Photo by Kimberly Wear
By: Megan Hesse
Opioid overdose rates are at an all-time high, with each year’s record-breaking the previous one. In 2015, a combination of prescription opioids, heroin, and fentanyl contributed to more than 33,000 overdose deaths.
Meanwhile, even as rates continue to skyrocket to the point where the president has declared the crisis to be a public health emergency, there is a ray of hope in the form of a new drug called Narcan that can reverse opioid overdoses and whose use is rapidly spreading across the country.
Narcan is quickly becoming a valuable weapon against the opioid epidemic. It is easy enough to be used by almost anyone and is already available over-the-counter in nearly every state in the US, greatly expanding its life-saving potential.
What is Narcan & How Is It Different from Naloxone?
Narcan is the brand name for a specific form of the drug naloxone. Unlike partial agonists like buprenorphine, which partially blocks opioid effects while still providing its own, milder version of them, naloxone is what is known as a pure opioid antagonist. This means that naloxone does not produce any opioid effects and instead binds to the brain’s opioid receptors and rendering any opioid drugs in a person’s system essentially powerless.
While these properties give naloxone the ability to reverse an overdose and save someone’s life, this sudden and complete stoppage will initiate an immediate and often extremely painful withdrawal in the body, so it is reserved strictly as an emergency measure.
Currently, the FDA has approved three different formulations of naloxone:
- Injectable: This is the generic form of naloxone and requires professional training in order to be properly administered.
- Auto-Injectable: Sold under the brand name EVZIO, this is a pre-filled injection device meant to make it easy for someone without prior training to administer a dose.
- Nasal Spray: This is Narcan, and it is a pre-filled, needle-free, substance that is sprayed into the nostrils. It requires no assembly and can be easily administered by anyone from first responders to family members.
Developed in 2013 in a partnership between the National Institute on Drug Abuse and a company called LightLake Therapeutics, its approval was fast-tracked by the FDA so that it could begin to help stem the tide of overdose deaths as soon as possible.
Narcan can reverse the effects of not only prescription opioids, but also drugs like heroin and even fentanyl. Though multiple doses might be required, it has no effect on overdoses from substances other than opioids. Fast-acting, it binds to the brain’s opioid receptors within two to three minutes, with a half-life of about 30 minutes, buying time for emergency medical help to arrive and provide further assistance.
What Narcan doesn’t do is replace emergency medical assistance. Someone who has been given Narcan will not suddenly be fine or no longer addicted to opioids, instead will just be in less danger of dying from opioid poisoning. They will still require medical help as soon as possible, and should, once the immediate threat has passed, be placed into medical detox treatment.
Are There Any Narcan Side Effects?
There is no such thing as a drug free of side effects, and Narcan does come with its own set of them. Some of the common Narcan side effects include:
- Nasal swelling, congestion, inflammation, dryness
- Increased blood pressure
However, the most unpleasant and potentially dangerous of the Narcan side effects is a result of its intended use. The rapid reversal of an overdose by way of blocking all opioid effects shocks the body into near immediate drug withdrawal. Some of these withdrawal symptoms include:
- Nausea, vomiting, diarrhea
- Stomach cramping
- Increased heart rate
- Muscle aches
- Flu-like symptoms (fever, chills, sneezing, weakness)
Since the half-life of the drug is so brief, the Narcan side effects will typically subside in a couple of hours, but they are still very intense, and anyone experiencing them should be carefully monitored by a medical professional. Overall, it’s still a small price to pay when it comes to preventing a fatal overdose.
How is Narcan Prescribed?
The Centers for Disease Control and Prevention (CDC) has recommended that access to Narcan be expanded to include, among other things, standing orders at pharmacies to more fully and effectively utilize the drug. A standing order serves to make Narcan an over-the-counter medication that anyone would be able to purchase at a pharmacy without needing a prescription.
At the forefront of this expansion is CVS, which had already been attempting to combat prescription painkiller abuse by restricting its customers to a one week supply. Other pharmacy companies such as Walgreens are right behind them, making the push to provide Narcan without a prescription.
Currently, pharmacists are legally allowed to dispense or distribute Narcan without needing a patient-specific prescription in 49 states, though there are differences in how this is put in place. For example, 43 of these 49 states, including Florida, allow Narcan to be made available through a standing order. As for the others:
- In Kansas, South Carolina, and West Virginia, they operate under what’s called a protocol order, which are special, statewide written orders that pharmacists have to follow if they’re going to distribute Narcan, like providing an informational pamphlet, for example.
- In Idaho and Connecticut, while a doctor’s prescription is not required, someone cannot purchase Narcan without pharmacist prescriptive authority, which means it is the responsibility of the pharmacist to decide on whether to write the prescription and provide Narcan on a case-by-case basis.
- In states like Oregon, the state has both protocol order and pharmacist prescriptive authority, which in the case of this specific state, pharmacists can prescribe and provide Narcan, but only after being trained.
- In Oklahoma, a specific statewide legislation was passed to make Narcan as accessible as possible, including at pharmacies, where the drug is sometimes offered at no charge.
- At this time, Nebraska is the only state in the country that does not allow the purchase of Narcan without a doctor’s prescription, though a training protocol is being finalized for Nebraska pharmacists that will enable them to dispense Narcan.
Expanding Access & Saving Lives
Currently, only a small number of states have legislation in place requiring emergency responders to carry Narcan. However, with its clear and obvious benefits and the ever-rising death toll from opioid overdose, it won’t be long until Narcan is a standard tool for emergency first-responders nationwide.
With the expanding access to this drug, despite the Narcan side effects, more lives will be saved and more people will be given a second chance. Hopefully, from there, they can enter into treatment and start their journey towards recovery, turning the tide in the fight against opioid addiction.