Consider This from NPR - How Over-The-Counter Narcan Could Help Save More Lives

Episode Date: April 3, 2023

The FDA has approved over-the-counter sales of Narcan, a nasal spray version of the life-saving medication naloxone. The medication is known for its ability to rapidly reverse an opioid overdose. The FDA's move will make Narcan more widely available than ever before. But experts say this is just one step in the right direction, when it comes to preventing overdose deaths.NPR's Ailsa Chang speaks with Nabarun Dasgupta, a senior scientist at the University of North Carolina who has been studying opioid overdose prevention and addiction treatment since 2002, about what this means for the opioid epidemic. In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for NPR and the following message come from the Kauffman Foundation, providing access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity, regardless of race, gender, or geography. Kauffman.org Mike Selleck has a lot of experience administering the life-saving medication naloxone. His work involves helping people who are experiencing drug addiction, including addiction to opioids. The most recent time he had to reverse an overdose was in his own neighborhood. Selick was walking his dog when he saw someone lying in the grass across from his driveway.

They were breathing very poorly and shallowly. I think a lot of people had already seen it, but just assume the person was asleep or drunk or something. So if I hadn't had a lot of experience recognizing overdoses and reversing them over the years, I probably wouldn't have thought anything of it. Selick dialed 911 as he ran into his house, just like he has every time he has reversed an overdose. Once inside his home, he grabbed Narcan. It's a nasal spray form of naloxone, which is used to rapidly reverse an opioid overdose. I sprayed one into one of his nostrils and watched his breathing. Luckily, this person was breathing poorly, but on their own,

so I didn't actually have to do rescue breathing. Selick has been doing community outreach since 2010 to people who use drugs. Now he works for the National Harm Reduction Coalition. He says overdose happens because opioids affect the part of your brain that controls breathing, and people end up suffocating and dying from the lack of oxygen. He weighed about two to three minutes before administering the second dose, so he was still out. I administered the second dose. The person woke up pretty much immediately. They were up a little confused and talking. That was the moment when emergency responders arrived. They were able to talk to the person Selick treated and took them to the hospital in an ambulance.

I've called 911 before and had it take 45 minutes for rescue workers to show up. If you're not breathing for 45 minutes, you're dead. He says this is why it's so important to get Narcan in the hands of bystanders. People like friends, siblings, parents, co-workers, roommates, anyone who is around people who use drugs. The CDC estimates that nearly half of overdose deaths in 2021 had potential bystanders, bystanders who could have prevented a death if there was Narcan on hand. All of the evidence has shown that the people who respond first are not uniform first responders. They're people in the community. First responders have had access to naloxone for decades. In 2015, the FDA approved its use more widely in the form of Narcan as a prescription drug. And last week, the FDA approved its use more widely in the form of Narcan as a prescription

drug. And last week, the FDA approved Narcan for over-the-counter sales, something that advocates have been pushing for for years. That will make the drug more widely available than it ever has been before, which, Selig says, is a great thing. Harm reduction is all about keeping people alive. If somebody overdoses and nobody responds, there's no chance for a tomorrow, there's no chance for better outcomes, and people have lost a loved one. We want people to survive.

Consider this. The FDA's approval for over-the-counter sales of Narcan is a big deal. It expands access to life-saving medication at a time when opioid deaths continue to rise. According to the CDC, more than 106,000 people died from an overdose in 2021 alone. After the break, we hear how this move by the FDA could be a promising step forward in the fight against the opioid epidemic overall. From NPR, I'm Elsa Cheng. It's Monday, April 3rd. This message comes from WISE, the app for doing things in other currencies.

Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE.com. T's and C's apply. It's Consider This from NPR. Over 930,000 people have died from a drug overdose in the U.S. since 1999. And according to the CDC, 75% of drug overdose deaths in 2020 involved opioids. Naloxone is seen as a miracle medication because of its ability to rapidly reverse an opioid overdose in minutes. And in 2015, when the FDA first approved Narcan, the first prepackaged naloxone nasal spray, it put the power of a life-saving medication

into the hands of people that needed it most. But it was only available with a prescription or through free community handout programs. Now, with the FDA's recent approval for over-the-counter sales, it will be available to more people than ever before. And to learn more about this, we spoke to Nabroon Dasgupta. He's a senior scientist at the University of North Carolina, and he's been studying opioid overdose prevention and addiction treatment since 2002. I asked him what difference an easy-to-use nasal spray applicator for naloxone has made in overdose death prevention since the first FDA approval in 2015.

So the nasal spray really opened up naloxone to be distributed in areas where it had not been before. So folks who were afraid of the former version, which included needles, could now just have something that works as easy as a nasal spray. So this allowed for places like prisons and jails to have naloxone where needles would not be acceptable. But more importantly, it brought it out into community groups who are interfacing with people who use drugs and could carry this around a little bit more easy. And typically up until now, what kinds of people have most commonly been administering naloxone? Like, I'm assuming we're talking about EMTs, police officers.

