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EM:RAP 2017 March Canadian Edition

Hans Rosenberg, MD and Thara Kumar, MD
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EM:RAP 2017 March Written Summary 580 KB - PDF

With the ever-growing spotlight on the opioid crisis in Canada, our guest Dr. Thara Kumar discusses the current scope of the issue, then some tips and tricks for the use of Naloxone in overdoses and treating withdrawal like a pro.

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John Michael B., M.D. -

Hi thank you very much for the riveting discussion of management of narcotic overdoses in the ER. As usual I found this most helpful and practical. However a couple of questions arose during the course of the discussion. First all the question who is brought to the emergency room in acute precipitated withdrawal secondary to Narcan administration. I agree that Suboxone sounds excellent but it does not work right away. In the meantime the patient may be agitated to the extent that he can do harm to himself or someone else. Is there anything else you might use in the short-term other than waiting for the Narcan to wear off.

Otherwise my only other bone of contention would be to state the obvious. We ask we have no body of knowledge which suggested giving Narcan out promiscuous the is going to affect the rate of overdose deaths. As matter of fact this could have unintended consequences in that if a young person thinks there is a antidote nearby he/she may go on to take street fentanyl feeling a false sense of security. Since we know that street fentanyl is sold with varying degrees of potency in theory this could cause increased mortality rates. Therefore think it unwise to proceed down this corridor of intervention until we know for sure that it will not be causing more problems than it solves.

As with harm reduction overall we need more evidence. Clearly the safe injection sites in Vancouver have not been proven to reduce overall risks of overdose deaths or HIV transmission. The one or 2 papers that have been written have been wildly criticized for their lack of significant evidence and their inability to demonstrate overall reduction in mortality other than a purely local and transient salutary effect.

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Crashing Slowly Full episode audio for MD edition 238:10 min - 332 MB - M4AEM:RAP 2017 March German Edition Deutsche 73:21 min - 101 MB - MP3EM:RAP 2017 March Spanish Edition Español 89:05 min - 122 MB - MP3EM:RAP 2017 March Aussie Edition Australian 16:33 min - 23 MB - MP3EM:RAP 2017 March French Edition Français 25:15 min - 35 MB - MP3EM:RAP 2017 March Canadian Edition Canadian 28:50 min - 40 MB - MP3EM:RAP 2017 March Board Review Answers 262 KB - PDFEM:RAP 2017 March Board Review Questions 218 KB - PDFEM:RAP 2017 March MP3 Files 316 MB - ZIPEM:RAP 2017 March Written Summary 580 KB - PDF

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