yes, Memento is the best reference test for that. A same in the documentary, Memento. So by 2003, San Francisco and Chicago had both, those both have well established harm reduction

movements at this point, had started the practice of publicly accessible no locks trying to get no locks on out of the hospital and into the hands of people who need it. And basically, all you have to do is train someone to one, recognize an overdose, and then two, administer the no locks on. And then three, call 911. Sure.

This is actually really important. And this is true in the state of West Virginia. I don't know if this is true nationwide. But if you receive training in the Lockstone administration, you'll find this out here. You do have to call for an ambulance after you administer a Lockstone or you could be held liable. Oh, weird. Okay. Because no Lockstone can save a life, but it does wear off. or naloxone, or you could be held liable. Oh, weird, okay. Because naloxone can save a life, but it does wear off. And for some people, once it wears off, the overdose has pat, like they are out of harm's way, and they'll be okay,

I have also seen other people who receive the naloxone wake up, are breathing fine, seem okay, and then relapse about a half an hour later, or thereabouts. So it's important that you do call medical professionals, like you call for help, because otherwise you might think you've helped that person, and then you leave the scene, and they relapse. Oh gosh, okay. Yeah. So that's really important to know, and if you do receive training, they would tell you

that. So now it's recommended, like you give it to obviously, well, anybody, anybody should carry it. But people who use drugs or people who are prescribed chronic narcotic therapy should have naloxone because overdoses do happen even if you've been taking a medication for a long time for a variety of reasons. For friends and family members of either people who, you know, are using something like heroin, like somebody with addiction or someone who is again on chronic opiates

for some reason. Community members, a lot of local health departments will offer free training sessions. Ars does. You just sign up, you go in for free, they teach you, here's what an overdose looks like, here's how you give an alloxone, try it out, they've got some testers, and then they give you an alloxone to take with you so that you can carry it with you. And they also, in a lot of these places, wood pass laws to stipulate that, you can't be prosecuted for trying to help somebody

with the alloxone. You can if you don't fall through, but you can for, I mean, you're not gonna get in to get in trouble because you're getting somebody in a lock zone. You're saying don't check it out halfway through. If you start it. Well, I think it's important to know that for a lot of people in an overdose, giving them the naloxone isn't 100% fixed, you know, because I've seen it. I have seen people who've received naloxone and are awake talking to me and then right

back out. It's a protocol just another one. If you're still there in that case, yes, then we give more niloxone. In the cases that I have managed, I have had to give more niloxone because they've either been in the hospital. I've been monitoring them awaiting EMS. But that's why you call you mess, right? The sad part of this story is that Dr. Fishman would actually lose a stepson to a diction when he

overdosed on heroin in 2003. His wife, Joy, became somewhat of an advocate for Naloxone, realizing later as she saw some of the forms that were introduced, that how helpful this would have been, had someone had that wherever it was that he initially overdosed, and he was found outside the ER, and it was too late by then. But in 2014, Evesio, which is an auto-injector, which means it's like, you can look up a picture of it. It's like a little cube type thing that talks to you and tells you what to do. Oh, nice.

I can use that for everything. Yeah. I mean, it's just like you said, like the paddles, like the defibrillators out in the field, they just tells you, you open it up and it says stick this pad here, stick this pad here, now back away, now push this button. You know, it tells you all that stuff. It's the same kind of thing. You open it up and it talks to you and tells you exactly where to put it and what to do with it. So that's really helpful or really helpful. And then there's also the nasal

spray, which is the Narcan, which I feel like is the most well known. That's been around since 2015. It's kind of come to Xerox. It is. Narcan has become sort of synonymous for the medication, the generic name, which is naloxone. But it's because it's so easy. It's so easy to carry that nasal spray. It's the one that I choose to carry personally. I'm very comfortable with its use. And they all work well. I mean, the thing is like whether you're actually getting, I mean, you might actually get like a vial of naloxone and a syringe. Those are out there. We have those that we hand out.

