Panel backs moving opioid antidote Narcan over the counter
February 16, 2023 8:12 AM Subscribe
Rad rad rad rad rad this will absolutely save many lives
posted by an octopus IRL at 10:41 AM on February 16, 2023 [3 favorites]
posted by an octopus IRL at 10:41 AM on February 16, 2023 [3 favorites]
Seriously this is something really exciting and good in the midst of many many bad things happening and having another resource more readily available to allow us to take care of each other is a beautiful thing.
posted by an octopus IRL at 10:42 AM on February 16, 2023 [5 favorites]
posted by an octopus IRL at 10:42 AM on February 16, 2023 [5 favorites]
Good. This feels like a no-brainer, as a layperson.
In Rhode Island you can get it for free: https://preventoverdoseri.org/get-naloxone/ I hope other states offer it, too.
posted by wenestvedt at 10:45 AM on February 16, 2023 [2 favorites]
In Rhode Island you can get it for free: https://preventoverdoseri.org/get-naloxone/ I hope other states offer it, too.
posted by wenestvedt at 10:45 AM on February 16, 2023 [2 favorites]
Here in PA, we have a standing order at all state pharmacies to make it available to the general public. (I believe other states have done this too.) I have Narcan in both my backpack and bike first aid kit; I got mine for free from Prevention Point Pittsburgh. But most of the people in my social circle regard this as a curiosity.
posted by sockshaveholes at 11:01 AM on February 16, 2023 [5 favorites]
posted by sockshaveholes at 11:01 AM on February 16, 2023 [5 favorites]
It's available in California, though you should take a course on how to use it properly. I think you get CEU if you do take that course.
California Department of Public Health has a page on Nalaxone, and where are they available (even outside California)
Unfortunately, pharmacies are allowed to charge big bucks for it, but GoodRX has coupons on that for those that needs to pay $$$. I think I checked it a couple months ago when the subject came on on Reddit, and GoodRX coupons in California brought the cost down to $20 per spray ($40 a box)
posted by kschang at 11:14 AM on February 16, 2023 [3 favorites]
California Department of Public Health has a page on Nalaxone, and where are they available (even outside California)
Unfortunately, pharmacies are allowed to charge big bucks for it, but GoodRX has coupons on that for those that needs to pay $$$. I think I checked it a couple months ago when the subject came on on Reddit, and GoodRX coupons in California brought the cost down to $20 per spray ($40 a box)
posted by kschang at 11:14 AM on February 16, 2023 [3 favorites]
Advocates have done a shit ton of work over the last 2 decades, starting with Dan Bigg in Chicago, to make naloxone accessible and available to people who use drugs, who continue to reverse the vast majority of overdoses reversed in this country. And we've done a whole lot of work to create those state by state policies to make it available from pharmacies, with standing orders, through harm reduction programs. All of which are workarounds of the fact that it's a prescription drug per the FDA. This is indeed a big step forward, and will remove one barrier, but it is ALSO happening because Emergent Biosciences has decided that they could really step into their role as profiteers on the overdose crisis and make even MORE money off it.
It's a good thing, happening in a problematic way. In conclusion, support your local harm reduction program!
posted by gingerbeer at 11:20 AM on February 16, 2023 [7 favorites]
It's a good thing, happening in a problematic way. In conclusion, support your local harm reduction program!
posted by gingerbeer at 11:20 AM on February 16, 2023 [7 favorites]
Someone here pointed out long ago that naltrexone is used off-label to treat Crohn's, which is very plausible to me because of the constipating effects of opioids in general, and that it's much cheaper than the available prescription drugs.
I also suspect you can use it to generate a kind of natural high by taking a very small dose and ramping it up as your body adapts, which it will probably do by adding opioid receptors and increasing the production of endogenous opioids. Then when you stop taking the naloxone, suddenly everything you do is more pleasurable, and I see no reason that couldn’t last for a long time.
posted by jamjam at 12:14 PM on February 16, 2023
I also suspect you can use it to generate a kind of natural high by taking a very small dose and ramping it up as your body adapts, which it will probably do by adding opioid receptors and increasing the production of endogenous opioids. Then when you stop taking the naloxone, suddenly everything you do is more pleasurable, and I see no reason that couldn’t last for a long time.
posted by jamjam at 12:14 PM on February 16, 2023
Naltrexone and naloxone are two different drugs, although you are certainly not the first person to confuse them. And no, you can't microdose naloxone to get high.
