Jackson Falconer
BRADENTON – Amid a new opioid epidemic in Manatee County and throughout the U.S., many states and communities seeing their overdose rates skyrocket are acting to increase the availability of the anti-overdose medication naloxone, also known as Narcan. One such way of increasing access to the medication–by making it available to purchase without a prescription–has been gaining traction in several states, despite some pushback from opponents of the measure.
Naloxone prevents fatalities by reversing the effects of overdoses though intravenous and nasal spray versions. Some of the more widely supported measures to increase its availability have included allowing first responders to carry the medication, as well as authorizing doctors to prescribe it.
In some instances, naloxone kits have been dispensed to community law enforcement agencies. Last month, one of the drug's manufacturers
donated 400 kits, or 800 doses, to the Sarasota County Sheriff's Office. The greater access to naloxone for EMTs and police, as well as making the drug available through a prescription, was made possible in Florida through the
Emergency Treatment and Recovery Act, which passed through the state legislature before Gov. Rick Scott signed it into law this past summer.
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| Injectable naloxone (photo: Washington.edu) |
While such laws have now been successfully passed in
more than twenty states, the over-the-counter measure has seen slower, yet still significant, acceptance. With the Emergency Treatment Act's passage still fresh, any future potential changes to naloxone access in Florida may take some time. Proponents of OTC naloxone argue that allowing patients to purchase it without having to see a doctor prevents overdoses.
But opponents of OTC availability have argued that such access would only encourage addicts to continue with their drug abuse, and administer their opioid doses with less care. In Indiana–which has been part of the recent multistate heroin overdose spike–one of those opposing voices has been Boone County prosecutor Todd Meyer.
Meyer said he feels the potential negative impact of making the drug available over-the-counter outweighs the potential positives. "I understand the logic certainly, and believe wholeheartedly in the notion of having it widely available," such as with first responders and parents of addicts, he said.
But Meyer believes that heroin dealers would take advantage of its over-the-counter availability and use it as "ammunition" to push their product. He pointed to the state's new needle sharing program, which he said dealers have exploited to assure buyers of a safe intravenous experience. Meyer also said he's been told of addicts who, in conversations with health professionals, have expressed a sense of relief about having naloxone on hand. "They know they've kind of been given a green light," he said.
When asked about the 'enabler' argument made by OTC opponents, Jay Wolfson, a distinguished service professor at USF, said, "There is no evidence that making a treatment to opioid overdose more available would create increased demand for the opioid, nor that dealers would be able to more successfully 'sell' opioids if each sale also included a separate naloxone dose in the event of overdose."
Wolfson also touched on the potential dangers of naloxone, noting that while it can't be abused recreationally, it can instantly put the user into sickly opioid withdrawal. He said, "While clinically supervised withdrawal from opioids and attentive management and follow through are most desirable–the option of increased self care and management via OTC availability of naloxone may provide a marginal benefit with few clinical or social costs."
Indiana State Senator Jim Merritt, who plans to sponsor state legislation next year that would make naloxone available over-the-counter, also rejected the anti-OTC argument. "For those addicts who have a heroin dose on daily basis, they don't purposely overdose, so there's not a mindset of, 'Anyone living with me has anti-OD meds, so I'm gonna stick as much heroin in my veins as possible,'" he said.
Merrit's argument has been backed by
several recent academic studies, one of which was based on a Los Angeles program that educated heroin addicts on how to properly use naloxone.
That study found no rise in the subjects' drug use after they left the program.
In fact, Karla Wagner, an assistant professor at the University of Nevada who worked on the study, has noted that the research found users' intravenous habits decreasing following their participation in the program. "In the research that I've done, we actually saw that three months after people participated in the (naloxone) program, 53 percent said their drug use had gone down,"
she told The Nevada Sagebrush earlier this year.
Before Merritt supported over-the-counter availability for naloxone, he first advocated giving EMTs access to carry the drug, and giving physicians the authority to prescribe it. But he found that those measures were not helping enough to prevent fatal overdoses, which have especially scourged Indiana's rural areas.
"We were finding that physicians were demanding they see the person they were prescribing it to," which he said had a deterrent effect for many patients unwilling to see a doctor to get access to the medication.
Merritt said the state also found that pharmacies were not filling prescriptions for the drug, as they did not want to take the financial risk of having it on hand. He believes a solution would be legislation that gives pharmacies a standing order to carry the drug, an action that was recently taken by Pennsylvania Governor Tom Wolf.
Mark Fontaine, executive director for the Florida Alcohol and Drug Abuse Association, said his group supports making the drug more widely available in the state. "The number one priority is to save lives and the medication has proven effective at that," he said.
Fontaine also said other steps must be taken to help reduce fatal overdoses. He noted that medical care after use of naloxone is still needed, and said there needs to be a greater connection with emergency rooms and those involved in treating addiction, "so we can make an intervention with those people and try to create a pathway to enter treatment."
CVS Pharmacy has begun selling naloxone in fourteen states that have authorized over-the-counter access. Mike DeAngelis, a spokesperson for CVS, said the company would move to sell the drug in Florida without requiring a prescription if state lawmakers make it allowable to do so.
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