A recent study published in the International Journal of Drug Policy found that increasing naloxone distribution to the general public, as well as to first responders, could be a cost-effective and realistic way to reduce overdose deaths. When police, emergency service workers and other first responders have access to naloxone, opioid overdose death rates fell 21%.
When people witness an opioid overdose, they may hesitate to contact 911 because they worry about the consequences. Even when first responders have naloxone, if 911 isn’t contacted soon enough, the drug may be unable to keep the drug overdose from becoming fatal. This danger highlights why making naloxone more accessible to everyone and not just first responders is an important component of curbing deaths from the opioid epidemic.
Naloxone Prescriptions Doubled in One Year
Naloxone is a generic version of a drug commonly known as Narcan. Naloxone can be administered to reverse opioid overdoses, which have gone up exponentially in the past decade in the United States. The number of naloxone prescriptions doubled from 2017 to 2019. While naloxone prescriptions have increased, for every 69 high-dose opioid prescriptions that are dispensed, pharmacies dispense only one opioid overdose reversal drug.
Dr. Anne Schuchat, who serves as the principal deputy director of the Centers for Disease Control and Prevention, said in an interview that while the ratio of naloxone to high-dose opioid prescriptions may never be equal, she believes the current ratio is too low.
There are significant geographic discrepancies in naloxone prescriptions. Some counties in the country were dispensing reversal drugs 25 times more than others. Dispensing rates tended to be lowest in rural counties.
According to the NIH Director’s Blog, states that offer more flexible access to naloxone and overdose reversal drugs have more significant reductions in deaths. One of the changing regulations that seem to be making the most impact is allowing pharmacists to dispense naloxone without a prescription. In these states, where a pharmacist can dispense naloxone without a doctor’s orders, it’s described as falling under naloxone access laws (NALs). NALs vary in the exact provisions.
In states with direct-authority NALs, deadly opioid overdose rates seem to have gone down the most — an average of 27%.
Along with offering more accessibility to the overdose drug, other approaches need to be used at the same time. The widespread use of a drug that reduces overdose rates is known as a harm reduction program. Some people express concerns that harm reduction is promoting drug misuse, but declines in recent drug overdoses show how important the availability of naloxone can be.
Recent Increases in Naloxone Distribution
The number of naloxone prescriptions increased in the United States at retail pharmacies from 271,000 to 557,000 from 2017 to 2019. At the same time, overdose deaths have stopped rising for the first time in almost 30 years.
While the increased availability of naloxone is promising, the opioid epidemic is far from over. More work remains to be done to safeguard people from the deadly effects of opioid misuse and addiction.
U.S. Drug Overdose Deaths Not Declining Yet
In October 2018, the Centers for Disease Control and Prevention reported a decline of 2.8% in the number of overdose deaths in a 12-month period ending in 2018 as compared to the 12 months that ended in September 2017. At the time, public health officials said not to draw conclusions based on only a half year of data.
Now, however, provisional data from the CDC shows that the overdose death rate could be close to declining for the first time in decades. Some states are making more progress than others. For example, Missouri and New Jersey will likely see an increase in overdose fatalities as many states see decreases.
Improving Access to Overdose Reversal Drugs
Along with allowing pharmacists to provide naloxone without a prescription, there are other steps being taken throughout the country to make the opioid overdose reversal drugs more available. Examples include:
- In 2016, the CDC issued a recommendation that doctors offer naloxone to chronic pain patients when they prescribe high-dose opioids
- In some states, there is an effort to expand access to opioid overdose reversal drugs, including blanket prescriptions for entire communities so someone doesn’t need an individual prescription
- As part of larger harm reduction strategies, some communities and groups issue naloxone at syringe exchange sites
- There is also a federal push to have businesses, even airlines, have naloxone on-hand
What to Do If You Suspect a Drug Overdose
If you think someone is experiencing an overdose, the first thing you should do is call 911. Drug overdose symptoms, especially if the overdose is from opioids, can include:
- Being unresponsive to outside stimulus
- Loss of consciousness
- Being awake but unable to speak
- Choking or gurgling sounds
- Slow, shallow or stopped breathing
- Skin that turns a grayish or bluish color
- Pale, clammy skin
- Lips and fingernails may turn blue or purplish
- Erratic, slow or non-existent pulse
Beyond calling 911, if a drug overdose is occurring and it’s likely related to opioids, try and determine if Narcan is available. Along with administering Narcan if at all possible, rescue breathing should be performed until emergency services arrive. Chest compressions aren’t as important in an opioid overdose as they are in a situation like cardiac arrest. During an opioid overdose, the person’s breathing is depressed or stopped, so they need oxygen.
Dyson, Tauren. “Access to naloxone reduces opioid overdose deaths, saves money, study says.” UPI, August 21, 2019. Accessed August 26, 2019.
Towsend, Tarlise; et. al. “Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States.” International Journal of Drug Policy, August 19, 2019. Accessed August 26, 2019.
Harm Reduction Coalition. “Overdose Prevention.” Accessed August 26, 2019.
Joseph, Andrew. “For every 69 high-dose opioid prescriptions, U.S. pharmacies dispensed only one overdose-reversal drug.” STAT, August 6, 2019. Accessed August 26, 2019.
Collins, Francis. “Easier Access to Naloxone Linked to Fewer Opioid Deaths.” NIH Director’s Blog, May 14, 2019. Accessed August 26, 2019.
Stobbe, Mike. “A lifesaving, overdose-reversing drug might be slowing the opioid crisis.” USA Today, August 6, 2019. Accessed August 26, 2019.
Rosenberg, Jaime. “Provisional Data Predict Overdose Death Rates Will Fall For First Time in Decades.” AJMC, June 26, 2019. Accessed August 26, 2019.
CDC Newsroom. “Still Not Enough Naloxone Where It’s Needed Most.” August 6, 2019. Accessed August 26, 2019.
Centers for Disease Control and Prevention. “Life-Saving Naloxone From Pharmacies.” August 6, 2019. Accessed October 7, 2019.
Harm Reduction Coalition. “Perform Rescue Breathing or Chest Compressions.” Accessed August 26, 2019.