Last December, I reported the FDA had announced that naloxone (Narcan) was going over-the-counter. Well, it has. Naloxone has been used by emergency rooms and emergency medical personnel for decades as an antidote for opioid drug overdoses. Countless lives have been saved by the use of naloxone because it’s affect on opioids is immediate. Now, after decades of use without adverse effects, it is being sold directly to consumers in hopes of reducing the number of opioid overdose deaths.
Prior to going OTC, naloxone was given intravenously, subcutaneously (inject under the skin), intramuscularly (into a large muscle), and, since 2015, intranasally. It had to be given by someone trained in administration. The fastest most effective route is IV because results are almost immediate. Any patient found unconscious on the street, or brought to the ER comatose, was given naloxone both as an antidote and a test to see if the problem was opioid related. If the patient “woke up” it was an overdose. Naloxone is harmless if given to a patient not affected by opioids, But it’s a miracle drug if the patient has OD’d.
Making it available OTC increases access to the drug and should result in fewer overdose deaths. That would be the hope of rational people. But my concern is the availability of an immediate antidote administered by friends makes it easier for abusers to use drugs more often and with much less caution. It’s like gonorrhea and penicillin; if you know you will get well with penicillin, promiscuity is more likely to occur. (Poor analogy, I know!).
Each spray of naloxone contains 4 mg of the drug. 4 mg is the therapeutic dose. Administer one spray in one nostril immediately, but if the patient is not better after 3-4 minutes, an additional spray in the other nostril is indicated. My sense is that most, if not all, who read this blog will never be in a situation where naloxone is necessary, but knowing about it could be lifesaving.
Where I see naloxone being used is for overdoses taken by folks who are depressed and attempting suicide. Whether it works depends on what they take to OD. I don’t have any problem with Naloxone going OTC. It will undoubtedly save many lives, but it could have the opposite effect. Drug users who would have been treated in the emergency may forgo that route in favor of using OTC naloxone and find themselves in a worse situation. Let’s hope that’s not what happens.
