More and more, the answer appears to be a fairly new twist on an old drug designed to reverse opioid overdose: naloxone.
The FDA first approved naloxone, a medication that can revive someone who has stopped breathing from an overdose in a matter of seconds, in 1971. At first, emergency medical personnel gave patients the drug through an IV and did so with dramatic results.
Naloxone can also be given as a shot into the thigh with a prefilled auto-injector.
But in November 2015, with the opioid crisis raging, the FDA approved Narcan, a nasal spray version of naloxone, in the hopes that the new formulation would make it easier for caregivers, family, and friends to use it and save more lives.
The CDC’s most recent data show that 70,237 people died in 2017 from a drug overdose. Nearly 48,000 of those were from opioids. As an EMS captain with the Washington, D.C., Fire and Emergency Medical Services Department, it’s a number that hits Mark Baker hard. Those same statistics put D.C. and four states in the top five for the highest rate of overdose deaths.
“We revive people who have overdosed on narcotics daily,” Baker said. “Narcan is a wonderful drug for opioid overdose and narcotics.”
But it’s not a cure, he cautions, so there should always be a follow-up by a medical professional.
Last year alone, D.C. Fire dispatched 4,363 overdose calls. Baker says while he still prefers giving someone the drug in a vein, the nasal spray is now being used more often.
“It’s just a safer route, safer way to administer. The less needles we have floating around, the less possibility people get stuck. It’s a lot safer for everybody in general.”
It’s so safe that today, 49 states and the District of Columbia offer this lifesaving drug without a prescription. Only Hawaii does not. These states have issued standing orders that allow a prescription-only medication to be sold without a prescription at the pharmacy. Anyone in those states can now simply walk into a pharmacy and get Narcan -- and an explanation of how to use it -- from a pharmacist.
How the Drug Works
Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), one of 27 institutes and centers at the National Institutes of Health, has done research on Narcan.
Naloxone works by taking over opioid receptors in the brain. It forces out opioid drugs like heroin and fentanyl to block their effects, she says.
“In the breathing centers of the brain, naloxone displaces the opioids drugs, thus restoring breathing during an overdose,” she says.
Volkow told WebMD that Narcan works for any opioid drug when people are no longer breathing on their own, and she says the side effects are as low as it gets for a medication.
"It’s actually quite safe. It’s an amazing medication in this respect,” she says. “I haven’t seen anything as dramatic as how you restore breathing with naloxone. We want to do whatever it takes to make naloxone as widely available as possible, because it makes the difference between someone dying and someone not dying.”
Volkow says she’s very comfortable with it being so available, and that includes to libraries, colleges, universities, and even high schools.
Maryland-based pharmaceutical company Emergent BioSolutions announced in October that it would supply two doses of Narcan to every public library branch in the country. Three years ago, Adapt Pharma, Narcan’s manufacturer, worked with the National Association of School Nurses to provide free Narcan to every high school in the country. Currently, 2,185 high schools in 48 states -- all but West Virginia and Wyoming -- and Washington, D.C., take part in that program. A year later, colleges and universities were added.
Georgia is one of those states. In 2014, then-Gov. Nathan Deal signed Georgia’s Medical Amnesty Law. It increases access to naloxone and provides immunity from civil or criminal liability to both those receiving and giving the drug.
The Georgia Department of Education says schools began to stock Narcan after that law was passed. Each school district decides whether they will stock the drug, and they are not required to report it to the state.
‘We Are Empowering Families and Friends’
Some 600 miles away, Baltimore is a city that has struggled with drug addiction and abuse for many years. Jennifer Martin, a deputy commissioner at the Baltimore City Health Department, told WebMD that last year alone, residents saved 1,178 lives with Narcan.
“Through our naloxone education and training efforts, we’ve really been able to put a lifesaving medication into the hands of tens of thousands of Baltimore residents,” she says. “We are empowering families and friends of individuals who suffer from the disease of addiction to be able to save their loved one’s life if necessary.”
Martin says the city has had an overdose education and response program in place since 2004.
“But in 2015, that was when we issued a citywide prescription around naloxone specifically to address the growing opioid crisis here in the city,” she says.
More than 51,000 Baltimore residents have been trained to use naloxone in the past 3 years, Martin says. City residents successfully used naloxone more than 4,400 times from 2015 to 2018.
It’s a common refrain: Narcan saves lives. Narcan is safe. So much so that NIDA
is doing a study to evaluate what policies are more likely to make Narcan as widely available as possible. That research evaluates the effects of making it available over the counter as opposed to the standing orders now in place at pharmacies.
And the FDA, it seems, is on board. In January, it announced efforts to support making naloxone over-the-counter (OTC). It has come up with a model drug facts label (DFL) -- required for all OTC medications -- and did comprehension testing to make sure consumers understand the label instructions and use Narcan in the right way.
Still, Volkow stressed, it’s just one piece of the puzzle. “Without it during an opioid overdose, that’s it for that particular individual. However, by itself naloxone is not going to solve the opioid crisis. You need to treat; you need to prevent opioid use disorders. The combination of prevention, treatment, and overdose reversal strategies, along with the policies and resources to sustain them, is what’s going to actually solve the crisis.”