Naloxone, otherwise known as Narcan, has become something of a wonder drug over the last five years and has single-handedly saved thousands if not hundreds of thousands of lives during the current opioid epidemic in America.
So why has it been so difficult for people to get their hands on?
First of all, what is Naloxone?
Naloxone, or Narcan, is an opiate antagonist. It is a medication designed to reverse the effects of an opioid overdose. It does this by binding to the opioid receptors in the brain and more or less shoves the opiates out of them to bring the person back from an overdose. It restores normal breathing, regulates heartbeat, and promotes blood circulation to the body.
As of right now, there are three ways to administer Naloxone to someone, and that is through an injection, an auto-injection (similarly to an epi-pen) and a nasal spray. Narcan, the nasal spray version, is the most commonly used Naloxone method, and it is usually administered by paramedics, ER doctors and nurses, and first responders.
As for the nation, medical providers are permitted to administer Naloxone in all fifty states. Some states have made it so that ONLY medical professionals are legally allowed to administer and hold Naloxone medications, but some states, usually those that are harder hit by the opioid epidemic, have made the drug a little more widely distributed for the communities as well.
There are efforts currently underway to increase civilian use and access to Naloxone, as studies have shown how many lives can be saved if more people, especially those in rural areas or for people without healthcare coverage.
According to the Substance Abuse and Mental Health Services Administration, or, SAMHSA, Naloxone has been permitted to be prescribed for high-risk patients since the 1970’s. People were considered high risk if they:
- Were prescribed a high dosage of prescription opioids
- Had health conditions that limited breathing
- Had a history of addiction or substance abuse
- Used non-prescribed opioids
- Were receiving Medication Assisted Therapy (methadone treatment)
However, as of late, and with the ever-increasing amount of opioid-related overdoses, state governments, hard reduction programs, and citizens have been pushing to increase access to the life-saving drug.
When people think of first responders, they think of police officers, paramedics, and EMT’s. However, studies show that for opioid overdoses, the first responders are primarily friends and family members, harm reduction program staff, needle exchange staff, even strangers!
So, these new laws, as of January 2018, are working to increasing access of Naloxone to other people that may not even use opioids, therein, increasing access to anyone who wants to help, rather than just to people who are paid to help, or people who might not be able to help themselves.
As of now, many states are permitting what they call “third party prescriptions” for people who want access to Naloxone but do not do opioids themselves. Most commonly, parents, spouses, loved ones, family members, or coworkers of someone who is an opioid addict.
Some of these states require training and instructional materials be handed out for people who are receiving the drug, so they feel confident administering it if and when necessary.
There are an increasing amount of Americans who are going uncovered by health insurance, and for many people who abuse opioids, being able to afford health insurance is often not at the top of their list. For this reason, access to Naloxone should be made more accessible to those people, without having to see a medical practitioner in order to receive one.
So far, there are several types of non-patient specific prescriptions that exist among some states in the U.S., that were created with the intention of creating wider accessibility to people who either cannot afford to see a medical professional for a personal prescription, or who are unable or unwilling to go due to either stigma or transportation or even awareness that they could. Here are some of the ways some states have made this process easier:
- Standing Orders from Prescribers: Written by prescribers, this would ensure that there would be a constant supply of Naloxone at certain pharmacies around the community so at risk residents can simply pick up a Naloxone prescription if needed.
- Protocol Orders from a Board: These would work in about the same way that the standing order would, with the exception that the order would be placed by a state board of health or a pharmacy licensing board, rather than an individual practitioner. These are always written at the state level, meaning any pharmacists who distribute them are authorized to do so.
- Pharmacist Prescriptive Authority: this method allows any pharmacist, regardless of a present prescription for a Prescriber, a pharmaceutical board, or a board of health agreement. This method is only allowed in a very small number of states, and there are many stipulations that do come for these pharmacists who choose to use this method. Not only are they required to document every time they distribute a Naloxone medication, but they are also expected to undergo a training course, and give any patients purchasing Naloxone training and instructional materials as well.
Could Lives Really Be Saved by Expanding Naloxone Access?
According to the American Medical Association, over 33,000 lives were lost to opioid overdose in 2015, and that number has only been increasing. However, with more and more people given access to Naloxone, we can expect to see a hearty decrease in those lives lost. Studies show that not everyone who experiences an overdose stops using heroin or opioids afterward, but Naloxone affords them the opportunity to get another try at life.
- From 1996-2014, organizations such as Needle Exchanges and community-based overdose prevention services recorded more than 26,000 opioid overdose reversals in the U.S. through Naloxone administration.
- When states have enacted laws to increase Naloxone access, opioid-related deaths have been shown to decrease from 9-10%
- In the first 8 weeks of the year 2017, the number of prescribed doses of Naloxone increased by 340% in comparison to that time frame in the year before.
Naloxone is proven to save lives, and it is proven to afford many people the opportunity to seek substance abuse treatment or other community-based means of getting help. Most people that overdose never intended to do so, as a large portion of today’s street drugs has become laced with the deadly drug Fentanyl. Despite that, many people have been saved by Naloxone, and have had the opportunity to get clean.