Naloxone nasal spray possibly save lives, but is hard to find

While preparing a talk to medical students on the topic of substance use disorders, I noted that naloxone (brand name Narcan) nasal spray was now available in Georgia, at any pharmacy, over the counter without a prescription. At least that was my impression.

For my talk, I thought it would be an effective teaching prop to have a real naloxone inhaler with me, and to demonstrate its use. Since it was OTC, I thought I would have no problem obtaining one. I visited my local pharmacy.

There were no naloxone inhalers available in my pharmacy. There had been no requests for the inhaler, either from patients or their family members, emergency medical service providers or other health care providers. This was a bit surprising, so I decided to further investigate.

In the Feb. 16 New England Journal of Medicine, authors Frank and Pollack discussed the “rising mortality” attributed to the increasing use of fentanyl and its inclusion in batches of heroin and other illegal recreational drugs. Fentanyl is an almost 20 times cheaper substitute for many of those drugs, and producers use it to increase their profit margins. Fentanyl is also a popular component in “counterfeit” versions of OxyContin, Xanax (alprazolam), and Norco (acetaminophen-hydrocodone).

Unfortunately, fentanyl can be more harmful than the drug it “cuts.” Frank and Pollack remarked that fentanyl “can rapidly suppress respiration and cause death more quickly than other opioids.” So users of recreational opioids not only risk death from the illegal drugs they know they are taking, but also from a potentially more deadly substance whose presence is likely unknown to them.

Those authors discussed methods to decrease the number of deaths attributed to drug overdoses, and listed naloxone nasal spray, in the hands of users, friends of users and family members, as a potentially effective tool to reverse overdoses and save lives. In the case of fentanyl, “more rapid administration (and perhaps escalation to additional doses)” may be necessary, when compared to reversal of other opioids, including heroin. Naloxone needs to be given quickly, even before first responders arrive.

On Dec. 14, 2016, Gov. Nathan Deal supported removal of naloxone from the dangerous drug list, reclassifying it as a Schedule V exempt drug, and allowing it to be dispensed OTC, with the hope that drug users, their friends and family members will have ready access to the lifesaving medication, should the need arise. Previously, in 2014, the Georgia 911 Medical Amnesty Law extended certain legal protections to those who administer naloxone to an overdose victim. Saving lives in this manner may give users, many of whom are young and potentially remediable, a second chance.

Curious about naloxone nasal spray’s local availability, I Googled “pharmacies near me” and obtained a list of 20 pharmacies. I called them and asked if they had naloxone nasal spray in stock.

None of the pharmacies had naloxone nasal spray in stock. A few said it could be ordered and would arrive within a day or two. A few commented that I was the only person to request this medication. A few were aware of its ultimate OTC availability, but indicated, “the details are being worked out.”

Though approved for use by average citizens, naloxone nasal spray has not yet become widely available in our area. I hope this article will increase awareness of the potential benefit of this medication, and that it will become an effective “harm reduction” tool in the effort to stem the tide of drug abuse fatalities, allowing many otherwise ill-fated users that second chance at rehabilitation.

This story was originally published March 24, 2017 at 6:24 PM with the headline "Naloxone nasal spray possibly save lives, but is hard to find."