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Naloxone:
Cocaine:
Heroin:
- Think about having a discussion regarding use of IM/IN naloxone and the availability of kits with our high risk patients or their families – if they have a ton of opioid/opiate prescriptions on the prescription monitoring database, they are high risk.
- Other groups: sickle cell, cancer patients, chronic pain, fibromyalgia, elderly patients on opioids/opiates, heroin overdose patients. Think about offering this to parents of pediatric patients with sickle cell disease and other young children in the home.
- Kits are $32.29 at the Walgreens across from CMC University and you can walk in without a prescription and get a kit from the pharmacy.
- Great resources available at the NC Harm Reduction Coalition and Project Lazarus websites.
- There are many good You tube videos demonstrating use out there.
Cocaine:
- Most cocaine in US adulterated with levamisole.
- Agranulocytosis can occur in patients exposed to levamisole repeatedly leading to immune compromise or more serious infections.
Heroin:
- Be on the look out for clostridial infections in patients using IV or skin popping.
- Consider asking this sub group of patients about tetanus status at they are at increased risk for developing tetanus.
- Be wary of patients with heavy eyelids, complaints of dysphagia and dysphonia who use IV/subcutaneous heroin as they are at risk for developing wound botulism – a clinical diagnosis.
- Treatment of wound botulism is more involved than infant botulism – patients need wound debridement, antibiotics AND antitoxin.
