Study shows that states need more naloxone

Distribution of OD antidote needs redirection to community programs

More than 100,000 Americans died of drug overdoses in the first full year of the pandemic, according to data released last fall by the Centers for Disease Control and Prevention. New research on the availability of the opioid antidote naloxone raises the question, how many of those lives could have been saved?

“As a country, I think we need a massive increase in the amount of naloxone going into the hands of people who use drugs and the people who are more likely to witness and experience an overdose and are more likely to respond,” said Traci Green, Ph.D., MSc, a professor, and director of the Opioid Policy Research Collaborative at Brandeis University in Waltham.

Green co-authored the study which finds most states lacking sufficient distribution of naloxone, more commonly known by the brand name, Narcan, such that there’s a shortage of the lifesaving drug where it’s needed most. The research appears in The Lancet Public Health.

Naloxone is a prescription drug. But recognizing the important role it plays in reviving those who have overdosed on opioids, some states don’t treat it that way -- so that it’s readily accessible.

“In Massachusetts, there’s a standing order for Narcan,” said Jennifer Knight-Levine, executive director of the SAFE Coalition, which supports those in recovery and in need of mental health services. “Which means you can go to any pharmacy and request Narcan.”

Naloxone is also available through prescribers -- that is, doctors, physician assistants, and nurse practitioners. But none of these routes is best at getting the drug where it needs to go -- given the kind of epidemic much of the U.S. is dealing with, Green said.

“What we really found is that the community-based programs are those that get naloxone out to people who use drugs,” Green said. “And it matches the epidemic type -- that is, that fentanyl requires a lot of naloxone in places, really, on-demand.”

But Green said there seems a bit of a disconnect when it comes to funneling resources to such programs.

“We’re lucky, I think, because lately there’s been more attention on naloxone for expanding access through federal funds to this life-saving medication,” Green said. “However, not all those grants or investments are going to community-based programs.”

Green said it’s important to expand the base of community-based programs, such as mutual aid societies and community health centers because they efficiently distribute naloxone. This has become especially important in the era of Covid, she said.

“Isolation is killing us,” she said. “And we are seeing overdoses increase dramatically.  We’ve never seen overdoses higher than in this last year. In every corner of this country, we are seeing overdoses increase.”

On a local level, Knight-Levine said there is a critical shortage of personnel and other resources to support those in recovery.

“We’ve seen a stark increase in folks needing services due to a relapse,” she said. “Whether we’re working with middle or high school youth, or we’re working with parents or older adults, there is a huge need for clinical support, for peer support.”

Knight-Levine echoed the need for more naloxone -- though she said part of the shortage problem may be a supply issue brought about by the unavailability last year of Pfizer’s injectable version -- followed by a pricing issue.

SAFE Coalition just purchased nasal naloxone at $95 a unit. The injectable used to cost 1/5 of that, Knight-Levine said.

“The price point and availability are crucial in communities,” she said.