Naloxone, which also goes by the brand name of Narcan, is a drug used to reverse the effects of an otherwise-lethal opioid overdose. The drug has become a standard tool in the hands of emergency responders, families and emergency rooms during this time of crisis. Naloxone can be injected or used as a nasal spray, and can stop the effects of an opioid overdose within minutes. It has been such a vital drug for overdose victims; the World Health Organization placed it on the list of essential medications in 1983.
As the number of overdoses increases, some American towns and cities are having trouble keeping up with the cost of naloxone and the demand for Emergency Response Services. In Middletown, Ohio, for example, there have been over 600 overdoses in the first six months of 2017, which is more than the number of overdoses in all of 2016. In fact, the city’s fire department responds to more overdoses (approximately 4 to 5 a day) than it does fires.
The Cost of Saving Lives
Naloxone may be a life-saving drug, but its costs and high demand have been a struggle for some communities. One dose can cost $36, which has become increasingly difficult for the city of Middletown to afford. In some cases, one person may require multiple doses, based on the amount, strength, and duration of the opioid used. In fact, this year, the city estimates that it will spend over $90,000 on Naloxone, which is 50% more than the allotted budget for medications in their ambulances. Furthermore, a recent article in the Scientific American indicates that the price of Naloxone may be increasing, ultimately making it more difficult for health officials to help their communities.
However, to combat the cost of saving residents from opioid overdose, City Councilman Dan Picard suggested a solution that may be controversial:
If a person overdoses one or two times, emergency responders will come to that person’s aid. However, a third time, and there may not be a response.
Although the idea may help the city have enough money to meet the costs of crises, Picard’s plan has already received plenty of criticism. His suggestions have triggered angry posts on Facebook, emails, and Tweets, and the deputy director of the Harm Reduction Coalition, Daniel Raymond, has also criticized the plan. Raymond commented that “Picard’s plan is insulting to the families of people struggling with drug addiction.”
In response, Picard says that if the city runs out of money, there won’t be funds available for others who need help for a heart attack, injury, or other emergencies. Also, Picard pointed out to the opponents of the plan that most people overdosing in Middletown are transients, not residents. Ohio is at the heart of the nation’s opioid epidemic. The city of Middletown is still researching whether Picard’s idea is worth pursuing, and some officials are taking his suggestion into further consideration.
Multiple Doses of Narcan Needed for Stronger Opioid Formulations
As mentioned above, when a person overdoses on opioids, it may require more than one dose of Naloxone ( Narcan) to revive them. One Middletown woman required 12 doses before she became conscious again. Part of the problem is that various powerful and unknown strands of opioids are surfacing in our streets. Drugs like Carfentanil, which is 10,000 times stronger than morphine and 100 times stronger than fentanyl are directly linked to a dramatic increase in overdoses, which is already at an alarming level amid the national opioid crisis. Just two milligrams of the drug (about a toss of a salt shaker) can be lethal.
Not everyone is so sure about the extensive resources applied in the use and availability of Naloxone. Some suggest that the drug does not prevent relapse, and in a country with such shortage of mental health care, people will inevitably be left without the adequate resources to break the addiction cycle. Some even question whether the availability of Naloxone, combined with cheap opioids, might encourage drug users to continue to push the limits.
What we know with certainty is that there are not enough resources to go around, not only in Middletown but around the country. According to a new report by the Blue Cross Blue Shield Association, the rate of those struggling with opioid dependency has grown by nearly eight times the rate of accessible and efficient medical care. One article explained the situation exclaiming: it is easier to get high than to get help.
The Blue Cross Blue Shield (BCBS) report also revealed that one in five of its members filled at least one opioid prescription in 2015. The bottom of the report breaks down this ratio by state. Also, as other research has confirmed, the stronger the dose and the more often someone uses opioids, the more likely he or she will struggle with dependency to the medication. Interpreters of the report suggest that the country is failing to respond appropriately to the opioid crisis.
Essentially, three things are being done to help solve the opioid crisis:
- Make opioids less accessible. Doctors are being encouraged to prescribe fewer pills and find alternatives to opioid medication.
- Expose and break down labs that are making stronger forms of opiates. Organizations such as the Drug Enforcement Administration (DEA) are trying to find clandestine labs, many of which are overseas, to prevent dangerous opioids from coming into the country.
- Make Naloxone more available to the public. Naloxone has been distributed to some families of opioid abusers, in the event that their loved one suffers an overdose. Also, first responders, such as police officers and paramedics, are equipping themselves with the life-saving drug Naloxone. Even the pharmacy store CVS is making the drug available to its customers without a prescription.
These combined efforts are saving lives, however, it is far from being enough to make a significant difference in the opioid epidemic.
Although getting high might be easier than getting help, finding adequate medical and emotional support, provides a better chance to live a healthy life. It gives someone the opportunity to truly be with friends, family, and other loved ones. Seeking help also gives the chance to pursue a dream and reach for aspirations that can be meaningful and rewarding.
Keep in mind; there are available drug treatment options that can avoid the months of shame and distress. As no single treatment is effective or indicated for all individuals, diverse treatment options including medical and psychosocial approaches are needed. Opioid tolerance, dependence, and addiction are all partially manifestations of important brain changes. The opioid abuser often lives in the constant struggle to overcome the effects of these changes. Medical detoxification procedures, such as the Waismann Method, use Naltrexone which is a non-addictive antagonist that acts on the same brain structures as addictive opioids. It rapidly assists the brain to normalize its functions, giving the individual an instant chance, to commence a productive and healthy path.
So where does this all leave us? First, as concerned citizens, we need to recognize our role as part of the cause. Second, we need to take a life-saving approach rather than insisting on archaic and failed forms of treatment. Lastly, we need to use all available measures including Naloxone to save a life, but we also need to start seeing and hearing the individual affected by the opioid addiction, instead of being blinded by the stigmatized “addiction diagnosis.”