Naloxone: An Important Tool in Combating the Opioid Crisis

 

Naloxone

The Opioid Epidemic in the United States

The United States is facing a public health crisis due to widespread misuse of prescription opioids and rise in opioid overdoses. According to the Centers for Disease Control and Prevention (CDC), more than 42,000 people died due to opioid overdose in 2016. Opioid overdose deaths have increased six-fold since 1999. The widespread availability of potent synthetic opioids such as fentanyl have further exacerbated the crisis. The economic burden of prescription opioid misuse alone is estimated to be $78.5 billion, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

What is Narcan?

Narcan is a life-saving medicine that can reverse the effects of an opioid overdose. It works by blocking the effects of opioids on the brain and restoring normal breathing within two to eight minutes. Naloxone has been used safely by medical professionals for more than 40 years to reverse life-threatening respiratory depression caused by opioid overdose. It has no potential for abuse as it has no effect on people who are not physically dependent on opioids. Narcan is available by prescription as an injection (Injectable Narcan, EVZIO) and a nasal spray (NARCAN Nasal Spray).

Increasing Access to Naloxone

Public health experts consider expanded access to narcan as a critical component of addressing the national opioid overdose crisis. Several states and municipalities have taken steps to increase the availability of narcan through community programs, first responder protocols, and co-prescription policies. Standalone narcan prescriptions and immunization protocols have allowed pharmacists in some states to prescribe and dispense narcan without an individual prescription. The Department of Health and Human Services has also set up initiatives to make narcan more accessible. However, barriers such as cost and lack of awareness remain obstacles in ensuring ubiquitous availability of this life-saving drug.

The Financial Impact of Increased Naloxone Access

Increased availability and use of narcan have had important financial implications. Research indicates that expanding narcan access is highly cost-effective. A study estimated that one year of narcan distribution in the state of Wisconsin prevented 185 deaths, producing $6 million in medical and work productivity cost savings. Scaling up narcan distribution to the national level could save $5.1 billion in annual health care costs from opioid overdose deaths and non-fatal overdoses prevented. While upfront costs involved in narcan acquisition can be significant, these are greatly outweighed by long-term societal savings from reducing overdose deaths and emergency room visits.

Private spending on narcan has also grown exponentially with rising demand. Total U.S. retail pharmaceutical spending on narcan grew from $5 million in 2011 to $87 million in 2018. It is projected to reach $150 million by 2022. Narcan manufacturers including Kaleo pharmaceuticals and Adapt Pharmaceuticals have benefited from this increased market. Adapt's NARCAN nasal spray, for example, brought in over $87 million in sales in 2018 alone, establishing it as one of the company's flagship brands. With projected continued rise in opioid misuse, the narcan market is expected to witness steady growth in the coming years.

Challenges to Wider adoption

While narcan access has expanded considerably compared to a few years ago, important challenges remain as barriers to universal adoption of this life-saving medication. Persistent issues include lack of awareness among at-risk groups, concern about enabling drug abuse, high drug prices, and reluctance among some first responders and law enforcement. Fear of retaliation or legal problems may discourage reporting of overdoses in some cases. Community-based programs that provide narcan alongside education and counseling show most promise in sustainable overdose prevention. Continuous advocacy and coordination between public health agencies, medical community, law enforcement, and policymakers will be essential to tackling these challenges and making narcan universally accessible.

The opioid crisis ravaging communities nationwide poses an enormous health and economic burden. As overdoses have skyrocketed, expanding access to narcan has emerged as a promising public health strategy to prevent opioid overdose deaths. Increased availability has multiple benefits including cost savings from reducing overdose deaths and emergency department visits. However, there is still room for progress in addressing existing barriers and making naloxone as ubiquitous as AED devices in public spaces. Coordinated efforts to increase awareness, bring down drug prices, and remove socio-legal impediments can help optimize the lifesaving potential of this important medication.

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