Today, Explained - Should you carry Narcan?

Episode Date: April 5, 2023

The drug that brings people overdosing on opioids back from the brink of death in minutes just got approved for over-the-counter use. The Wall Street Journal’s Julie Wernau explains why she carries it with her everywhere she goes. This episode was produced by Hady Mawajdeh, edited by Jolie Myers, fact-checked by Laura Bullard, engineered by Paul Robert Mounsey, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained   Help keep this show and all of Vox's journalism free by making a gift to Vox today: bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

America, America has a problem. It's a drug problem. It's mostly an opioid problem. The situation right now with the drug supply in America is that fentanyl is showing up in just about everything you can imagine. The opioid problem is so bad, users might be taking them when they're trying to take other drugs. And so people are overdosing of

fentanyl who were taking meth, who were taking cocaine, who were taking pills, who were just out for a party night on the weekend. And if you don't know you're taking opioids, it gets a lot easier to overdose. Over 100,000 people have died from drug overdoses in the past 12 months. The vast majority from opiates, including synthetic drugs like fentanyl. But there is a quick and easy drug that can reverse an opioid overdose. It's about to be available over the counter. It's ahead on Today Explained. The all-new FanDuel Sportsbook and Casino is bringing you more action than ever. Want more ways to follow your faves?

Check out our new player prop tracking with real-time notifications. Or how about more ways to customize your casino page with our new favorite and recently played games tabs? And to top it all off, quick and secure withdrawals. Get more everything with FanDuel Sportsbook and Casino. Gambling problem? Call 1-866-531-2600. Visit connectsontario.ca. I'm Julie Wernow.

I'm a health and medicine reporter at The Wall Street Journal. Tell us, Julie, what is up with Narcan? So last week, the FDA approved this medication that people use to reverse an overdose for over-the-counter use, which means that pretty soon you can walk into a retail pharmacy and just pick up this medication along with like your vitamins and Tylenol and any other number of things you might grab at the pharmacy. And that's a big deal? It's a big deal. It's something that people have been advocating for for years. We have a pretty serious opioid crisis out there. New numbers out today from the CDC show how drug overdoses have surged during the pandemic.

More than 107,000 Americans died of drug overdoses in 2021. That's the highest annual death toll ever recorded and a 15% increase from the year before. Deaths involving fentanyl, meth, and cocaine rose sharply. So they were asking that this medication, which is in some ways kind of a miracle drug, I mean, it literally just takes someone who is not breathing, who is not responsive, and pulls them out of that state. You can see it through police body cams. This woman in the back of a Salt Lake City PD squad car isn't breathing. The officer sprays naloxone up her nose with a device called Narcan. Stay with me.

Watch it take effect. There you go. There you go. There you go. And so we have got approval for that for the first time ever in decades of the opioid crisis. And if people have been asking for it for years,

why did this just get approved, you know, a few days ago? Well, that's a great question, and the answer might not be what you would expect. The FDA actually kept pushing and pushing and pushing the pharmaceutical companies to go ahead and apply for these drugs to be over-the-counter, and nobody was showing up for years. And so little by little, the FDA made it almost impossible for them not to apply. For example, a couple years ago, they said,

here, here's what the packaging could look like if you want to apply, and actually made a mock-up of a potential over-the-counter version of Narcan. They don't do that kind of thing that often. They also then came out with a statement that essentially said, if we see scientific evidence that there's no reason that this drug shouldn't be over the counter, anyone who continues to sell it as a prescription only drug will be doing something against the law. And that, little by little, pushed the pharmaceutical companies to start the process of applying for these medications to go over the counter.

So in all this time where people have been advocating to make it easier to get Narcan, and the sort of move to make it easier has been punted down the road, has it been really hard to get this drug? Well, what's interesting is originally, right, I mean, this is a prescription-only medication, and so it would be the kind of thing that you'd have to go to a doctor. The doctor would have to give you a prescription. Then you go to your pharmacy, you get it filled, etc. Because there was no over-the-counter version of this, states, advocacy groups, anyone you can think of that works with drug dealers, health advocates, figured out all these workarounds and at the state

level made it possible to get this drug a little bit easier. So for instance, if you walk into your pharmacy right now and you don't have a prescription, you ask for it, they'll give you this medication. And the reason is they have this, what they call statewide standing orders. Think of this as a prescription for everyone in the state, whether it's a police department, a fire department, or even an individual, to go and obtain this drug so that they can start saving lives. Also, you have insurers will pay for it. They've tried so many ways to make this medication accessible and work around the fact that we didn't have

an over-the-counter version of it. Interesting. Okay, so though this is a major change and it's a big deal, essentially a bunch of states had figured out a way to get this to people even without this change. They figured out ways. In fact, in some states, you know, depending how liberal they've been with those standing orders, they've got it in free vending machines. What?

