Over-the-Counter Narcan is a small victory in the overdose crisis. We need more

A shiny circular pin on my purse reads “I WEAR NALOXONE”, proclaiming that I am ready to respond to an opioid overdose– an event that kills more than 180 people every day in this country. It means that when someone stops breathing, turns blue and unresponsive after an overdose, I can administer naloxone to reverse another tragedy.

I am neither a medical professional nor a qualified EMT. Anyone can reverse an overdose in an emergency, in addition to calling 911 and giving artificial respirations. We could all carry this miracle drug in our purses and back pockets.

THE The FDA made it easier last month by approving the over-the-counter sale of Emergent BioSolutions Narcan Nasal Spray. The first anti-overdose drug approved for community use and now available over the counter, it delivers a naloxone spray through the nose and works in minutes. This decision has been a long time coming; emergency medical personnel have used naloxone for decades, and it has been prescribed to laypersons since 1996. As a harm reduction expert, I know that while finally allowing an over-the-counter naloxone product is a step in the right direction, it doesn’t go far enough.

Every year we lose more Americans to drug overdoses than the total number of lives lost in the Vietnam War. In 2021, it was more than 107,000 people. The drug overdose crisis has lowered the the life expectancy of the average American even before the COVID-19 pandemic, where isolation and economic struggle drove overdose deaths to an all-time high. In Maryland, as in most countries, we have seen the illegally manufactured opioid fentanyl boost a rapid increase in overdose deaths. Fentanyl—100 times stronger than morphine—causes respiratory arrest even faster than heroin. And the one from Maryland drug control programin which used accessories are tested as part of statewide harm reduction programs, shows that there is hardly any heroin left in the illicit drug market. It’s mostly fentanyl. Naloxone is the most important tool available to respond to this high-risk environment, and we need aggressive action to reverse the devastating trend of deaths.

We can start by freeing naloxone, in all of its formulations (including injections), from prescription requirements, not just in a more expensive nasal spray. It has long earned the OTC designation in all its forms; it is safe and effective, has no potential for abuse, and can be used by anyone without training. Harm reduction programswhich are comprehensive care centers that, without judgment, help people who use drugs, distributed it since 1996. State laws that swept the country officially made naloxone accessible outside of medical settings, meanwhile, after 2001. Nonprofits and government organizations then began distributing it on street corners, in encampments homeless people, hair salons and beyond. Research shows its widespread distribution to those most likely to witness an overdose – people who use drugs –reduces overall opioid overdose death rates.

The failure”war on drugswhich criminalized drugs and imprisoned people who used them, helps to explain the long-delayed federal response to the overdose crisis. We have overinvested in prison cells and underinvested in drug treatment and harm reduction. It is only in the past 10 years that we have seen a move towards a more compassionate and humanizing approach that has increased the importance of harm reduction, including naloxone.

Previously, nonprofits and harm reduction activists led a bottom-up revitalization of health care for people who use drugs by applying creative ways to deliver naloxone and other lifesaving supplies to them despite the legal barriers. For example, Dan Bigg and the Chicago Recovery Alliance circumvented naloxone prescription requirements in the 1990s by having prescriptions written by doctors in the field alongside staff who provided training. While these nonprofits are always in the best position to provide naloxone to people who use drugs, they cannot distribute enough to stem the tide of overdose deaths. The lack of federal support has left them underfunded and understaffed, struggling to meet an ever-increasing demand for their services. The Biden administration has only approved the first federal expenditures specifically for harm reduction, $30 million, in 2021.

Moreover, cost outweighs convenience with naloxone. While an over-the-counter nasal spray is welcome, community distribution of all formulations of naloxone to those most at risk of overdose—free of charge— remains essential to have it at hand at each overdose. We don’t know if Narcan will be affordable for everyone who needs it. Also, product placement matters avoid the stigma surrounding drug use. People may not want to be seen holding a Narcan box in the queue. Harm reduction programs that meet people where they are with free naloxone circumvent these barriers.

The federal government should completely remove all forms and strengths of naloxone from prescription. Federal funding should be directed to companies like Alliance Remedy, led by the nation’s top naloxone experts, which negotiates cheap naloxone prices with pharmaceutical companies and distributes it to harm reduction programs. Public funds could then support organizations providing free naloxone to people who use drugs and their families in innovative ways. Without prescription limitations, naloxone could be more readily offered in key locations such as a homeless shelter, emergency department, opioid treatment program, or prison, as well as churches, parlors hairstyle and skate parks (why not?). Naloxone in vending machines increases the reach of harm reduction programs, just like home delivery by email. A whole new world of free naloxone distribution is critical to reversing overdose death trends and needs support.

Going further, ending the opioid overdose crisis requires decriminalizing drugs and reinvesting in behavioral health. Oregon voters made it possible in 2020influenced by European countries like Portugal where decriminalization and investment in harm reduction have kept drug use and related deaths well below European averages. On the ground, I see this sea change in US drug policy as not only possible, but inevitable. We need to keep people alive to benefit from this dramatic change, and that starts with the release of naloxone.

This is an opinion and analytical article, and the opinions expressed by the author or authors are not necessarily those of American scientist.