
Driving an Ambulance in the Age of Narcan - bookofjoe
https://hazlitt.net/longreads/magic-eraser-juice
======
staticautomatic
I live in SF and work in Civic Center. Not long ago I attended to a guy who
was OD'ing on the sidewalk, and a number of things about the experience
surprised me. I called 911 when the guy started seizing. He stopped breathing
but still had a decent radial pulse, and I was surprised that the 911 operator
wanted me to start chest compressions nonetheless. I was doubly surprised that
the operator wanted me to stay on the phone while I did it, which is basically
impossible. I just said "I know how to do it I'm putting the phone down." As I
was doing it I yelled for Narcan and the junkies on the block immediately
leapt into action trying to find some. Eventually somebody came by with some
and set about giving him an IM injection. I thought, "I don't know if that
needle is clean but I also don't know when the EMT's will get here so I guess
it's better for him to get hep or HIV than for him to die." When the EMT's
finally showed (probably quicker than it seemed) the first thing they did was
start yelling at everyone, especially the woman with the Narcan. I found it
very unprofessional.

~~~
neilv
I'm very glad you and the nearby opioid addicts were able to help that person.

Regarding the EMTs yelling, could they have been trying to clear people away,
to be confident the scene safe for themselves (one of the first steps I've
heard some first responders have), or to get access to the patient? Or maybe
the opioid epidemic is wearing heavily on them, though they keep doing their
job?

(I looked into EMT-B training a while ago, and it's a really difficult, scary,
and severely underpaid job. I probably couldn't do that job for very long,
emotionally, even if I could afford it financially. Ironically, the
compensation for being an EMT, helping people, seems unfortunately backwards,
by societal value, with a lot of software jobs I'm considering right now.)

~~~
hyperdimension
I agree with you re: the bottom point about EMT's salaries. It's the same with
teachers; they're one of the most essential parts of society, and they're paid
so little.

An example: in Georgia, just picking a random county, teachers make around
20,000~60,000$ a year, leaning more toward the lower end. It seems that
importance to society and salary are negatively correlated...

You can look them up here:
[http://open.georgia.gov/openga/salaryTravel/list](http://open.georgia.gov/openga/salaryTravel/list)

Also, a somewhat-related video I watched recently (a fantastic channel, by the
way:)
[https://youtube.com/watch?v=VOAaFyv_shY](https://youtube.com/watch?v=VOAaFyv_shY)

~~~
nine_k
> _they 're one of the most essential parts of society, and they're paid so
> little._

They can somehow hire enough even at this salaries, and appear to think that's
enough. Quality of education is hard to measure, and it takes very long to
measure, much longer than a typical election term.

~~~
FlyMoreRockets
Agreed, however the turnover is terrible. With the low wages and tough working
conditions, the department I worked had 15 EMT-firefighters when fully
staffed, which was pretty much never. We averaged a little over two and a half
new hires a year the time I worked there, nearl 17 percent turnover, every
year. Ran into a former coworker a the grocery store a few months ago, he told
me an entire shift just quit, a third of the department. That is no way to run
a business.

------
safeplanet-fesa
I strongly believe that calling medications by their brand name is a bad idea.
It's marketing departments' work to put into peoples' heads their stupid and
annoying brand names. They want people to seek %brand_name% rather than
%chemical_name%. They want people not even to know actual names of the
chemicals. It's so widespread that people start thinking that medications
called by their brand names are more effective than their generics. Companies
that produce and sell generics have to write on the packages "compares to the
active ingredient of %brand_name%™" otherwise people will not buy it. People
don't know what diphenhydramine is, they only know B......l, and it's the only
antihistamine they know. For that reason, when two exactly same medications
are located at the counter right next to each other, one plain small
adequately-looking box with a generic, and another one is a colorful oversized
stupidly-named box with words "ultra", "fast", "extra", that easily costs 3
times more, people go for the later. Don't propagate this practice.

~~~
LeoPanthera
This seems to be a uniquely American problem. I’m a Brit who now lives in the
USA, but back in the UK, calling things by their generic drug name was the
default, and while brand names were also still common, there was usually more
than one to choose from.

Aside: It took me far too long to figure out that “paracetamol” is called
“acetaminophen” in the USA. You would think that at least the generic names
would be universal.