Once you gain access to a locker, it pops open. You reach inside and you'll find a bag with two doses of Narcan, gloves, a face shield, and a visual aid on how to administer the life-saving doses. You can go into the city center somewhere and you'll see, you know, you punch in a code and out comes your little kit with naloxone in it. Okay. So depending where you live, it's difficult to extremely easy to get Narcan right now. That's right. Part of the problem has been, though, that that's not the same everywhere,

right? Because ultimately you still have, for the most part, these pharmacists are like the gatekeeper for whether or not you get these prescriptions. And so there are some people who will not sell it to you on like ethical grounds, essentially. There's also the fact that a lot of the sort of free Narcan that's out there is in the hands of big harm reduction groups that work with drug users. So if you're sort of a recreational drug user or you just want to have this stuff on hand, you probably aren't really that, you're not in the know about who those groups are and where to go to get it. It might be,

you know, something that ends up being on your to-do list, you know, for three years and it doesn't happen versus, oh, I'm in here and I'm buying my shampoo. That's right. I'm going to grab my Narcan. So maybe this change then to make Narcan over the counter is just making it more consistent across the country. Is that what we're going to see? Yes, that's right. Also, I think it's a very important symbolic move for the country. Essentially, the country is policy-wise trying to move away from this idea that the only way to deal with drug use is abstinence, that, you know, we need to eradicate drug use in America versus that there are really obvious tools that we can use that help reduce the harm to the people who are using drugs, particularly, in this case, death. It's in some ways, you know, the lowest hanging fruit, right?

Can we keep people alive? Does that mean that they're going to stop using drugs? Not necessarily. Does it keep them alive so that they can go to treatment if they want to? It does. So that's a little bit where we're starting right now in terms of thinking in this country about reducing harm to drug users. So are there any drawbacks to making this drug easier to get? So I would say that the people who are really not in favor of just widespread adoption of Narcan are folks who think that this is enabling drug use. There are many drug users who are overdosing multiple times a week. It's 50 times more powerful than heroin and 100 times more powerful than morphine. I've talked to drug users who are overdosing

multiple times a day. It is the deadliest drug threat our country has ever faced. Because fentanyl is so unpredictable in our supply and is so powerful. Drug dealers found that mixing a little bit of illicit fentanyl into heroin could make their product much more potent. The white powder could be pressed into counterfeit pain pills that look like Vicodin or Xanax. The white powder is measured in milligrams, and it only takes a few grains for someone to overdose. And so the folks who, you know, are against this saturating the entire market are saying, well, like, if you overdose once, you know, which doesn't always kill you, and it's horrific, and you end up in the hospital, maybe that would be your path to drug

treatment, and you wouldn't do drugs anymore, right? That was the thinking on it. And of course, on the other side, people say, well, also, there's a very strong chance you'll just die. So it's a difficult conversation that a lot of public health officials are having about how do we make sure that people aren't dying, but at the same time, like, what's the pathway here to treatment? So, right. Greater availability could encourage people to use opioids, fentanyl, whatever. But we're currently in a situation where people are just using them anyway without as easy access to Narcan. It's sort of like the helmet effect argument. I don't know if you've heard of this. Yeah, yeah, yeah, yeah.

Yeah, so it's this idea that people end up getting injured because they have this idea that they have this safety lever of the helmet or the padding and end up going harder and more hardcore, right? So there's this idea with drugs. It sounds like the issue we're talking about broadly here is just the stigma associated with drug use, especially opioid use, which is way scarier than say pot use where there's already stigma. Should I say pot? People laughing when I say pot. I don't know why I say pot. I know. What are the kids calling it these days? I don't know. There's pot, weed, marijuana, what have you. Delta 8. How do you do, fellow kids? What? So what are we to do? Address the issue and provide these kinds of drugs that can revive people and save lives or make them hard to get so that people might be, in theory, more careful, but it doesn't necessarily seem that way when we have over 100,000 overdose deaths a year.

