After writing several previous newsletters on the stunning rise in opioid

overdoses in the US, including among adolescents , I thought it was worth

taking a look at what happens after an overdose, particularly for adolescents.

I talked to Dr. Sivabalaji Kaliamurthy about what he’s encountering. A child

and adolescent addiction psychiatrist who is board certified in general
psychiatry, child psychiatry and addiction psychiatry, Kaliamurthy is also the
director of the addiction clinic at Children’s National Hospital in Washington,
DC.

He told me that his clinic, which he set up in early 2022, has gone from getting
one or two opioid use referrals per month to eight or more per month now, a
year later.

He particularly wanted to discuss some major news: The opioid overdose

antidote naloxone, sold as Narcan, got approval from the US Food and Drug
Administration  on March 29, the day we talked, to be sold over the counter.

Excerpts from our conversation, edited for flow, are below.

View Narcan as a fire extinguisher to have on hand

WOLF: What is your reaction to Narcan being available over the counter?

KALIAMURTHY: When I do an evaluation (of a patient), regardless of the

substance use, you’re always talking about naloxone, brand name Narcan. …

The message that I present parents with is always that it’s kind of like having a
fire extinguisher at home. You hope you never need to use it, but you’re glad
that you have it if you need to use it.

Access is important. There are some controversies around increasing access to

naloxone and fears that this may encourage more substance use. We have
scientific research looking into this very specific question.

And overall, there’s one study  that came out this month that found that across
44 states where they increased access to naloxone for adolescents, it did not
increase the rates of substance use in this population. And in some states, it
actually decreased opioid use among adolescents. …

The FDA approved the over-the-counter sale of naloxone, specifically the

brand Narcan, because of how easily it can be administered. Naloxone also
comes in other formulations, like injections, but Narcan is a nasal spray. We’re
hoping that it will be out later this summer.

The challenge remains how much is it going to cost? On average, it can cost
anywhere between $50 to $100 right now. If it becomes over-the-counter, we
don’t want insurances to stop covering [it].
It will be interesting to see how the manufacturer goes about introducing it
over the counter.

An antidote, not a treatment

WOLF: You said it’s like a fire extinguisher. Should everybody have it, or just
people whose kids have demonstrated addictive behavior?

KALIAMURTHY: Everyone should have it. Naloxone is not a treatment; it is

more of an antidote. It reverses opioid overdoses, and the person who has the
opioid overdose is never the one who’s going to use it somewhere in the
community.

The view from one hospital

WOLF: I’ve reported on a surge in overdoses. What are you seeing at
Children’s?

KALIAMURTHY: We are seeing an increase in the number of kids

presenting to the hospital after experiencing an opioid overdose, and in
general, opioid overdose deaths in the DMV (Washington, DC, Maryland,
Virginia) region have significantly increased in the last two years. That aligns
with a national trend we are seeing with regards to opioid overdoses.