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.
Most cocaine in US adulterated with levamisole.
Agranulocytosis can occur in patients exposed to levamisole repeatedly leading to immune compromise or more serious infections.
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.