There’s one life-saving drug that, if administered quickly and properly, can stop nearly all opioid overdoses in their tracks: naloxone, commonly known as Narcan. Patented in 1961, the drug works by preventing the brain’s receptors from bonding with opioids, eliminating their effects on the body. Narcan can’t stop the addiction, but it can stop an overdose.
In 2018, U.S. Surgeon General Jerome Adams issued an advisory calling for more people to carry and learn how to administer Narcan, which is already carried by many EMTs and police officers.
“The call to action is to recognize if you’re at risk,” Adams told NPR. “And if you or a loved one are at risk, keep within reach, know how to use naloxone … We should think of naloxone like an EpiPen or CPR. Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond.”
Some believe making Narcan more accessible is the key to curbing the opioid crisis. That’s why most U.S. states have recently implemented a so-called standing order that allows people to get Narcan from a pharmacist without having to visit a doctor. Still, several factors seem to be preventing Narcan from being as ubiquitous as advocates like Adams might hope.
One problem is stigma. A 2017 study published in the Journal of the American Pharmacists’ Association showed how both pharmacists and addicts report being uncomfortable engaging in face-to-face discussions about the need for Narcan. The researchers argued that this stigma might be reduced through policies that call for pharmacies to universally offer Narcan to patients obtaining opioid prescriptions.
Another component of the stigma surrounding Narcan is an argument that says increasing the drug’s accessibility actually enables addicts. The idea is that addicts are more willing to take risks, and take increasingly dangerous drugs like fentanyl, when they know they have a life-saving drug in their pocket. Proponents of this idea might argue that Narcan “subsidizes recklessness,” but others say denying medical patients a lifesaving drug isn’t the answer.
“I understand the frustration,” Police Chief Thomas Synan Jr. of Newtown, Ohio, told The Associated Press. “I understand the feeling that someone is doing something to themselves, so why do the rest of us have to pay? But our job is to save lives, period.”
But perhaps the biggest obstacle to increasing the accessibility of Narcan is the price. As STAT points out, a life-saving dose of Narcan cost just $1 a decade ago, but now “costs $150 for the nasal spray, a 150-fold increase,” while a “naloxone auto-injector, approved in 2016, costs $4,500.”
As Stephen Wood wrote for Harvard Law School’s Bill of Health, these price increases came “when the opioid epidemic was at its peak, and they came without any explanation.” If the prices don’t drop, it’s unlikely that efforts like standing orders and community distribution programs will be effective.
Ultimately, Wood argued, it’s all about the money for pharmaceutical companies.
“Naloxone has gone from a $21 million dollar a year industry prior to 2014, to a booming $274 million dollar take per year since 2015. There is no doubt: pharmaceutical companies are making money off the opioid epidemic. Additionally, those who need this drug the most, often don’t have access to it. They are the under- or uninsured, so waving a co-pay is moot.
There are plenty of opportunities to reduce costs. Several authorities have asked for induction of federal law 28 U.S.C. section 1498, which would allow the United States to contract with a manufacturer to act on their behalf to create a less costly product. However, this still puts the onus of the cost on the tax payer. The pharmaceutical industry brought us the opioids that sparked this epidemic, heavily marketing oxycontin and oxycodone, which retail at around $1.25 a pill. What could possibly justify the antidote costing upwards of 3,600 percent more? There is no justification for this and policy makers need to draw their attention to this scamming of the general public in a time of crisis.”