I think one of the things that's changing the conversation a little bit right now, which is why you're seeing more conversations that allow more Narcan or fentanyl test strips, et cetera, is that we came out of the pandemic and faced a totally new drug market. If it weren't for the COVID pandemic, this would be the epidemic that Americans are talking about. This is now killing more than 100,000 people a year. In that drug market, fentanyl is in a lot more things than heroin, dope, what you're expecting. It's showing up in cocaine. It's showing up in these fake pills that look so good. They look better than the real pills.

So people are at parties who are not hardened, you know, heroin users and are encountering fentanyl. These are people who maybe don't need drug treatment because they might do like a little Coke every, you know, six months or something like that. And so I think that's changed things because people are turning up dead around the country who grabbed his annex from a friend at a party. It feels a little too random to people right now, I think. And that is changing the conversation. And, you know, one thing that I always like to point out is that unlike the COVID pandemic that largely hit older Americans, this crisis is really hitting young people, which has a devastating impact on communities, on economies. And there's also no end in sight. Unlike COVID, which we're slowly putting behind us, this seems to just keep getting worse. Fentanyl users are pretty accustomed to

fentanyl. They're actually very smart about how to use it. They have learned, you know, how to stay safer. If you are completely ignorant about opioids and never use them and it just shows up, that's a different story. That's scary. Support for Today Explained comes from Aura. Aura believes that sharing pictures is a great way to keep up with family, and Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter.

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explained to you. Julie, I think it's high time I ask you, what is Narcan? So Narcan is actually a brand name for a drug whose scientific name is naloxone. Now, what this drug does is actually pretty simple. If you have opioids in your system, they like to sit on the opioid receptor, aptly named. That's what it's called? Yes, it's a particular opioid receptor that the opioid will just sit on and kind of hang out. These receptors are found on cells in your brain,

spinal cord, and other areas of your body. Opioids act on these receptors to make you feel less pain. And what it will do is, if you've had too much, it's going to reduce breathing, respiration, etc. This is how people's hearts stop, right? Soon, lips and hands start to turn blue. Within just a couple of minutes, without oxygen, brain damage can start to happen. So naloxone also has a very strong affinity for this same receptor. And the opioids don't just like stay on the receptor, they kind

of cycle through. And it's a little bit hard to explain, but essentially the naloxone comes in and it replaces the opioid before it can get back on, but essentially the naloxone comes in and it replaces the opioid before it can get back on the receptor. When naloxone attaches itself to the opioid receptors, it counters the effect of the drug. Soon it begins to reverse the impact of the overdose and restores breathing, knocks every other, you know, the opioids just like leave your whole system. They can't get back on the receptor, which is also why one of the not so fun parts about getting revived with naloxone is that immediately, if you're an opioid user, you're going to go into some pretty bad withdrawal. Sometimes they can come back in a daze, often mad, scared and aggressive as they're coming down from their high. But you'll be alive. What does naloxone, at least in its Narcan form, look like? How does it work?

Yeah, so if no one's ever seen this drug, it's actually ridiculously simple. What they did is they put naloxone inside this, essentially like a nasal spray type contraption. The person is passed out. You put it up the person's nose. You hit the spray function and you've delivered the dose. That's how it works. Within two to eight minutes, the person will come out of it. They might be a little mad at you because they're going to be in really bad withdrawal. They might not be, you know, in the most happy state, but they will have their breathing restored and be back to square one. And for people who are just learning about this drug and this process, like, where is

this happening? Where are people using Narcan in this country right now? So this is a drug that's in a lot of places and growing to more places. So it's showing up in schools, in churches, with first responders, you know, police officers, EMTs. It's in hospitals. It might be at your workplace. And it's in old ladies' purses. It's very small.

