How Does Naloxone (Narcan) Affect a Drug Evaluation?
How Does Naloxone (Narcan) Affect a Drug Evaluation?
Does Naloxone Administration Negate a Drug Evaluation?
A DRE stopped me at a conference and wanted to know a very common question: How does Naloxone administration by paramedics affect the outcome of a drug influence evaluation?
The Naloxone (Narcan) Scenario
The DRE gave me an example of a recent case. A driver, under the influence of a Narcotic Analgesic (Opiate for those trained in DAR) had crashed and seriously injured another driver. It was a serious crime; driving under the influence of a drug causing a major injury to another. During patient treatment by the paramedics, someone identified that the suspect driver may have overdosed on an Opioid. The suspect was given Naloxone and became alert almost immediately.
What would you do if the suspect driver was given naloxone?
There was debate among the officers and DRE's present as to whether a drug evaluation should be done. Some officers believed that an evaluation would be attacked later in court.
What Should You Do?
Each incident is different. There is no right or wrong answer, which is why we get so much great training; to make the best decision we can when we have less than perfect circumstances. However, from my experience, you should attempt a drug evaluation if you think there is evidence that can prove or disprove if the driver was under the influence.
In this incident, the driver recovered almost immediately after Naloxone administration. Look, Naloxone only works on Narcotic drugs. If you give Naloxone to someone who is unconscious and doesn't have a narcotic in their system, you will see no result (and no harm to the patient). So, by seeing that the Naloxone worked, you just got evidence that the suspect was under the influence of a Narcotic Analgesic (Opiate). This is great evidence! Now that the suspect is awake, there are still signs and symptoms that can be documented in your drug evaluation.
What are two things that cause constricted pupils?
I know you won't have the perfect pulse or perfect pupil size, but the best evidence was that the Naloxone worked! The paramedics just proved your case! Sometimes we do drug evaluations that don't give us expected results. But, you can't ignore what you saw before the evaluation was started. Here, the officers witnessed a comatose suspect who had constricted pupils and a very week pulse. All of those are indicators of drug influence and should be documented. We also know that those are great indicators of Narcotic Analgesic (Opiate) influence.
You may have to do the evaluation in a way that you are not used to. I had a case long ago where a juvenile under the influence of alcohol and cannabis ran a red light and struck a car killing the other driver. I was called out from home and took over the DUI portion of the investigation. I did the evaluation while the suspect was strapped to a backboard in a hospital room. Without interfering with patient care, I started my evaluation. I wasn't able to do a lot of the evaluation because of the conditions, but I did all of the steps that I could do. I still had enough to come up with a conclusion. This suspect was later convicted.
But Wait, There's More!
Before you do your evaluation, make sure that the suspect was not given drugs during treatment. At times, some suspects may be given Narcotics or CNS Depressants by the paramedics. This will definitely have an impact on your evaluation. However, keep in mind that I highly doubt that paramedics will give a person having an opiate overdose another opiate for treatment. But, I have had suspects having a CNS Stimulant overdose treated with a CNS Depressant. Even in those cases, I still had evidence to show CNS Stimulant influence. Just document what the suspect looked like before, during and after treatment. Your decision isn't made just on the drug evaluation, it is made based on the totality of the circumstances.