posted by gingerbeer at 12:23 PM on February 16, 2023 [7 favorites]
posted by gingerbeer at 12:23 PM on February 16, 2023 [7 favorites]
Here's some good coverage of the FDA meeting.
posted by gingerbeer at 12:24 PM on February 16, 2023 [2 favorites]
posted by gingerbeer at 12:24 PM on February 16, 2023 [2 favorites]
This is great. I've seen blog posts and tweets urging everyone to carry Narcan, but I didn't know how to go about getting it without making someone think I had an opioid problem in a way that might show up on my Permanent Record. Cowardly, I know. A guy asked me for Narcan once for a woman on the ground, but thankfully she came around in some kind of way, and they didn't want an ambulance -- who could blame them. I don't know if coming around meant she wouldn't have needed it in the first place, but I never forgot it, and I hope to be able to help when I'm asked again. (I say when because I see a lot of folks with problems around here.)
posted by Countess Elena at 12:50 PM on February 16, 2023 [2 favorites]
posted by Countess Elena at 12:50 PM on February 16, 2023 [2 favorites]
I didn’t confuse them, gingerbeer; I said naltrexone because the person who pointed out the connection with Crohn's said naltrexone, not naloxone.
However I did assume naltrexone and naloxone are both opioid receptor blockers. Am I in error about that? If so, I would appreciate knowing it — assuming your purpose in making the comment was to inform, rather than to belittle me as ignorant, of course.
posted by jamjam at 1:20 PM on February 16, 2023
However I did assume naltrexone and naloxone are both opioid receptor blockers. Am I in error about that? If so, I would appreciate knowing it — assuming your purpose in making the comment was to inform, rather than to belittle me as ignorant, of course.
posted by jamjam at 1:20 PM on February 16, 2023
Both naltrexone and naloxone are opioid antagonists so they block opioid receptors. They both don't activate those receptors so don't cause an opioid high. However, there's a key difference between the two:
Naltrexone is long-term. It is taken pre-emptively as part of treatment for opioid addiction.
Naloxone is short-acting. It is taken in emergency situations to keep someone alive after they have taken an opioid.
posted by happyinmotion at 2:48 PM on February 16, 2023 [3 favorites]
Naltrexone is long-term. It is taken pre-emptively as part of treatment for opioid addiction.
Naloxone is short-acting. It is taken in emergency situations to keep someone alive after they have taken an opioid.
posted by happyinmotion at 2:48 PM on February 16, 2023 [3 favorites]
In British Columbia, there's a program to provide free Naloxone.
posted by porpoise at 3:15 PM on February 16, 2023 [1 favorite]
posted by porpoise at 3:15 PM on February 16, 2023 [1 favorite]
but I didn't know how to go about getting it without making someone think I had an opioid problem in a way that might show up on my Permanent Record.
Your state or city very likely has a training and will probably provide you with a kit afterwards. Thought I might have to use mine the other day; thank God, I didn't.
posted by praemunire at 4:20 PM on February 16, 2023 [1 favorite]
Your state or city very likely has a training and will probably provide you with a kit afterwards. Thought I might have to use mine the other day; thank God, I didn't.
posted by praemunire at 4:20 PM on February 16, 2023 [1 favorite]
I always just assumed it was OTC. Turns out it is in my state, but not every pharmacy will stock it. Damn.
posted by The Underpants Monster at 5:17 PM on February 16, 2023
posted by The Underpants Monster at 5:17 PM on February 16, 2023
but I didn't know how to go about getting it without making someone think I had an opioid problem in a way that might show up on my Permanent Record.
So I think it's worth pointing out that, at least in the US, there's really no such thing as a Permanent Record, and the government is barely competent at keeping track of who has felony warrants in neighboring states. The one time we tried keeping track of OTC drug purchases (to keep people from cooking meth, unsuccessfully), it cost the taxpayer $300M to implement and an unknown amount per year to maintain (the joy of unappropriated funds).