The auto-injector, there's like a nasal atomizer. I don't see those around a lot, which is slightly different than the narcan, but same sort of idea. It's a spray. And then the actual narcan itself, they all work. They all work. And again, if you think someone's overdosing, you're not going to harm them by giving them the lock zone. It's okay to do it again. And they teach you that in the

training. Sometimes you'll require more than one dose. Who's the other side effects like the hallucinations and what happened? No, I mean, the problem with the lock zone that, I mean, the main problem is that as it will stop your overdose, but you also may experience some withdraw symptoms at that time. But like I said, it is also short-lived, which is why you have to call EMS after you administer it. It's not going to be in your system for too long, but it would save your life. So I would highly advocate, like if you check out in your area, I know that here in Huntington, it's really easy to receive Narcan training and be able to carry Narcan with you.

The R state, West Virginia, has what's called a standing order for Narcan, meaning that you don't have to have a prescription to get it. You can prescribe it to somebody to take with them, but you don't have to have a prescription. You can go to the pharmacy and ask for it. Is it really expensive? Like every person? It's not very expensive and you can get it for free at a lot of places. Health departments will hand it out for free. The place where I volunteer, Harmony House, hands it out for free. We have a lot of community organizations that will hand it out for free. It's, you

will find it many places. If it is something that you're interested in it is not hard to I mean like I just Google that of curiosity Narcan training near me and there are tons of different websites that will tell you where your closest Narcan training is Where you can get no lock zone Like that there's all kinds of getting a lock zone now, but we're gonna mean there's tons of different places that you can go to find out locally where you could. And it's so easy to be trained and you might be in a situation

where someone has overdosed out in your community and they could die except you're there and you're holding a nasal spray, which takes no time to learn how to administer and you could save their life. Nice. Yeah. I'll do it. I'll get the training.

Get off my back. I'll do it. I mean, I can teach you. Oh, but I don't need the training. I'm just gonna get some. I'm just gonna get a bunch. I have some. I get really around me a lot of my agency here, said.

Okay, I'm sorry. You go do it. I feel like if this is so important and all your heroes have an log zone, you would have enlisted me a lot of my agency here said. Okay, I'm sorry. You go do it. I feel like if this is so important and all your heroes have an lock zone, you would have like enlisted me a while ago. I feel like there is a lack of trust and I would like to address it now in a protracted form. I guess you could, you know what, Justin,

even you, listen, hey listeners, even Justin McElroy. The greatest hallway. That could be paid to the kids of use. Listen, hey listeners, even Justin McElroy. That could be paid to the use of use. Learn how to use Naloxone and save a life by administering it. Even Justin could do it. Wow, let's wrap up Sydney. I feel like we've extended past the point

where this is entertaining for our listeners. They, you know, they sensitive they get about, they're a hero, they're podcasting here at Justin McElroy being sort of torn down. And I just on a personal note, I did want to throw out there our area of the country and this is not unique to just us. I know there are other areas who have had similar issues, but the addiction is a big problem here in West Virginia. And locally, our harm reduction programs are constantly

being threatened by real scumbags. Politicians who refuse to understand the science, who refuse to understand that we're trying to help people stay healthier and stay alive and work their way towards recovery on their own terms and their own time so that it's something that is long lasting. And that, you know, Naloxone is a huge part of that because it's life-saving. Again, it's life-saving. We had a front page store, we had a front page of the newspaper in this week's show where the top story, okay, the story below the fold was that our stupid, morally bankrupt, A.G. Patrick Morrissey is suing the Biden administration

because there's no border wall to keep opioids out of West Virginia because that's how it happened. That's why we have a crisis here. That's how it happened. Is it coming up from Mexico? Not the pill mills and the pharmaceutical manufacturers and the notes. You don't, you absolute don'ts and then above the fold

Like like to say above the full same day shutting down that the the harm reduction programs had taken effect like Yeah, the we had a temporary stay the ACLU fought heroically to stop the the bill from going into effect But the day the bill from going into effect, but the day. So yeah, we, what this day, this is our way saying, but yeah, I hope we can. Our harm reduction program is still alive. I don't know if you're a local listener, but the rumor went out that ours was closing.

