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    NPR‏Verified account @NPR Oct 29

    To understand why someone might refuse naloxone during a suspected overdose, it helps to understand how it works — including that it can send someone into instant withdrawal.https://n.pr/2Q4m2Aq 

    12:02 PM - 29 Oct 2018
    • 45 Retweets
    • 81 Likes
    • M. L. Lanzillotta Lee M. Miringoff Nina Aaron Lovegren bari Abby Loden Paige Young Matthew Battle Phoebe Wright
    25 replies 45 retweets 81 likes
      1. New conversation
      2. Kathy Steiner‏ @kakss1_kathy Oct 29
        Replying to @NPR

        From someone who has administered Narcan dozens of times. There is no decision - you use it to save a life. What balderdash. Who would counsel delay to decide re: withdrawal....vs withdrawal from life.

        2 replies 1 retweet 16 likes
      3. KipperCat‏ @KipperCatSnack Oct 29
        Replying to @kakss1_kathy @NPR

        From what I understand, most of the patients who need it are not even conscious enough to decline care so it falls under assume consent anyway. Am I right?

        2 replies 1 retweet 5 likes
      4. Nick Nacca‏ @nicholasenacca Oct 30
        Replying to @KipperCatSnack @kakss1_kathy @NPR

        ALL patients who need it are incapapable of communicating assent or dissent by definition of opioid overdose.

        0 replies 1 retweet 7 likes
      5. End of conversation
      1. New conversation
      2. Zachary Siegel‏ @ZachWritesStuff Oct 30
        Replying to @NPR

        How can someone—who isn’t conscious—refuse something?

        1 reply 2 retweets 56 likes
      3. 1 more reply
      1. New conversation
      2. Chris Allison‏ @ChrisAllison_VT Oct 31
        Replying to @NPR

        In EMS or an ER, we give just enough naloxone (eg 0.4mg) to restart breathing, not induce withdrawal. Home rescue kits have larger doses (2-4mg) so that it will work on first try, which saves lives. If awake enough to refuse, the patient doesn’t need. This case is more complex.

        1 reply 2 retweets 19 likes
      3. Chris Allison‏ @ChrisAllison_VT Oct 31
        Replying to @ChrisAllison_VT @NPR

        But more importantly, understand that persons addicted to opioids have brain chemistry and reward system hijacked, such that risking death to avoid withdrawal seems rational. Empathy starts with acknowledging that people make decisions that make sense from their viewpoint.

        1 reply 0 retweets 11 likes
      4. Taylor Nichols, MD‏ @tnicholsmd Oct 31
        Replying to @ChrisAllison_VT @NPR

        0.4mg can absolutely still induce withdrawal. If the patient is unconscious and not breathing, this is still worth doing, and you can always give repeat doses.

        1 reply 0 retweets 2 likes
      5. Taylor Nichols, MD‏ @tnicholsmd Oct 31
        Replying to @tnicholsmd @ChrisAllison_VT @NPR

        However, in less severe cases involving decreased responsiveness or still breathing with known or suspected opioid use, you can dilute and give smaller amounts or you can nebulize the 2mg and the patient essentially will self-titrate, taking off the mask once awake enough.

        0 replies 0 retweets 2 likes
      6. End of conversation
      1. larry marshall‏ @lwmarsha Oct 29
        Replying to @NPR

        if you can refuse narcan you dont need narcan

        0 replies 2 retweets 26 likes
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      1. New conversation
      2. Julie Cooper‏ @darwinscorner Oct 30
        Replying to @NPR

        The information here is good but to be clear the patient was not the one trying to refuse the naloxone, her friend was trying to refuse on her behalf. If you can refuse it yourself you don’t need it.

        1 reply 1 retweet 38 likes
      3. 1 more reply
      1. Jilly Mac RN‏ @Jemc613 Oct 30
        Replying to @NPR

        You realize that if someone is overdosing, they are unresponsive and therefore consent is implied. They are unable to provide expressed consent, nor can they refuse.

        0 replies 0 retweets 13 likes
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      1. Sexy Spider Jerusalem‏Verified account @thomdunn Oct 29
        Replying to @NPR

        Yes, I can't imagine why someone who is literally in the middle of dying from an overdose might make a poor decision about their overdose-inspired death

        0 replies 0 retweets 9 likes
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      1. David A. Marcus, MD‏ @EMIMDoc Oct 31
        Replying to @NPR

        Dear @npr - if a person is alert enough and capable of refusing naloxone, it’s generally not indicated.

        0 replies 0 retweets 5 likes
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      1. Caitlyn‏ @Caitlnn Oct 30
        Replying to @NPR

        Your coverage on opiates, including this, has been horrifically bad. You've promoted misinformation and even information that is damaging to people who use drugs and those who love them. I'm disappointed and disgusted with @NPR.

        0 replies 0 retweets 6 likes
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      1. whats his face‏ @lone_redseat_ Oct 29
        Replying to @NPR

        But like it also could like save your life too man

        0 replies 0 retweets 5 likes
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      1. Daniel K. Colby‏ @Danipedia Nov 1
        Replying to @NPR

        Happy to provide a medical toxicology consult to the usually reliable @NPR as they’ve completely misfired on this entire issue.

        0 replies 0 retweets 4 likes
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      1. Mr. Roby‏ @will_fain_roby Oct 31
        Replying to @NPR

        Your refusal to correct this ridiculous story has ended a literal lifetime of NPR listenership and donations.

        0 replies 0 retweets 3 likes
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      1. Alex Limkakeng‏ @alimkakeng Oct 31
        Replying to @NPR

        I agree. It helps to understand how it works. The writer of this title clearly doesn’t.

        0 replies 0 retweets 3 likes
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