But that said: if anyone lives in an area where there's a limited number of pharmacists and they're assholes (which is honestly not my general experience with pharmacists, but I'm sure they do exist), or has some other awkward situation where you're falling between the cracks, whatever it may be, MeMail me. Because I have a super-chill pharmacist and will totally not buy Narcan and definitely won't mail it to you, because that's probably illegal. So we can discuss exactly how I won't do that privately. Capisci?
posted by Kadin2048 at 6:40 PM on February 16, 2023 [3 favorites]
So I think it's worth pointing out that, at least in the US, there's really no such thing as a Permanent Record, and the government is barely competent at keeping track of who has felony warrants in neighboring states. The one time we tried keeping track of OTC drug purchases (to keep people from cooking meth, unsuccessfully), it cost the taxpayer $300M to implement and an unknown amount per year to maintain (the joy of unappropriated funds).
But that said: if anyone lives in an area where there's a limited number of pharmacists and they're assholes (which is honestly not my general experience with pharmacists, but I'm sure they do exist), or has some other awkward situation where you're falling between the cracks, whatever it may be, MeMail me. Because I have a super-chill pharmacist and will totally not buy Narcan and definitely won't mail it to you, because that's probably illegal. So we can discuss exactly how I won't do that privately. Capisci?
posted by Kadin2048 at 6:40 PM on February 16, 2023 [3 favorites]
I'm quite shocked. The other day I was walking around and found a kit in a free library. I didn't take it, but the next one was sitting on the flat top of a garbage can. I put it in my first aid kit. The people most likely to need one of these are typically not organized enough to find a drugstore and they probably don't have the cash to buy one. I assumed that if it's important to save lives, they'd be free. Having to get permission to buy the treatment for someone who's overdosed seems staggeringly counterproductive. It's at times like this that I realize just how much damage the war on drugs has done, not just to our society but to our sense of right and wrong and our ideas of just how much our fellow humans should suffer to protect us from nothing.
posted by AugustusCrunch at 9:06 PM on February 16, 2023 [3 favorites]
posted by AugustusCrunch at 9:06 PM on February 16, 2023 [3 favorites]
I assumed that if it's important to save lives, they'd be free.
They are often given away free by needle exchange/harm reduction organizations, where such organizations are allowed to exist.
And drug users do buy things like needles at the pharmacy, too, in places where the pharmacist is willing/allowed to sell them. But I’m not sure that’s who they expect to be the main buyer of OTC (but not free) naloxone.
posted by atoxyl at 9:46 PM on February 16, 2023
They are often given away free by needle exchange/harm reduction organizations, where such organizations are allowed to exist.
And drug users do buy things like needles at the pharmacy, too, in places where the pharmacist is willing/allowed to sell them. But I’m not sure that’s who they expect to be the main buyer of OTC (but not free) naloxone.
posted by atoxyl at 9:46 PM on February 16, 2023
Naloxone is extremely important for saving lives, but most of the lives to be saved are of a very stigmatized and criminalized set of people in this country, namely people who use drugs, and therefore there have been a lot of barriers to making it more accessible. Naloxone does nothing in your body if you don't have opioids in your system. It is extremely safe and effective, and would have been OTC long ago except for the fact that most policy makers don't give a shit about people who use drugs. And/or think that they are irresponsible, zombies, unable to make good decisions, or don't care about themselves or anyone else, or insert other misinformed stereotype about people who use drugs.
Yes, I do believe that most people should carry naloxone. What is probably most available, although not cheapest, is the nasal spray, branded as Narcan. There are other formulations that are much cheaper, namely a generic injectable (IM) variety. The training required to use it is primarily about how to recognize an overdose. Here's a link to a very good training (and a way to get it shipped to you, depending on where you live.)
Harm reduction organizations in many places distribute naloxone for free; the organization where I work distributed tens of thousands of doses last year, and people reported over 5,000 overdose reversals with the naloxone we gave them. If you can afford to pay for it, however, or get your insurance to do so, please do, instead of taking it from underfunded harm reduction programs.
The FDA had previously said that they were willing to entertain a proposal to make naloxone OTC, but that would require an expensive amount of marketing research and data, and with generic naloxone, there was no financial incentive to do that work. Emergent, however, has figured out how to profiteer off this by using a nasal spray formulation which is not (yet) generic, so they do have the financial incentive to do the work needed. Advocates have been pushing the FDA for years to consider this a public health emergency and take unilateral action to make it OTC, but the FDA has refused.
posted by gingerbeer at 10:59 PM on February 16, 2023 [5 favorites]
Yes, I do believe that most people should carry naloxone. What is probably most available, although not cheapest, is the nasal spray, branded as Narcan. There are other formulations that are much cheaper, namely a generic injectable (IM) variety. The training required to use it is primarily about how to recognize an overdose. Here's a link to a very good training (and a way to get it shipped to you, depending on where you live.)