You can fit it anywhere. Old ladies in America are carrying around Narcan in their purses? Well, I guess that's a hope. It depends who the old lady is, right? It's been 84 years. But I think it's something, you know, if your son, grandchild, cousin, brother, if you know that there's someone who's using drugs and you just want to have this thing around,

just in case, yeah, a good place for it would be your purse, for sure. I have two doses of it in my purse. I carry all the time. I hope I never have to use them. But, you know, it's pretty easy to carry around. It's also something that people should know is that the place and the people that are most likely to use this drug are actually drug users and people who are with other drug users. There's been lots of studies that have shown that unlike opioids of the past, fentanyl, illicit fentanyl, which is what is all over the drug supply now and is much more potent than, say, you know,

the pills that caused this crisis in the first place, it just works so fast that if you really want to revive someone, you need to be like right there when it happens. And so that's a big reason for this push is that it used to be, you call 911, they show up, it could be a while later and you're able to really revive someone. In this case, it could happen within a few minutes. And by the time 911 gets there, it could be too late. And so that's why we're seeing this everywhere you can imagine is they're trying to saturate the United States with overdose reversal medications to hopefully unwind some of the deaths that we're seeing. Because this might soon lead to a saturation, I have to ask, what if you're someone who doesn't need this drug but takes it? What if a kid is going through grandma's purse, finds her Narcan, seizes a little nasal spray, and takes a pop? That's such a great question because that was my worry is like, well, I don't know.

What if this person's not overdosing and I accidentally give them this drug, right? It doesn't do anything to you if you are not on opioids. Oh, good. Yeah. In fact, one of the ways that they test for approval with the FDA is they give it to people who are not on opioids and then they like test to see how much of the drug they got in their system. But the people who are in those clinical trials feel absolutely nothing. Like they're like, why are you spraying this thing in my nose? Yeah. So it's totally innocuous if you're not on opioids. It would work for anything that is an opioid. So it could be a prescription pill that's an opioid. It could be fentanyl. It could be heroin. It's all the same to the brain, if that makes sense. What it won't

work on is other kinds of overdose, like alcohol. There's a tranquilizer right now that's been making its way into the drug supply that people refer to as trank. It's not going to work on that. It's not going to work on your benzos. So what health professionals recommend is, like we talked about before, it's not going to hurt them. Just try it. Even if you think, you know what, this isn't, they overdosed from, I think, something else. You never know what people have taken. They might not know what they've taken. So it's worth a try. Will this decision by FDA be a difference maker? Do you think we'll see overdose numbers drop? I hate to say this because everyone says this on every podcast, but time will tell. One of the reasons that time will tell is we're still waiting on information from retailers and insurers about pricing.

Is this drug going over the counter going to mean that it's actually more affordable or is it actually going to be more expensive all told? So right now, I mean, I walk into the CPS pharmacy and get this prescription only supposedly drug, right, behind the counter and give them my insurance card. It cost me 10 bucks. It costs like 125 bucks to the insurer. So there are a lot of non-prescription drugs you can get your insurance to pay for, but it's up to them to tell us if they're going to pay for it. So I, you know, if I want to go get my Flonase or something for my allergies, my insurer will actually help cover it even though it's an over-the-counter drug now. You can't necessarily

do that with everything, but we're waiting to find that out. At the same time, the manufacturer could say, we're going to sell this to the Walgreens and Rite-Aids and CVS pharmacies of the world for $4. But those guys could say, well, we want to take a cut and we're going to sell it back to the public for $45. So we're waiting to find out what the pricing is going to look like, which we might not really know until late summer. But that ultimately could have an impact on how big of a game changer this is. It could have an impact on how big of a game changer it is for Narcan. One thing that people don't realize is that this is just the first drug maker who's going over the counter. There are a couple of other drug makers, one of which

is a nonprofit pharmaceutical company, you don't hear about that very often, that is specifically set up just to try to create a nearly free version of over-the-counter naloxone. So when those competitors, you know, get through the FDA process and enter the marketplace, for sure, this is going to be a game changer. The pricing is going to go down across the board and it will be, you know, something you can go grab with your bar of soap. That was Julie Warnow. She reports on health and medicine for The Wall Street Journal. Our show today was produced by Hadi Mawagdi.

He had help from Jolie Myers, Paul Robert Mounsey, and Laura Bullard. I'm Sean Ramos for him. This is Today Explained. Thank you.