Getting Access to the Overdose Antidote
The director of the Office of National Drug Control Policy, Gil Kerlikowske, recently made a call to action to prevent deaths from drug overdose. One of his main tools for doing so would be wider access to naloxone, a drug that is considered to be an antidote to overdose by opioid drugs. Right now, the drug is only available as a prescription, although some members of law enforcement carry it with them as well. Kerlikowske would like to see addicts, patients with chronic pain who take opioid painkillers, and family members of the former have better access to the life-saving medication.
Naloxone is what is known as an opioid inverse agonist, or an antagonist, which means that it can counteract the effects of taking too many opioid drugs. Opioids are drugs derived from or naturally occurring in the opium poppy and include the illegal narcotic heroin, as well as prescription painkillers such as morphine, oxycodone, codeine, and others.
Opioid drugs have an effect on the human body by binding to receptors in the central and peripheral nervous systems called opioid receptors. Naloxone acts by blocking these receptors to stop the action of the opioid. It is most commonly given to a patient by intravenous injection. This allows it to work quickly, in as little as a minute. It can also be delivered subcutaneously or as a nasal spray.
Most recently, a certain form of naloxone has been shown to have a promising ability to prevent addiction to opioids. A study found that (in rats, at least) this form of naloxone, when given with prescription opioid painkillers boosts the effectiveness of the drug, while simultaneously eliminating the high. Without the high, there is no reason for a user to become addicted. Further research is needed, but the preliminary results are encouraging.
Kerlikowske made his statements about preventing overdose deaths while visiting with a group called Project Lazarus. The group is a non-profit, public health, and secular organization in North Carolina dedicated to reducing drug overdose rates. According to their website, in 2007 Wilkes County in North Carolina had the third highest rate for overdose deaths in the country. While the organization began there, they now cover the entire state and partner with Community Care of North Carolina and the Chronic Pain Initiative to work towards reducing overdoses. Increasing access to naloxone and providing the antidote free of charge is just one way the group achieves its goal of saving lives.
Both Project Lazarus and Kerlikowske believe that increasing access to naloxone is just one way to help prevent overdoses, but it is an important one. The Centers for Disease Control and Prevention report that quick administration of naloxone has saved more than 10,000 lives.
Not only does naloxone save the lives of those who are able to get an injection after overdosing, it gives many of those survivors a new lease on life and the motivation to get treatment. Kerlikowske referred to the story of one such young woman whose brother was already in a drug treatment program that was partnering with Project Lazarus. He found his sister unresponsive and called 911 before administering his naloxone. She woke up, recovered, and entered a treatment program to try to beat her addiction.
Access to Naloxone
Currently, access to naloxone is not widespread. It is available only as a prescription, to some law enforcement officers, or in some instances such as Project Lazarus, through community and drug treatment programs. In the spring, the FDA discussed the possibility of making naloxone an over the counter drug, but there are hurdles to get through first. A manufacturer would need to get approval to make naloxone available for purchase, which would mean expensive testing. There may be other ways of getting naloxone to market as an over the counter drug, but it is currently unclear as to whether there is enough push to get it done.
In August, Representative Mary Bono Mack of California, along with Representative Donna Edwards of Maryland introduced a bill to the House called the Stop Overdose State Act. The bill, if passed, would give federal money to more programs like Project Lazarus. This would help to increase access to naloxone. Whether there is enough will to put federal dollars towards this Act is in doubt.
While an antidote to overdosing saves thousands of lives, it is one piece of a larger puzzle of prevention. When health care professionals, addiction experts, community organizations, and policy makers can all come together to increase awareness and availability of naloxone as well as other means of preventing addiction, everyone wins.