As with the addicts Dave Swan was talking about, one needs to be careful when and how one reverses the effect of narcotics. Some years ago there was a big interest among intensive care physicians in using naloxone to treat septic shock. It seems that as the body systems are shutting down, there is an outpouring of endorphins (opioid compounds produced by the body) that tended to dilate capillaries and lower blood pressure as well as relieve pain, essentially helping us to slide swiftly and comfortably down the final slope. The reasoning went that if you could block those endorphin effects, you might keep the blood pressure up and have more time to treat the cause of the shock, and eventually save a life. As I recall, the attempts met with limited success.

I don't know what the current state of the art is. I do, however, remember a lecturer saying, "I don't know about you, but if I'm dying of septic shock and my body is trying to make my last moments pleasant and pain-free, the last thing I want is for some doctor to give me Narcan and make me fully awake and feeling all that terrible pain and fear right before I die." I think he had a good point. I don't know if this ever became standard treatment, but maybe someone out there does. Sometimes we in the medical field do well to remember the old maxim, "Primum non nocere" -- first, do no harm.

Aloha,
Mark