It's not closing. We are doing everything we can to keep it alive. But if getting the lock zone to people who need it is something that you care about and you have a couple bucks at Cabal County, the Cabal, the county we live in is participating in free Naloxone Day on September 1st. It's our Sava Life Day, we're calling it.

And there's a fundraiser to help us, basically the vast, you can see the breakdown is on the site, but the vast majority of the money we're raising is to just buy an R-can, just to buy as much. Naloxone is we can to hand out for free to people in the community and to help educate people to destigmatize addiction and encourage people that this is a problem. And I think that the story about Dr. Fishman and the unfortunate story about his stepson just underlines that anyone can have addiction. It is not a comment on your class, your intelligence, your morality.

It has nothing to do with that. It is a medical condition and it has been experienced by people of all race, religion, creed, and social strata. And I know that if you're from this area, you've been personally affected by it, I'm sure in some way. I know I have family and friends and community members and this is a thing you can do. So I would encourage you to go get trained

in a lock zone, carrying a lock zone, you could save a life. You talked about the fundraiser, but you didn't say that people could go. We have a go fund me. Right. If you head to bit.ly, forward slash, so bones, no lock zone, just want to make it easy to remember. It's not our fundraiser, but so it is not something,

it's not my organization, it's not personal. It is an organization that I work with to help get an arcant out to the community. Sobones, Naloxone, N-A-L-O-O-X-O-N-E. Thank you so much for listening to the podcast. We hope you've enjoyed yourself. We hope that you're having a fun summer. Hope that you're having a fun summer.

I don't know why I said that. It's like the weirdest thing. It's like I'm signing your yearbook as you're listening. No, we just did a podcast about Narcan. Yeah, I know I'm just trying to bring up the energy a little bit I'll go help if you can by the way Thank you so much for listening thanks to the tax Be hero be hero carry not carry Narcan carry Narcan Well next time we do a live show we'll just have everybody in the crowd We'll shout it out like we got your Narcan

We do a live show. We'll just have everybody in the crowd. We'll shout it out like we got you're not again With you like getting up in the air be like the new lighters. Yeah, well, I mean you joke but like for real No, it's true. I know it's good. I do do stigmatize it what you know, you can be a hero You can be a superhero. I don't hear a good idea. I just had people need like cool Naloxone like personalized like carriers. You know what I mean? Like cute. Like a little holster? Like a little, no, that's kind of like,

that gets into like keys on the land, your territory. Well, maybe a holster I guess, like something where it's like. A carabiner. You need a carabiner with your naloxone on it. Okay, well, we'll workshop it. We can come up with that. Yeah, thanks to TaxPairs for using the

show I'm Edith and C. and Drew and I'm Drew Bumper Program. And thanks to you for listening. We appreciate it. That's gonna do it for us for this week. So until next time, my name is Justin McElroy. I'm Cindy McElroy. It's always, don't drill a hole in your head. Alright! Maximumfun.org

Comedy and Culture Artistone? Audience Supported orc, comedy and culture. Artists don't, audience supported. Hey, I'm Jordan Morris, creator of the Max Fun, scripted sci-fi comedy podcast, Bubble. We just released a special episode of Bubble to celebrate the launch of our new graphic novel. At SF Sketch Fest in 2019, we recorded a live show with Alison Becker, Eliza Skitter, Mike Mitchell, Kristella Alonzo, and special guests, Jean Grey, Jonathan Colton, Jesse Thorne, Nick Wigorne,

and a bunch of other cool folks. We suspect she'll show signs of mutation when in a state of excitement. Now Annie matched with him on Tinder, so she's gonna act as the honeypot. I do enjoy being called a honeypot. Hey, no it's better than honey? Gravy. Oh yeah, can I be the gravy sack?

Out now on MaximumFun.org and wherever you get podcasts and pick up the graphic novel at your local bookstore today. you