The federal Food and Drug Administration has declared Narcan, a nasally administered form of the drug naloxone that counteracts opioid overdoses, safe for over-the-counter access at pharmacies nationwide, prompting positive reactions this week from local health experts and public safety officials.
Agencies including the East Hampton Town Police Department and the rehabilitation organization Phoenix House said the transition of Narcan from prescription only to over the counter will answer a demand that is often shrouded in stigma because of its association with illicit drugs.
“It’s like A.E.D.s [automated external defibrillators],” said Sgt. Ken Alversa. “In the future, you’ll probably see Narcan in every public place and building. From a public safety perspective, the more tools we can put out there into the community, the better off we are.”
Dr. Jarid Pachter, who practices family and addiction medicine in Southold for the Stony Brook network of hospitals and medical offices, likened it to “wearing a seatbelt in the car.”
“Undoubtedly, as long as the price is such that people can afford it and they have equal access to it, the more Narcan that is available to people the more lives it will save,” he said.
Ann-Marie Foster, executive director of Phoenix House of New York/Long Island, which has outpatient and inpatient treatment centers in East Hampton and Wainscott respectively, said, “Now that Narcan is more accessible, it will save lives.”
The New York Times reported on Aug. 30 that more than 100,000 people died of opioid overdoses in the United States in each of the last two years, and that the number of victims is expected to reach 165,000 by 2025. “It’s still as grave as ever. . . . It doesn’t seem like it’s slowing up,” Ms. Foster said. “The problem is that so many people who die of overdoses die in silence, die in back alleys, or bathrooms in homes, and they go unnoticed.”
She is hopeful that the new over-the-counter availability “will lend to taking away the stigma and secrecy of it, introduce the power of this medication to save lives, and begin the conversation about the deadly effects of overdoses,” Ms. Foster said. “Then we have to do the work of prevention and treatment and get people into rehab and housing — all of the things that go along with this, if we really want to change the numbers.”
Last Thursday, Phoenix House marked International Overdose Awareness Day with speakers, a candlelight vigil, and training sessions on the use of Narcan. Sergeant Alversa, who often leads these sessions, explained that prior forms of Narcan were complicated to use, for instance involving a needle or an assembly of a two-piece set. Now it’s one device, similar, he said, to the “Flonase-type spray.” You just unwrap it, insert it into a person’s nostril, and depress the plunger to release the nasal-spray medication.
“We continue to do Narcan trainings for schools, the public, and whoever wants them,” Sergeant Alversa said. “The more Narcan that’s out there, the better and safer the community is. Narcan doesn’t have any negative side effects, even if the person administering it is erring in administering it.”
Dr. Pachter said it’s important that if Narcan is used on someone who has overdosed, it’s still important to call for help. “Hopefully they’re revived and are okay, but the appropriate next step is still to call 911. Oftentimes when you revive someone with Narcan, it puts them into withdrawal from the opiate, so they may start to get agitated or have panic or anxiety. . . . Your best bet is to call 911 and say, ‘I just used Narcan on somebody.’ “
According to an Aug. 30 announcement from Emergent BioSolutions, the manufacturer of Narcan, the suggested retail price for a box containing two 4-milligram doses is $44.99.
“Expanding access and awareness is critical given the staggering toll of the epidemic mainly driven by synthetic opioids, like fentanyl,” Emergent BioSolutions said in its release. “Last year, approximately every seven minutes one life was lost due to an opioid overdose, and today it is the leading cause of accidental death in the U.S. . . . Having Narcan Nasal Spray in a first-aid kit, or carrying it on the go in case of an opioid emergency, can make a difference and help reverse the effects of opioids while waiting for emergency personnel to arrive.”
At least one key issue remains: availability. While Park Place Chemists, White’s Apothecary, and the Sag Harbor Pharmacy said they already stock prescription naloxone and plan on stocking over-the-counter Narcan, it’s currently hard to get.
“I would like to have it over-the-counter, however it doesn’t appear that my wholesalers have it available yet,” said Conor Cassara, a pharmacist and owner of Park Place Chemists in East Hampton. “Because of the demand, it has been back-ordered recently. There’s a bit of a supply issue. We’re just waiting for it to become available.”
“There’s a demand for it everywhere,” said Chris Tsiros, pharmacist and manager at White’s Apothecary in East Hampton.
Mr. Cassara pointed out that it’s not just an antidote for people using party drugs like cocaine, which is often laced with the deadly opioid fentanyl, but that it can also be used in case of an accidental overdose of prescription oxycodone.
“I think that it will alleviate some of the worry about people being put on pain medications for the first time,” he said. “It’s a preventative measure in the event of an adverse reaction or accidental overdose. It’s only a good thing.”
Matthew Blanchette, senior manager for retail communications for CVS, which has two locations in East Hampton Village and one in Southampton Village, said in an email to The Star that Narcan is to be available here, as part of the CVS network of more than 7,500 stores.
“All CVS pharmacists are trained on how naloxone works and can provide education and counsel to patients prior to purchase,” he wrote. “We also hope the F.D.A.’s approval of over-the-counter naloxone will lead to more naloxone products in the marketplace to help ensure affordable access for customers.”
The Times has reported that previous iterations of Narcan were eligible for coverage by health insurance companies, but that may not be the case for over-the-counter purchases. Mr. Blanchette said Narcan will be eligible for health-savings and flexible-spending account usage at CVS.