Traditionally, naloxone was used in emergency departments and by EMS on ambulances. So starting in 1996, Dan Bigg in Chicago found ways to get his hands on naloxone and hand it out directly to people who use drugs, people who are injecting heroin and were dying of overdose. That has now grown into what is national policy, bolstered by two decades of scientific evidence showing that this works and is effective in reversing overdose death rates. Okay. Just to be clear, though, Narcan, the nasal spray form, it's really simple to use, right? Like almost anyone can learn very quickly how to administer it. Am I correct? Absolutely. It's a motion that most people have already done.

You put something in your nose, you press the plunger, and it fires out the naloxone into your nose. There's really not very many ways to screw it up. Okay. That's very reassuring to hear. Well, with this latest development, we're hearing that the price of the nasal spray to the average consumer could land anywhere between, what, like $35 and $65. What do you think of that price? Like, do you think it might deter people from going out and buying it because it's still kind of expensive? What we know works in public health is if the price of the antidote is cheaper than the price of the dope, right? If we're talking about $10 for a dose of fentanyl or heroin, then the price of the antidote needs to at least be on par with that and ideally much less.

So we have a long way to go. Okay, that makes sense. But what if the price first over-the-counter product is going to hopefully entice other pharmaceutical companies to come to the table with cheaper devices, cheaper nasal sprayers, cheaper nasal swabs, maybe something that dissolves inside the cheek. There's a lot of ways to deliver naloxone into the body that are going to be cheaper than this first product. So we should stay tuned. Okay. And then when it comes to actually physically procuring it, do you get the sense that Narcan will be something that I could just grab off the shelf at the pharmacy? Or would I have to go up to someone and have a whole conversation

with a pharmacy employee to get me the nasal spray and then maybe worry about being judged for requesting it. What do you think? That's a very real risk that the stigma that already exists within the healthcare system against people who use drugs is going to get perpetuated in the way that Narcan is available. It wouldn't surprise me to see it locked up behind the counter because of its price. It's also a fairly large box. And so pharmacy space is at a premium. And I would be surprised if pharmacies were able to have inventory of large amounts of this antidote. There's this amazing vision of having the nasal spray available at every gas station in the country, right? It sounds like such a good idea. But if you go into a gas station, you don't see any other products that are in the $40 to $50 range. So I'm skeptical that that's

going to be where it goes. What I do think is going to happen is that vape shops and head shops are surprisingly ubiquitous in our country, and they do sell products in that price range. They also attract a clientele who may be at higher risk for overdose. So I think that is an unusual partner for public health in many ways. But the kind of innovation that can happen when something is over the counter and we can see all the new places that we can put this product to get it in the hands of people who really need it. Well, what about the effect of all of this on the supply of free naloxone? I mean, what I'm talking about is, you know, right now a lot of community groups are able to provide this drug for free. And if a lot of the supply of this drug is now getting routed to pharmacies,

do you think the supply of free naloxone will diminish? This is a real concern. Over the last decade and a half, we've had four national shortages of naloxone. Anytime you have a monopoly on a pharmaceutical product, it's a recipe for disaster. So to prevent that, what we have done in the last year is to shore up the supply chain for the free and low-cost generic liquid injectable naloxone, the formulation that a lot of our harm reduction programs are relying on. Thanks to some guidance that the FDA issued last year, based on what they learned from COVID, we're able to ship bulk naloxone to harm reduction programs from a diversity of

suppliers for very cheap and without a prescription. So I think we've done the legwork to shore up the free supply chain, and I don't see that going anywhere. I think we're in a very good position, better than we have been in years. Okay. Well, I know that we've gone through several reservations about expanding availability of Narcan to pharmacies to be bought by just average consumers. Do you expect, despite these reservations, that making naloxone way more widely available as this over-the-counter nasal spray is going to make a big difference ultimately in lives saved? That's our hope, right? I mean, we're at a sad point in our country's history where we need the antidote to be available this widely. A lot of our prevention, a lot of our

policy that should have prevented this kind of overdose death volume hasn't worked. It's time for new solutions. We need new ideas, and we need to make these tools available. Naloxone is a miracle drug, but a lot of the miracle happens in the time after someone is reversed, in the care and the love that we give to people who we bring back from the dead and who we are there for to support in whatever the improvements that they can make in their own health and their own lives. So I think while we are really focused on naloxone today, I think there's so much more compassion that we could be showing to the people who survive overdose, whether it's a hospital bill that they now have to pay, whether it is physical problems, and whether it's the stigma of having a hidden behavior now be made public. That's where any one of us can really step up and bring our whole selves into caring for the people who have experienced overdose. That was Nabarun Dasgupta. He's a senior scientist at the University of

North Carolina. It's Consider This from NPR. I'm Elsa Chang.