Harm reduction organizations in many places distribute naloxone for free; the organization where I work distributed tens of thousands of doses last year, and people reported over 5,000 overdose reversals with the naloxone we gave them. If you can afford to pay for it, however, or get your insurance to do so, please do, instead of taking it from underfunded harm reduction programs.
The FDA had previously said that they were willing to entertain a proposal to make naloxone OTC, but that would require an expensive amount of marketing research and data, and with generic naloxone, there was no financial incentive to do that work. Emergent, however, has figured out how to profiteer off this by using a nasal spray formulation which is not (yet) generic, so they do have the financial incentive to do the work needed. Advocates have been pushing the FDA for years to consider this a public health emergency and take unilateral action to make it OTC, but the FDA has refused.
posted by gingerbeer at 10:59 PM on February 16, 2023 [5 favorites]
Re naltrexone (not naloxone)- it's honestly a kind of fascinating drug to me. It is useful for a surprising number of conditions. It was even being used as a COVID treatment recently (with more evidence of effectiveness than ivermectin.) We still don't understand exactly how it works for some of them, but it seems to have an anti-inflammatory activity as well as the opioid engagement. It's a very interesting treatment for alcohol use disorder. Unfortunately, it's also been packaged as a long-term injectable product by a very slimy pharma company which has pushed the long-acting version to be used in coercive and abusive ways, after conducting very unethical research in Russia. Funny how the profit motive just fucks things up.
posted by gingerbeer at 11:17 PM on February 16, 2023 [2 favorites]
posted by gingerbeer at 11:17 PM on February 16, 2023 [2 favorites]
Kadin2048: I appreciate that! I just looked into it, and apparently there is indeed a program in my state to provide training and free Narcan. I'm making a note. As to the "permanent record," I was thinking vaguely of algorithms that might decide to identify someone as high risk.
posted by Countess Elena at 10:02 AM on February 17, 2023 [2 favorites]
posted by Countess Elena at 10:02 AM on February 17, 2023 [2 favorites]
Countess Elena, I'm sorry that the stigma and criminalization of drug use is preventing you from accessing a medication that could potentially save someone's life. I would encourage you to access the NextDistro program that I linked to earlier. For Maine, it looks like they can mail you the injectable intramuscular formulation for free. If you want the nasal spray, I would recommend finding a pharmacy that stocks it and paying cash.
posted by gingerbeer at 10:14 AM on February 17, 2023 [1 favorite]
posted by gingerbeer at 10:14 AM on February 17, 2023 [1 favorite]
Just to add, your concerns are not at all unfounded, and I appreciate your caution on it. It's a very real barrier that I wish didn't exist. The problem is the system, not you.
posted by gingerbeer at 10:20 AM on February 17, 2023 [3 favorites]
posted by gingerbeer at 10:20 AM on February 17, 2023 [3 favorites]
I assumed that if it's important to save lives, they'd be free
I have some news for you about insulin...
posted by chariot pulled by cassowaries at 11:18 PM on February 17, 2023 [1 favorite]
I have some news for you about insulin...
posted by chariot pulled by cassowaries at 11:18 PM on February 17, 2023 [1 favorite]
In Australia you can access it for free and without a script through the Take Home Naloxone program.
Naloxone can be accessed for free and without a prescription from participating pharmacies, participating general practitioners and participating community health organisations.
The Department of Health and Aged Care estimates 16,900 people have accessed Take Home Naloxone between July 1, 2022 and December 31, 2022
posted by chariot pulled by cassowaries at 11:22 PM on February 17, 2023 [1 favorite]
Naloxone can be accessed for free and without a prescription from participating pharmacies, participating general practitioners and participating community health organisations.
The Department of Health and Aged Care estimates 16,900 people have accessed Take Home Naloxone between July 1, 2022 and December 31, 2022
posted by chariot pulled by cassowaries at 11:22 PM on February 17, 2023 [1 favorite]
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This thread has been archived and is closed to new comments
It seems like they might have looked around a little robadfress this problem. Thisbis available for free at pharmacist in Canada for anyone who asks for it, no questions asked. Has there been a problem with untrained people not knowing how to use it? Given that there are lots of marketing campaigns encouraging people to pick up a kit, I assume not.
posted by If only I had a penguin... at 8:35 AM on February 16, 2023 [1 favorite]