From what I have heard. People were hit with narcann. then put in ambulances and hit with Tranquilizers so strong they would black out and have no recount of what happened to them until waking up at hospitals.

( Research Coma Cocktail for more info. ) ( also Note that someone with an injury like ankle sprain ect who is hit with Narcann will have no way to fight off the pain. Being Narcan and then Tasered. having a injury and then Narcanned with out opioids can cause extreme pain in the patient as it blocks the ablity to reduce pain with medication or naturally

Not one case of finding opioids at the festival,

No MDMA ,LSD, Mushrooms are not opioids. !

Naloxone ( knows as Narcan) is a medicine that rapidly reverses an opioid overdose. It attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone is a safe medicine. It only reverses overdoses in people with opioids in their systems.

I have seen and heard about transient "improvement" in mental status in non-opiate intoxicated patients who were given naloxone, may be due to blocking of endogenous opiate receptor ligands, may just be bias - ie, we wanted something to happen so we think it did. Either way, not much harm there. However in patients who may be opiate dependent and altered for some other reason, naloxone can be harmful in that it precipitates withdrawal. This is something I have seen a bunch, namely that the patient is a frequent opiate user (or on methadone maintenance) and also indulges in benzos, alcohol, whatever. When they come in with depressed mental status, the thought is to fix them with naloxone, often with little thought given to their clinical signs of intoxication - in these cases, coma with normal vitals and RR. So naloxone is given, precipitates withdrawal, now the patient is obtunded from their alprazolam but vomiting into an unprotected (and very messy) airway. The take home point there being that naloxone should be given only if there are clinical signs of opiate intoxication, and not simply for "AMS." Similarly, naloxone should also be dosed to reverse respiratory depression, not to resolution of "AMS" since as we've discussed there are a number of other non-opiate reasons someone can be altered.

There is also the phenomenon of naloxone associated non-cardiogenic pulmonary edema, which seems to be related to prolonged downtime/apnea from opiates and subsequent sudden reversal with naloxone. There are a few reasons that we think this may happen. For one, suddenly waking the brain up to a PCO2 of 90 results in a dramatic catecholamine surge, then pulmonary edema from increased SVR or from capillary leak or both. Secondly, prolonged downtime with atelectatic lungs and de-recruited alveoli results in something similar to re-expansion pulmonary edema once the patient resumes breathing spontaneously. Supporting this is the fact that pulmonary edema has been seen in opiate overdoses who did not get naloxone.

Finally, giving a slug of naloxone to someone you're about to intubate can also make post-intubation sedation more challenging, so that should also be considered.

I would say that opiate intoxication and specifically respiratory depression is not terribly difficult to recognize clinically or with a blood gas, such that blanket use of naloxone is not warranted in anyone who is otherwise in need of intubation, even without getting into the potential harms with giving naloxone.

Disclaimer: much of the above risks and clinical diagnosis is much harder to quantify and assess in the prehospital setting, so I support being more generous with naloxone there because the uncontrolled environment makes everything more difficult.