~~~
yardie
I'm still trying to convince my wife, who's French, they are the same thing.
She's convinced the medicines in France are stronger.

~~~
LeoPanthera
I know that in the UK painkillers that contain codeine as an additive are
common, which makes them stronger. I don’t believe it’s possible to get it in
the USA.

To make up for it, it’s very difficult to buy painkillers in the UK in
quantities of more than about 8, while Costco sells jars of literally hundreds
of tablets.

~~~
watersb
US person here: I am familiar with codeine-(acetaminophen) mix everyone calls
"Tylenol-3". It requires a prescription.

------
pgrote
I was 35 before I understood, truly, deeply understood why people become
addicted to opiods. Prior to 35 never had pain medication of any kind. Got a
kidney stone, writhing in pain, vomiting, couldn't quit crying. The pain is
the worst you can experience.

IV Morphine wasn't touching it. Then she came in. An older lady and told me it
was going to be alright. She pulled a syringe up and I was blubbering in pain,
crying and explaining to her I would do anything to make the pain stop and how
I

I quit talking. I quit crying. I was comfortable. Happy. Content. The world
was fine.

It was Dilaudid.

When I was released it occurred to me that this is how people feel when using
the drugs.

The best explanation I've ever heard is from a reddit comment:

[https://www.youtube.com/watch?v=-9huWlXFA1s](https://www.youtube.com/watch?v=-9huWlXFA1s)

~~~
natalyarostova
It blows my mind people still link to that YouTube video. I wrote that comment
nearly 10 years ago, not that I have any proof. It's cool to see something I
wrote have staying power.

~~~
pgrote
Wow.

Are you still doing well?

I must say thank you to you for authoring something that spoke to me logically
and perfectly encapsulated the feeling I had.

I shared it with my teenage daughter and will share it with my other children
when they become older teenagers.

You have made an impact.

~~~
natalyarostova
I'm glad that it spoke to you! Yeah I wrote it when I was 21 and wayward.
Thankfully shortly thereafter I found that a strict regimen of programming,
lifting weights, exercise, math, statistics etc gave me more than enough
meaning to occupy my time and interest, at which point drugs got boring. Hence
why I'm on hacker news :)

~~~
soulofmischief
All you needed was stimulation and a plan. Without a plan you don't have
motivation and without motivation you develop anxiety and begin seeking an
escape. With a solid plan, you find that an addiction just gets in the way of
what you want to do. Glad you're doing better! Good luck!

~~~
natalyarostova
Yeah, stimulation was the big one. I eventually realized that it's sort of
impossible for me to 'relax' (more than 5 hours a week). I just can't do it,
and when I try I get frustrated. So I've developed a lot of self-development
hobbies instead, which works out well.

------
warbird
Interesting to bump into this article as a young friend recently quit his
just-obtained ambulance EMT job for, in essence, the exact issues described.

His take was less sympathetic (paraphrasing): "i thought i would be helping
society, not endlessly cleaning up after its recurring mess-making."

I know a few people in first response fields (eg, fire, emergency med, police)
and this is a common view, albeit not often leading them to quit their jobs.

Since there is seemingly no political will to prevent and mitigate drug
epidemics, the issue rolls downhill to emergency workers.

~~~
chkaloon
I worked for a year as an EMT, and saw a lot of folks who were extremely jaded
and unsympathetic after years of dealing with this. There were a few angels
who did really feel that they were doing the good work, but it is really hard
to keep that attitude up for long in the face of this.

~~~
FlyMoreRockets
Recently retired EMT here. You hit the nail on the head. For me, dealing with
the patients was the easy part. I had one simple rule: just be nice and show
that you care. Sometimes, that was the most important thing, especially with
the chronic "frequent fliers" we were picking up nearly every day.

Coworkers were the hardest part, not just that they were jaded, but they
actively viewed coworkers that did not ascribe to their jaded worldview as the
enemy.

