Narcan in Every Pocket

During the Great Depression, the goal was to get a chicken in every pot. Now that COVID has reignited the opioid epidemic, the goal should be Narcan in every pocket. Because only then will we truly be able to curb the rash of fatal opioid overdoses.

That’s what first responders are saying anyway. And so are addiction experts Lala Tanmoy (Tom) Das, Giselle Appel and Jonathan Avery. In fact, the three tag-teamed in Slate to say it. That’s how much the notion means to them. And we should listen to these three too. Especially considering Dr. Avery double-duties in addiction psychiatry at both Weill Cornell Medicine and New York-Presbyterian, Appel researches substance use disorders and works in the Weill Cornell psychiatry department, and Das is a doctor/doctoral student in the prestigious Weill Cornell/Rockefeller University/Memorial Sloan Kettering Tri-Institutional Program.

These addiction experts indeed know well of what they speak. And they’re but the latest in a longline of healthcare practitioners who are calling for Narcan to become as ubiquitous as Tylenol. In fact, that’s in the the very title of their call.

Making the Call for Narcan

Bandages? Check. Gauze? Check. Antiseptic? Check. Antibiotic? Check. Aspirin? Check. Ibuprofen? Check. Narcan? Check and double check. These are some of a first aid kit’s most essential components. There’s more of course, including musts such as a blanket, a flashlight, non-latex gloves and a manual. But this list isn’t meant to be comprehensive. It’s meant to show the addition of Narcan, which should now be considered an essential component of first aid kits everywhere.

So goes Slate’s Narcan Should Be As Ubiquitous As Tylenol. The writers actually use the term naloxone rather than the brand name Narcan. But since they also use the brand name Tylenol, we’ve decided to balance it all out. Yes, Narcan is still more expensive than the generic naloxone. So is the unwieldy-named brand Evzio. The latter lots more expensive. Hopefully though, the brand name makers will soon come to terms with their pricing, especially now that the patent’s expired.

Meantime, let’s get back to that ubiquity. As Slate points out, “the drug that reverses opioid overdoses is safe and easy to use.” Therefore it should be “in every first-aid kit in America, [right] next to the gauze, Band-Aids, and ibuprofen.” Why? Well, the answer is obvious. “The faster naloxone is given to a person, the greater chance we’ll avert an overdose-related death.”

To make its case, the piece cites Demi Lovato’s 2018 relapse and overdose. The singer, who’d been sober nearly six years, was found unresponsive in her Los Angeles home. A friend quickly administered naloxone and saved Lovato’s life.

Our colleagues at Recovery Boot Camp reported about Lovato’s relapse and overdose. They also praised the singer’s courageous “Sober” over at the Schnellenberger Family Foundation. More importantly perhaps, they made clear that relapse doesn’t mean an end to recovery.

Narcan in Every Pocket

Of course one first has to survive the relapse. That means Narcan. Or naloxone if you prefer. In every American pocket.

Or at least in every car, truck, plane and bus. Throw it in the glove box. Include it with the first aid. But have it on hand. “Naloxone has saved tens of thousands of lives,” continues Slate. “It’s easy to administer and extremely safe.” In fact, “the risk of handing it out to everyone in America is almost nil.” Really. Naloxone “has minimal negative side effects, even if given to someone who is incorrectly identified as experiencing an overdose.”

Furthermore, “naloxone access matters now more than ever.” Slate goes on show how the opioid epidemic has “drastically intensified” during COVID. In fact, they said overdoses have spiked 18%, 30% and 42% this March, April and May compared to the same months last year.

As you might suspect, fatalities have also shot up exponentially. In Seattle’s King County, for example, “synthetic opioid-related fatalities skyrocketed by 133 percent in the second quarter of this year.” That’s not the only area either. The American Medical Association said “more than 40 states have reported increases in opioid-related mortality.”

Granted not all of those overdoses were fatal. But that’s only because Narcan was on hand.

The Epidemic Within

The opioid epidemic never really went away. But for a time it did seem to abate some. Unfortunately, that time is clearly over. The COVID pandemic is making sure of that.

Slate says “it makes sense.” And they’re right. “In times of extreme stress, many Americans do turn to substance use to ease their pain.” And why wouldn’t they? “Social isolation, dilution of social support groups, disruption in addiction recovery services, the plunge in employment…” Any one of the aforementioned is enough to throw someone off the rails. Combine a few and, well… Uncertainty makes matters even worse. Much worse. And experts are projecting we could lose another 150,000 Americans through pandemic-related drug use, alcohol, and suicide over the next decade. That’s in addition to the already sky-high “norm.”

Reversing the Course

So what to do? Well, the Slate squad says “it is absolutely critical that we think outside the box and implement nuanced strategies for overdose prevention.” ASAP, if not even sooner. For instance, overdose education programs are now available to everyone. Most even give participants naloxone on their way out the door. Unfortunately, not everyone knows this. Perhaps then a few widespread public service announcements are in order.

A further “increase in community-tailored training programs and expanded Good Samaritan laws” would also help. But here there are also inherent gaps that still need closing. The Centers for Disease Control and Prevention said “bystanders were present at over 40 percent of 2018’s fatal opioid overdoses, yet naloxone was administered only 4% of the time.” That’s abominable.

Slate calls for increased “awareness, access, training, possession, and use.” Awareness is “a necessary first step in motivation to change behaviors,” they say, but it’s “only nominally helpful unless there is easy access to lifesaving medications and other preventative tools.”

It would also be helpful if naloxone were available without a prescription. The FDA still hasn’t done that. Consequently “many states have taken things into their own hands.” In fact, right now “people can obtain naloxone without a prescription in every state except Nebraska.” It’s still expensive though. Narcan can cost as much as $150 for two nasal-spray doses. Evzio is $4,500 for a two-dose package. Yes, most plans will cover this with only a small copay, whether or not the buyer has opioid use disorder. And “some state health departments have copayment assistance programs.” But still.

Healing Properties and Narcan

The Slate three say “the FDA should just go ahead and make naloxone an OTC drug.” Healing Properties wholeheartedly agrees. Let’s drop all barriers to access. Soonest. Furthermore, “making naloxone OTC would allow for competitors to make cheaper generic brands.” That means Narcan would have to drop in price or go bye-bye. The makers have got a jump on things, so they may as well stick around. But only if they make Narcan affordable for everyone. Narcan needs to be in everybody’s pocket. Or at least in their first aid kits and glove boxes and medicine cabinets. This way it’s readily available whenever an opioid overdose occurs. We’ve already lost far too many lives.

Please reach out if you or a loved one is battling addiction. We’re here to help.

(Image courtesy the good folks at Web MD — with great gratitude.)