Narcan = dose of reality

I just have to say that it was way too hot the other day. Yet my company doesn't think we should change uniforms and continue to wear winter weight uniforms all the time. OK, enough complaining...

     Anyway, my partner, our students, and myself get dispatched to what is basically the wild wild west of the area. This was very much out of our regular response area. But like good Paramedics we took our call and tried to do our part to save the world, one priority one at a time. The area we responded to usually requires us to have some sort of police presents at all times. Like I said, not the safest place in the world.
     So we show up to the little police substation to be met by one of the officers. He stated that they found a known heroin user in the back of their station semi conscious and "not breathing right". He was able to get him up and inside. Oh and did I mention it was approaching 100 degrees that day too? It sure was. It was so hot my balls were sticking to both of my legs!
     When we actually encounter our pt he was sitting/lying on a couple of chairs and was apparently feeling very good. He would just say "yup" to everything and had a big stupid grin on his face. Not that he was stupid, but it was one of those faces you would make if you just pulled a prank or are drunk and thought of something funny. But our altered mental status pt we have before us was very cooperative. Well, he didn't really fight us but wasn't really doing anything either. His vitals were mostly stable, but he was a bit tachycardic. Probably from the heat. He was sweating like pig. But then again, everyone was. Like I said, it was hot!
     I was proud of my student for getting an 18g IV on a known IV drug user. Our pts pupils were so small that almost looked like he didn't have any. So we did the usual AMS work up, IV, o2, EKG, CBG, and some fluid. We then started with a small dose of Narcan, the wonder drug. We did this enroute to the hospital. Started with one milligram and titrated to effect. He didn't have any real airway problems, but he wasn't breathing that fast so we figured we would give him a dose of reality.
     So we give the drug and a few minutes later our pt that was high as a kite came back to life with a very animated display. He suddenly goes from just saying "yup" to "What in da hell! Where am I at?!". We talked him down and told him the story and filled him in on the who, what, when, where, and why. He was cool with it and was all and all a nice guy.
     Now this may sound a bit jaded, but I am pretty sure he lied right to my face. He said he was clean for 9 months and that he is trying to quit. Now I am not a figure of authority so you don't have to blow smoke up my ass. The cops even know that he is a regular abuser of narcotics and that he does this all the time. But its not a good idea to accuse people of things like that when you are in a confined space with them. Narcan calls are always interesting.