Naloxone Continues to Save Lives

The Los Angeles Times recently reported that the decline in opioid deaths—the first in more than 3 decades—is related to the increased use of naloxone to reverse overdoses.¹ Moreover, the CDC reported that naloxone prescriptions doubled to about 557,000 in 2018 from 271,000 in 2017 and fewer than 1300 in 2012.²

As pharmacists know, the drug can restore breathing and reverse the effects of opioid ingestion. Caregivers, drug law enforcement, and parents of addicts are all taking advantage of it. Nasal naloxone, approved in 2015 as Narcan, made providing the drug to patients much more feasible for law enforcement and others unskilled in injecting medications.

I was one of several law enforcement officers involved in the attempt to get naloxone available to cops on the street. The needed change came from the Ohio Pharmacy Board, which allowed law enforcement to possess and use naloxone to reverse the epidemic of opioid abuse. The effort was successful, and law enforcement across our state began to administer the medication to try to help at least reduce the scourge that has plagued us.

Measuring the effectiveness of a new tool in law enforcement is always difficult. As this measure was passed, the number of overdose deaths continued to rise. That did not mean that naloxone use was not working but rather that the large increase in abuse would likely have been much larger had the drug not been available to law enforcement.

Although the pharmacy board’s measure allowed law enforcement to administer naloxone, implementing the use of this lifesaving drug was up to the head of each law enforcement agency. Some jumped at the chance for their officers to provide this medication, but sadly many did not. The reasons varied. For instance, some felt it was the job of emergency medical services (EMS) and fire personnel and not members of law enforcement, as administering naloxone takes officers away from other essential enforcement measures.

But law enforcement officers often arrived at the scene of overdoses before EMS or the fire department could respond. These officers many times were helpless to assist victims of overdose because they lacked the tools to reverse the effects of the opioids.

Many leaders in law enforcement eventually relented, allowing their officers to administer nalox- one to save lives. Some did so as the result of public pressure and others because they saw the positive impact naloxone was having on other communities. There are still some holdouts in Ohio who do not allow their officers to provide naloxone, and I feel for the citizens of their communities and hope that their local law enforcement agencies will see the light and change their minds.

As we applaud the reduction in opioid overdose deaths in this country, we face a new problem that naloxone will not address. The incredible increase in cocaine and crystal methamphetamine use is beginning to take its toll on the Midwest and beyond. Many drug task forces must now spend nearly all their time on fighting these 2 drugs, which are flooding into parts of the country in ounces and pounds instead of grams.

Methamphetamine is one of the most addictive drugs around, and naloxone cannot help meth users. Naloxone will reverse only an opioid overdose and does not prevent deaths caused by other drugs.

Cmdr. John Burke is a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.

REFERENCES

• Stobbe M. Decline in opioid deaths is tied to growing use of over- dose-reversing drug, CDC says. Los Angeles Times. August 6, 2019. latimes.com/science/story/2019-08-06/soaring-use-of-naloxone-tied- to-decline-in-opioid-deaths. Accessed September 19, 2019.
• Guy GP Jr, Haegerich TM, Evans ME, Losby JL, Young R, Jones CM. Vital signs: pharmacy-based naloxone dispens- ing - United States, 2012-2018. MMWR Morb Mortal Wkly Rep. 2019;68(31):679-686. doi: 10.15585/mmwr.mm6831e1.