Combating the growing opioid epidemic with the “rescue shot”

Ned Milenkovich

Heroin and prescription drug overdoses have reached epidemic levels in the United States, surpassing car accidents and firearms as the leading cause of injury deaths, an annual assessment by the U.S. Drug Enforcement Administration has found. 

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The opioid epidemic has grabbed the attention of politicians, public health officials, and drug company executives alike. U.S. Surgeon General Vivek Murthy called it "a top priority," and the House of Representatives is expected to review several bills specifically aimed at curbing the abuse of heroin and painkillers; the Senate passed similar legislation in March of this year.

As the country begins to recognize the degree to which opioids are abused, efforts to combat this massive public health issue have been focused on the opioid antagonist naloxone. It has long been used by hospital personnel and emergency medical technicians; now there is a movement to expand access and get it into the hands of first responders, as well as drug users and their family members.

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Legal framework

Forty-six states and the District of Columbia now have laws that allow physicians and other medical professions to prescribe or dispense naloxone. State laws supporting naloxone access fall under three categories:

* Good Samaritan laws: These laws protect individuals calling for help at the scene of an overdose from being arrested for drug possession.

* Liability protection/third-party administration: This protects both the prescriber and the bystander who may be administering the naloxone. It also permits prescription of naloxone to bystanders for use on opioid overdose victims.

* Collaborative practice agreements: These allow pharmacists to prescribe naloxone to at-risk individuals. They may be conducted with individual physicians or on a statewide basis.

Naloxone specifics

Frequently sold under the brand name Narcan, naloxone is touted as an important and potentially lifesaving tool in combating the nationwide epidemic that has led an estimated 2 million-plus Americans to become addicted to opioids and one of them to die of an overdose every 19 minutes.

Naloxone is used to reverse the effects of an opioid overdose by attaching to the same parts of the brain that receive heroin and other opioids, and then blocking the opioids for a period of 30-90 minutes, reversing the respiratory depression that would otherwise lead to death from overdose.

How it is supplied

Naloxone for take-home use can be supplied as an intramuscular (IM) injection or as an intranasal (IN)spray. Both formulations are effective. Patients and caregivers tend to prefer the nasal spray, while the components of the IM kit are more readily available in pharmacies. There is also a newly available auto-injector, which is convenient to prescribe and dispense, but is much more costly then the alternatives.

Expanded access

While states are continuing to adopt laws that increase accessibility to the lifesaving medication, the federal government is also lending its support and helping to create a solution.

In February, the White House proposed $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic, including $500 million to help states expand treatment of prescription drug overdoses, increase treatment, and expand access to naloxone.