~~~
dreamcompiler
Similar experience w.r.t. patients (my coworkers were great though). It's
really not about saving lives. It's about confidently telling somebody it's
going to be okay when they are having the worst day of their life. That means
the world to people.

------
cobbzilla
Narcan can also be delivered via nasal spray. I’ve heard of patients waking up
and immediately taking a swing at the medic who administered the narcan.

It’s fast and potent, but only lasts a few minutes. For a really bad OD, you
might go through several doses.

Where I am Narcan is $50+ per dose, a small price to save a life but kinda
crazy when you meet the same patients again and again.

~~~
AstralStorm
The problem with nasal spray is that the patient still has to breathe. That's
a tall order for someone who's OD'd. And it is why injectors are used instead.

~~~
throwaway8689
Not sure why you think this will be a problem. The naloxone won't block the
nose and will be absorbed through the nasal membranes. If the patient needs
extra oxygen or artifical ventilation that's still feasible.

------
zbentley
What lovely, sad writing. Really makes you feel the depth so which addiction
completely warps/removes agency.

Separately: the title should be as written in the article: "magic eraser
juice".

~~~
warbird
Agreed, of course. Bringing up agency is on point, as well. I should have
included that in my own comment, in short: the US has trouble being socially
effective due to wonky "will power"/moral accountability bias--it cannot
politically see bounded agencies, and therefore generates fails that strain
the lower systems.

All speaking super generally, I guess.

------
mnm1
Addiction isn't caused by heroin or oxy or any other drug by itself. It's
caused by people having hard, unfulfilled lives in a society that doesn't care
about and actively tries to hurt them. A society that doesn't care, that
doesn't provide purpose, jobs, homes, food, friends, relationships, nature, or
any kind of help. Fulfilled people with good lives who aren't in constant pain
don't get addicted. They might be dependent for awhile while the pain from
their surgery goes away but then they'll go back to their lives. People who
have no lives on the other hand will get addicted. If it's not heroin, it's
oxy. If but oxy meth. Or coke. Or even weed. Too bad we as people and as a
society still don't understand this and pretend like heroin is some magic
substance that everyone gets addicted to. Most users do not get addicted.
Usually around 90%. You never hear about them. You also never hear about the
addicts shooting up legal heroin for decades who don't overdose, don't get
sick, and have normal lives. Only the stupid drug war mantras live now despite
us knowing better from real experience with helping addicts and not making
them into criminals. Experiments have been happening all over the world for
decades but the drug warriors are the only ones that get the press. It's sad
that so many people's lives have to be ruined by their insanity. One day we'll
look back and wonder how we could have been so cruel and so stupid with all
the solutions already known to us.

~~~
safeplanet-fesa
I agree, drug withdrawal is painful with opioids and unbearably hellish is
GABAergics, and quitting can be very hard. But having purpose in life is what
defines if one will stay clean forever or will relapse time after time. I can
also add that some people no matter of their actual conditions just don't have
any meaning in life and they don't have any drive to participate in the
routine and maintain proper life because they either have poor chances for
good life or simply because they never asked to be born. Probably the
strongest urge to use a drug comes, in fact, from boredom. Some people just
need to kill time. To get by from the morning till the evening, when they can
go to bed and sleep.

------
chasd00
had a friend in college (late 90s), very smart, very successful but addicted
to pills. I have a joint disorder that puts me in a lot of pain so I always
had a prescribed rx of hydrocodone. He'd offer me $50 for one pill if he
didn't have his. I'd never seen real addiction until I met him. I've taken
just about every oral painkiller at some point but have managed to never
become addicted. Once I stopped growing the pain subsided and the rxs stopped.
I consider myself very fortunate in that regard.

