Investigators Encourage Naloxone Availability for Health Care Providers to Combat US Drug Epidemic

Researchers at Florida Atlantic University (FAU) are urging education for health care providers on the use and administration of naloxone (Narcan; Emergent BioSolutions) in their treatment programs, in a commentary published in The American Journal of Medicine. The opioid receptor antagonist comes as a nasal spray or auto-injector.

Earlier this week, 2 panels of FDA advisors unanimously voted to recommend that naloxone be made available without a prescription. The FDA will make a final decision in the coming weeks and has a Prescription Drug User Fee Act goal date of March 29, 2023.

Making naloxone more widely available to emergency workers could prevent up to 20% of overdose deaths from opioids.

“The United States accounts for less than 4.5% of the world’s population but accounts for more than 13% or 2.1 million of the more than 16 million people with opioid-use disorder,” Charles H. Hennekens, MD, PhD, senior author, first Sir Richard Doll Professor, and senior academic advisor in the Schmidt College of Medicine at FAU, said in a press release.

In 2021, more than 100,000 people in the United States died from a drug overdose, which is up 28.5% since 2020. Premature death from drug overdoses is considered a rising epidemic in the United States. Synthetic opioids are largely contributing to these deaths, with many containing lethal doses of fentanyl—a low cost, highly potent, and often illegally manufactured compound that can be deadly to all users.

Naloxone can reverse the fatal effects of a drug overdose by restoring normal respiration and heart rhythm. It Is recommended as an overdose treatment by the US Centers for Disease Control and Prevention, but the FAU investigators anticipate that it is being under-prescribed to patients who are prescribed opioids.

“About 1 in 5 patients prescribed opioids for chronic pain have overdosed and more than half take other prescription drugs that may cause overdose as well as abuse alcohol,” Hennekens said in the press release.

Investigators found that naloxone is only prescribed to 1.4% of every 70 patients prescribed high-dose opioid prescriptions. Investigators also wrote that naloxone should be available in locations with portable defibrillators. Naloxone, like defibrillators, can help patients who suffer from cardiac arrest; in the former instance, the patient suffers cardiac arrest because of opioid toxicity in the body.

Training health care providers about nasal or auto-injector naloxone may be a cost barrier, but retail naloxone is under $100. This is less than one-quarter of the cost of epinephrine auto-injectors ($400) used to treat anaphylaxis. The team also suggests that health care providers take it a step further and educate patients who use drugs, along with their families, about the importance of having naloxone as a nasal spray or auto-injector at home.

“Now is the time to become more proactive in the fight against opioid-related deaths,” said Allison Ferris, MD, corresponding author, chair of the Department of Medicine and an associate professor in the Schmidt College of Medicine, in a press release. “We propose a call to action for all health providers and state medical societies to ensure the widest distribution and easy availability of naloxone, including over the counter, which is likely to be FDA-approved very soon.”

Reference

Florida Atlantic University. Researchers endorse widespread naloxone over the counter to prevent drug overdose deaths. News Release. February 15, 2023. Accessed February 16, 2023. https://www.eurekalert.org/news-releases/979757