Naloxone: The Answer to an Epidemic
by Jenna Frawley
On Oct. 28, 2015, the Physician’s General of Pennsylvania signed a standing order for the drug naloxone to be dispensed by pharmacies per patient request. This means that, much like Robitussin AC or the Plan B pill, anyone in the state can buy naloxone straight from the pharmacy counter.
The decision to distribute naloxone in this manner was reached in response to the steadily increasing rate of heroin overdoses that have occurred in Pennsylvania. This trend, however, has not been isolated to just our state. The nationwide increase in opiate overdoses has been a growing problem since the 1990s.
Opiates are some of the most addictive drugs available, as they create both heavy psychological and physical dependence. Their withdrawal symptoms are rivaled only by alcohol and benzodiazepines, proving dangerous for people suffering from long-term addiction. The recent rise in opiate addiction is potentially linked to an important new drug released in 1996: OxyContin.
OxyContin or oxycodone is a powerful opiate that is available by prescription for the treatment of severe pain. Prior to its release, opiates had been reserved solely for the treatment of terminally ill cancer patients. However, after a series of marketing campaigns by the pharmaceutical company that released it, doctors expanded the use of opiates for all kinds of pain. According to Tom Frieden of the Centers for Disease Control and Prevention (CDC), the most common way that people become addicted to opiates is through a legitimate prescription, usually following some sort of injury or surgery. In order to combat the link between prescription drugs and opiate dependence, the government has pushed for tamper-proof pills and greater tracking of opiate prescriptions.
After becoming dependent on opiate painkillers, it is common for people to turn to heroin. This is largely because, while the cost of pain pills continues to rise, the price of heroin has dropped, making it a much more affordable and accessible drug. There are a few key reasons as to why heroin use can be more dangerous than prescription drug abuse. First, heroin is commonly injected, which can lead to more infections or overdoses than pills. Additionally, heroin is illegal in the United States, which means that the product is prone to becoming contaminated with substances such as toxic chemicals and other drugs. Currently, over 500,000 people are addicted to heroin in the United States, of which more than 8,000 have died of an overdose in the past year. The numbers are projected to rise even further in the coming years.
In reaction to the recent increase in overdoses, many states have started equipping police officers with naloxone (brand name Narcan), which is an opiate antagonist used to prevent overdoses. An antagonist is a chemical that blocks a receptor protein by binding to the receptor site but not eliciting a response. It can also bind elsewhere on the protein and change its conformation. Naloxone is a competitive inhibitor and occupies the receptor site of several different opiate receptors, thereby preventing the addictive opiate from working and thus reversing an overdose.
While paramedics have always kept naloxone on hand, giving it to police is a new practice. It originates only a few years ago in Quincy, Massachusetts, where police were trained to recognize the signs of opiate overdose, such as blueness of the lips, irregular or arrest of respiration, confusion and pinpoint pupils. Most officers are given the intranasal system as it is easier to administer than the intravenous one. The intranasal method can still be administered to patients with respiratory arrest due to the high density of blood vessels in the nose (this is assuming of course that cessation of breathing was caused by an opiate overdose). Since the introduction of the program, deaths due to opiate overdose have dropped by 90 percent in Quincy. This has triggered other police stations to emulate the system and even encouraged some states, like Pennsylvania, to allow the drug to be sold over-the-counter.
CVS is one such pharmacy that has agreed to sell naloxone in all 12 states where it has become legal. It is already in stock in New York and New Jersey, as they were the first states to allow this practice. The pharmacy chain will offer both intranasal and injectable versions of the drug. However, they expect the intranasal form to be distributed more often as it is easier to use. In terms of effect, there is no significant difference in the time it takes for the drug to act or in superiority between the intranasal and injectable versions. While CVS will likely extend this policy to Pennsylvania in the near future, it is not yet available. Currently, the only pharmacy in Pittsburgh that supplies this drug is the Center for Pharmacy Services located on Centre Ave., but this may likely change as pharmacies go through the process of adding it to their inventories.
Anytime a drug is transitioned to be sold over-the-counter, there is concern for whether it could be misused, such as if it were administered to someone who was not overdosing on opiates. Luckily, naloxone seems to have few adverse effects. The main concern is that, because it blocks almost all opiate receptors, a strong enough dose can bring on withdrawal effects, which may be dangerous for an individual with a dependence on opiates. However, these tend to disappear after about an hour, which is when naloxone tends to wear off. Because of this, treatment should be sought anytime naloxone is used because it may wear off before the opiate does, causing a person to slip back into overdose.
Overall, there are no significant repercussions to moving naloxone over-the-counter, and it has the potential to save thousands of lives. While naloxone will not necessarily prevent the drug epidemic from spreading, it will certainly lower the death toll. In addition, there is hope that this will also encourage society to accept addiction as a treatable disease and will hopefully be the first step in a series of policy changes that can combat the growing issue.