------
arittr
Really beautifully written - thanks for this. Refreshing to read an "inside"
perspective from the war I see every day on the street.

------
dreamcompiler
Holy hell this is great writing. I was a rural EMT in an area without a big
addiction problem. We had our share of repeat customers but nothing --
_nothing_ \-- like this. I'm not sure I could do what the author does every
day. The mixture of joy at saving lives coupled with the utter futility of
saving the same ones over and over. This is gut-wrenching.

------
nlh
Reading this leaves me so confused: why have we as a society (roughly - I know
there are exceptions) decided that things like heroin and cocaine are illegal
and worthy of criminal punishment (jail, etc) and things like opioids are
‘prescription painkillers’ and fully within the bounds of our laws. It’s
absurd.

~~~
maxerickson
Heroin is an opioid. In the US, it isn't used medically, apparently the
reasoning is that there are less additive opioids that are similarly effective
for managing pain.

~~~
solotronics
It's still used in a hospital setting.

~~~
maxerickson
I don't think heroin is used medically in the US. It's schedule I. It might be
used in extremely limited circumstances, but it isn't in use at most
hospitals.

Like others are saying, other powerful opioids are used instead.

~~~
martinald
Very common in the UK in hospital settings. Probably the one of the most used
strong painkillers - most people I know who have had painful surgery got it
post operation.

A GP could also prescribe it no problems. Indeed there are a small number of
people that get it prescribed if other drug treatments have failed.

------
limbicsystem
Un-hugged link
[https://web.archive.org/web/20190907135002/https://hazlitt.n...](https://web.archive.org/web/20190907135002/https://hazlitt.net/longreads/magic-
eraser-juice)

------
jknoepfler
What a beautiful essay. It's so difficult to see human suffering with a mix of
clear-headed honesty, empathy, and pragmatism. The author navigates this
impossible landscape with grace and sincerity. I'm glad they shared.

------
mirimir
Wow. That article is just beautiful.

I'm very glad that I never got into opioids. I've used them for pain relief,
but never really liked the other effects. Just lucky, I guess.

------
tomohawk
If you give someone Narcan, it is likely that they will be antagonistic
towards you, and could even attack you.

The addict will look like they will be OK after getting the Narcan, but the
opioids are still in their system. The Narcan will wear off any they could get
an OD from the drugs in their system.

~~~
dreamcompiler
This is why it's best to titrate the dose with Narcan, if you have the luxury
of doing so.

------
bookofjoe
Related: One Night Cough Syrup (1888)
[https://www.bookofjoe.com/2013/11/behindthemedspeak-one-
nigh...](https://www.bookofjoe.com/2013/11/behindthemedspeak-one-night-cough-
syrup-1888.html)

------
Havoc
I like this kind of write-up. Gritty & real view into a world obscured from
most of us

------
GnarfGnarf
Outstanding writing.

------
lsllc
This is such a great, well written piece!

------
leoh
"[Venture Capitalists and engineers in the Valley] wanted [to outdo one
another and buy more things] and couldn’t find enough [creative means to
generate truly useful inventions to make enough money] to pay for it all, so
[social media and gaming companies] flooded [the internet and internet-
connected gadgets] with [profoundly addicting software that was optimized for
maximizing the numbers of ads user saw, regardless of the value of the media
that attracted and held attention] instead. The addiction spread quickly, the
need grew, and soon [the minds of many] began to writhe and cripple under
the... curse."

------
kylek
>> “Is there anything, you think, that anyone could do for you? A program, a
counselor, a friend? Is there anything that we could do? You seem like someone
who could fight this. What would work, do you think, for you?”

>> He stares at his hands for what seems like a long time.

>> “No,” he says finally. “I don’t think there’s anything that would help.
It’s a hell of an addiction.”

It's a travesty that iboga[0] isn't widely available (or even known).

[0]
[https://en.wikipedia.org/wiki/Tabernanthe_iboga](https://en.wikipedia.org/wiki/Tabernanthe_iboga)

