The Economist explains

What is naloxone, and how does it reverse opioid overdoses?

America’s government has promised to improve access to the life-saving drug

4/19/2018 - Ross, California, USA: Marin County Fire EMS responder Robert Rocha demonstrates how to administer Naloxone, the antidote drug for opioid overdose also known as Narcan, Thursday, April 19, 2018 at the Ross Valley Fire Department station in Ross, Calif. Narcan is a drug that can reverse the effects of an opioid overdose and is being put into use by fist responders at a time when 91 Americans die from an opioid overdose each day. (Jessica Christian / San Francisco Chronicle / Polaris)Credit: Polaris / eyevineFor further information please contact eyevinetel: +44 (0) 20 8709 8709e-mail: info@eyevine.comwww.eyevine.com

MORE THAN 100,000 Americans died from drug overdoses between July 2020 and June 2021, according to provisional figures released by the Centres for Disease Control and Prevention on January 12th. That is the highest number on record. Some 75% of these deaths were caused by opioids, a class of drug that includes heroin and fentanyl, a prescription pain-killer that has flooded the black market. In an attempt to prevent more deaths, New York has become the first American city to open officially authorised safe-injection sites where people can inject drugs under the supervision of trained staff. On November 30th two clinics opened their doors. They provide access to clean needles and disposal facilities, and staff can administer naloxone, a drug that rapidly reverses the effect of an opioid overdose. Since they opened naloxone has reversed at least seven overdoses—each time potentially saving a life. Health officials have since proposed to introduce vending machines around the city that dispense the drug. What is naloxone, and how does it work?

Opioids work by attaching to receptors in nerve cells, altering the cells’ activity. They block pain signals sent from the brain and can cause feelings of euphoria, making them highly addictive if taken regularly. Opioids also relax a person’s breathing. During an overdose a person’s breathing can stop entirely, killing them. Naloxone, which is administered as an injection or nasal spray, has a stronger binding affinity with opioid receptors than the opioid itself, and so displaces the drug. The medicine causes no reaction, allowing the nerve cell to revert to its normal state. But dislodging the opioid can cause users to feel painful withdrawal symptoms if they are addicted. In the case of overdoses, naloxone allows users to breathe again, hopefully in time to save their lives.

The life-saving potential of naloxone is well documented. A survey by the National Harm Reduction Coalition, a New York-based advocacy group, found that between 1996 and 2014 136 community organisations in America gave out over 150,000 naloxone kits. They received reports of 26,463 overdose reversals, which is almost certainly an undercount. Rahul Gupta, director of America’s Office of National Drug Control Policy, said in November at his swearing-in that increasing naloxone’s availability was his first priority. Not everyone sees expanding access to naloxone as free of problems. Some worry about a moral hazard, encouraging opioid users to take risks. But a recent review in the International Journal of Drug Policy looking at take-home naloxone programmes, in which the medicine is given to users and witnesses, found no evidence of increased opioid use or overdoses.

Community groups are currently responsible for a large share of the drug’s distribution, but it is expensive. Many of them rely solely on Pfizer, an American pharmaceutical giant, which offers a concessionary rate for a generic injectable version of the drug. Problems with Pfizer’s supply chain in 2021 led to shortages and a backlog of orders. On the open market, kits cost anywhere between $30 and $75, a price at which activists say they are unable to meet demand. All states in America prescribe and distribute naloxone, but to varying degrees. At least 14 states have some provision that either enforces or recommends that naloxone is prescribed to any patient who is also taking a high-dosage opioid. In November the White House published a model law for states that would, among other measures, make this compulsory. And although many emergency-service staff carry naloxone, they often arrive too late to save a life, not least because witnesses can be hesitant to call 911 for fear of police involvement. Getting naloxone into more people’s hands would not solve America’s opioid crisis, but it would save lives.

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