OPINION: Combating Massachusetts's Silent Killer

FILED UNDER: Medicine, Public Health, Opioids, Overdose, Addiction, Narcan, Pharmaceuticals

By: Conor Birmingham, Emily Chiasson, Nika Greenberg, Amanda Stroiney Guest Contributors

Two people die every day from opioid overdose in Massachusetts, making it a higher cause of death than automobile accidents. On March 27, 2014, Gov. Deval Patrick dedicated $20M towards opioid overdose prevention programs in Massachusetts, and declared the epidemic a public health emergency. The past decade has seen a dramatic spike in opioid overdose deaths, yet it is has been an issue that was largely stigmatized and rarely spoken of. While preventing the abuse of these medications is the ideal, the immediate public health threat involves quickly saving the lives of people experiencing an overdose before it is too late.

Narcan auto-injector approved by the FDA.

Opioids are defined as powerful drugs that aid to manage extreme pain. They include prescription drugs such as Oxycontin, Percocet, Vicodin, Fentanyl, Codeine, Morphine or illegal substances such as heroin. While most of these drugs are commonly prescribed for medical or dental surgical relief, they are quite easy to abuse even when legally obtained. These drugs, especially heroin, are highly addictive and can frequently lead to overdoses and ultimately death. This issue is not only tragic, but also incredibly expensive. The hospitalization cost for people suffering from opioid dependence, abuse, and/or overdose cost Massachusetts more than $239 million in 2007. The increased number of people affected is also staggering. Only 325 people were treated for prescription drug opioid overdose in a hospital in 1992. This number increased by 950% in 2002, and has increased consistently ever since. In order to combat the overdose epidemic, the drug Narcan has been introduced. Narcan, the brand name for the drug Naloxone, has been used to reverse accidental or intentional opioid overdoses since 1971. One possible solution to this concerning public health issue is the wider distribution of Narcan to non-medical personnel, such as family members or caregivers to those at risk of an opioid overdose.

On April 3, 2014, the U.S. Food and Drug Administration (FDA) made a monumental step in the right direction by approving the at-home use of Narcan administered via autoinjector, a product similar to the Epi-Pen. An intranasal spray version of Narcan had previously been approved. Their expedited approval of another version of Narcan demonstrates the prudent necessity for this life-saving drug. Their approval of the drug; however, is not permanent solution to this epidemic. With the approval of the drug, there also needs to be money funded by the federal and state governments to help train laypeople in how to use Narcan. Luckily, Narcan is by no means a dangerous drug. If someone is currently overdosing from other illicit drugs, such as cocaine or methamphetamine, the Narcan will have no effect. Similarly, if someone was to accidentally inject Narcan into themselves or someone else, no harm would occur. The central argument in support of the approval of Narcan is rather simple; it saves lives. Regardless of the politics surrounding this issue, most can agree on the tragedy of the aforementioned statistics. Drug overdoses will likely continue to remain an existing problem, but increasing access to this preventative drug will saves lives in the most critical circumstances.

The central argument in support of the approval of Narcan is rather simple; it saves lives.

At a recent FDA hearing regarding Narcan, experts with a variety of backgrounds were given an opportunity to express their opinions regarding making this drug more readily available for those who need it. Healthcare providers and addiction specialists testified to the benefits as well as to the very few drawbacks of this drug. These individuals explained that Narcan was both safe, non-addictive, and that it cannot be misused [since] it blocks the action of opioids [and] produces the opposite of a high. Among the proponents were parents and relatives of opioid-overdose victims who expressed outrage over the lack of access to this drug. Many believed that Narcan could have been the antidote that saved their loved ones. For the many who pointed out the benefits of Narcan, choosing sides in the debate was a nobrainer. Many explained that the more available the drug is, the more likely it will be utilized. Due to the inherent safety of the drug, Narcans administration only presents the possibility of saving ones life. Approaching this matter from the perspective of pure statistics, it is clear that the benefits outweigh the risks when it comes to preserving ones life. While there are many positive aspects of Narcan and its success reviving those experiencing an opioid related overdose, there is more to consider when granting the public access to the drug. Due to the high demand for the drug, the prices for Narcan have increased dramatically. Amphastar Pharmaceuticals, currently the only producers of Narcan in the publically accessible nasal spray, have doubled the price of the life-saving drug Narcan to $42 per dose. This is almost twice the price it was seven years ago.

Those touched by this epidemic struggle to afford the medication that has the potential to save their loved ones lives. Drug users who are homeless, mentally ill, or impoverished may not have the means to buy an antidote, especially when that money could instead be spent on their addictive drug of choice. Moreover, their families may not be able to afford Narcan, leaving them to painfully watch their child, spouse, or friend die from a preventable death. Additionally, Narcan can be short-lived and may not completely reverse an overdose. Often, it takes more than one dose of Narcan to successfully revive a person. In fact, it can take upwards of five to six doses to successfully revive a person. People may not be aware that they should have multiple doses of Narcan ready in case of an overdose. It is crucial that the public is properly educated about the risks of Narcan administration and follow-up care. If immediate medical attention is not sought after the drug is administered, the drug addict may die from the withdrawal symptoms. It must be made clear to the public that a qualified healthcare provider is the next necessary step in the chain of survival for overdosing individuals. It is difficult to find an adult in Massachusetts that does not know of at least one person affected by opioid abuse. The FDAs approval for public access allows more families and caregivers of drug addicts to have a necessary first line of defense against the premature death of their loved ones. While the drug is expensive right now, an increased market will peak the interest of other pharmaceutical companies, which will hopefully help to decrease the price of Narcan. Thus, Narcan represents a great investment, and more funding and resources should be allocated for laypeople that wish to use Narcan. The drug can buy those suffering from opiate addiction a second chance at life. Neither price nor risk can outweigh the benefits of that.
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Contributors to this piece are students in Professor Laurie Edwards Advanced Writing in the Health Professions course at Northeastern University in Boston, MA.

References http://www.drugabuse.gov/publications/research-reports/prescriptiondrugs/opioids/what-are-opioids http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391465.htm http://odprevention.org/statistics/massachusetts-statistics/ http://www.bostonglobe.com/metro/regionals/north/2013/11/07/medford-reverelynn-lowell-and-gloucester-tackle-opiateabuse/wmZT2jmTEAQh1TFNJPA2kO/story.html http://articles.philly.com/2014-04-05/news/48870307_1_naloxone-narcan-opioids http://www.forbes.com/sites/davidkroll/2014/04/03/fda-rapidly-approves-naloxoneauto-injector-for-heroin-and-prescription-opioid-overdose/ http://www.nlm.nih.gov/medlineplus/druginfo/meds/a612022.html