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DPA Naloxone Issue Brief 0

DPA Naloxone Issue Brief 0

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Published by: webmaster@drugpolicy.org on Apr 25, 2012
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07/04/2013

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Expanding Access toNaloxone:Reducing Fatal Overdose,Saving Lives
Prepared By:
Drug Policy Alliance131 West 33rd Street15th FloorNew York, NY 10001212.613.8020 voice212.613.8021 faxwww.drugpolicy.org
 
 
2Expanding Access to Naloxone:Reducing Fatal Overdose, Saving Liveswww.drugpolicy.org
A serious but largely overlooked crisis has takenroot in the United States. This epidemiccontinues virtually unchecked despite theexistence of practical, low-cost interventions.More than 100 people die every day in the UnitedStates from a drug overdose.
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Overdose rateshave tripled since 1990
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and increased more than140 percent between 2000 and 2008.
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More thantwice as many people die every year from anaccidental drug overdose than from firearms.
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InDecember, the Centers for Disease Control andPrevention (CDC) announced that poisoningsurpassed auto collisions in 2008 as the leadingcause of accidental death in the United States.Drug overdoses account for 9 out of 10poisoning deaths, and more than 75 percent ofdrug overdoses are accidental.
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 A national response is urgently needed and longoverdue. Elected leaders, public officials andmedical professionals can no longer delay theimplementation of effective overdose reductionmeasures in every state and community. Failureto do so has already resulted in thousands ofneedless deaths every year.Today’s overdose crisis touches the lives ofevery type of family and individual, regardless ofage, class, ethnicity or gender. Contrary topopular belief, it’s not teenagers who die fromdrug overdose in the greatest numbers, but theirparents – people in their 40s and 50s are morelikely to die from an accidental drug overdosethan adolescents. Furthermore, it’s not illicitopiates like heroin that are primarily responsiblefor this growing crisis – more people die fromprescription opioid overdoses than from all illicitdrugs combined. (Opioids are a synthetic form ofopiate – such as oxycodone or hydrocodone –that are available by prescription only, typicallyonly for moderate-to-severe pain.)By expanding the availability of proven, effectiveoverdose interventions and improving educationand outreach for people at risk of accidentaloverdose, policymakers can help to prevent thetragic and unnecessary loss of life.Naloxone Saves Lives
Chief among today’s highly effective availablepractices to halt and reverse the growing toll ofaccidental overdose fatalities is naloxone hydrochloride(also known as Narcan™), a low-cost medicineavailable generically that was first approved by theFDA in 1971. Naloxone is an opioid antagonist thatblocks the brain cell receptors activated by prescriptionopioids such as oxycodone, as well as by illicit opiatessuch as heroin. It temporarily restores normalbreathing within two to three minutes of administration.Naloxone is the first line of treatment for emergencyroom physicians and paramedics upon encountering apatient experiencing an overdose. Ideally, emergencymedical responders are summoned as soon as anoverdose is detected. A dose of naloxone is thenadministered and rescue breathing is initiated ifnecessary. If the victim has not been revived after twominutes, another dose of naloxone is administered andso on until the naloxone has the desired effect.Naloxone’s effects last for 30 to 75 minutes, allowingtime for the arrival of emergency medical assistance.
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Though the research is contradictory, some studiessuggest that once the naloxone effect wears off,opioids in the circulatory system may become toxicagain and without medical attention victims cansubsequently cease breathing again.
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However,naloxone can be administered repeatedly withoutharm.Naloxone is most commonly administered viaintramuscular injection, but it can also be administeredintranasally using an atomizer device that delivers amist to the nasal mucus membrane. The device usedfor this latter form of administration is not yet FDAapproved, but it is in use by overdose preventionprograms in Massachusetts, New Mexico andelsewhere.
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 Naloxone’s only effects are to reverse respiratoryfailure resulting from an opiate overdose and to causeuncomfortable withdrawal symptoms in the dependentuser.
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It has no pharmacological effect if administeredto a person who has not taken opiates
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and has nopotential for abuse.
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It is impossible to overdose onnaloxone.
 
 
3Expanding Access to Naloxone:Reducing Fatal Overdose, Saving Liveswww.drugpolicy.org
Expanding the Availability of Naloxone
One key barrier to broader naloxone access in the U.S.is its status as a prescription drug. Depending on statelaw, prescriptions for naloxone must either be written toindividuals who have requested to carry the drug ormay be made by programs operating under standingorders from a physician.Advocates in some states are examining an alternativeapproach to increasing access to naloxone – changingthe drug’s FDA status from “prescription only” to “overthe counter” (OTC). Given that it has little to nopotential for misuse, naloxone could meet OTCstandards, making this option worthy of furtherconsideration.Providing take-home naloxone to prescription opioidpatients and their care providers is a simple step tohelp reduce accidental deaths. In a study researchingnaloxone distributed for later administration in case ofoverdose to people who inject heroin, it wasdetermined to be a “simple, inexpensive measure thathas the potential to significantly reduce mortalitycaused by heroin overdose.”
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 Another major barrier to expanding access to naloxonehas been its status as a generic medication that isgenerally only used by emergency medicalprofessionals. Because naloxone has limited use andis a generic medication, producing it does not yieldsubstantial profits. Many pharmaceutical companiesare unwilling to manufacture it, which has resulted in ascarcity of the medicine as demand increases for it.The scarcity of naloxone has increased its purchaseprice, which is another barrier to encouraging itsdistribution by service providers and other stakeholderswith limited funding.
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Improving Naloxone Awareness AmongProfessionals
Although naloxone is the standard treatment forreversing respiratory failure due to opiate overdoseand is widely used by EMS and other medicalpersonnel,
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lack of awareness about public need andphysician bias against drug users are ongoingobstacles to wider naloxone distribution. In a 2006survey of 571 physicians, just 23 percent were awareof the practice of prescribing naloxone to preventheroin overdose, and 54 percent said they would not“consider prescribing naloxone and explaining its useto a patient (who uses injection drugs) because of theirown negative views of injection drug users.”
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 Support is growing among some physicians andotherhealth professionals for regularly pairing naloxonewith all opioid prescriptions.
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Under this scenario,physicians would routinely write a prescription fornaloxone to accompany every prescription for opioidmedications. Such a convention would have the dualbenefits of safeguarding the life of the patient andnormalizing naloxone by educating the greater publicabout its function and proper use.It is particularly important to make naloxone availablein methadone clinics, addiction treatment programs,syringe exchange programs and emergency rooms.Law enforcement professionals and prison personnelshould also be trained on how to respond to opiateoverdose, including rescue breathing andadministration of naloxone. Individuals who arereleased from incarceration are at elevated risk of anoverdose and should be provided naloxone prior torelease into the community.
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