Naloxone Saves Lives, But Distribution is Still Controversial

About 16,000 people die each year of opioid overdose. Of these needless deaths, thousands could potentially be saved with the use of naloxone. Naloxone is a drug with numerous beneficial uses, the most notable of which is its ability to reverse overdoses that result from opioid abuse. It has been on the market since the 1960’s, but has only been deployed widely for the purpose of overdose reversal since 1996.

Its mechanism of action is not well understood, but it appears to work by binding to the κ, σ and especially µ opiate receptor sites in the central nervous system, antagonizing and competing with the opioid for space. Regardless of how it works, the bottom line is that it has been demonstrated to be, on the whole, safe and effective. It has immense potential to save lives in the hands of medical professionals and laymen alike–but it has a number of opponents, such as Maine governor Paul LePage, who argue that deploying it will enable drug users.

Last month, U.S. Attorney General Eric Holder called upon emergency first-responders to increase use and access to naloxone. Holder said the drug can be credited with reversing upwards of 10,000 overdose deaths nationwide since 2001. Massachusetts Senator Edward Markey, meanwhile, has introduced federal legislation for the protection of good Samaritans administering naloxone to overdosing individuals, and a 2012 law protects 911 callers attempting to get aid for overdosing friends from most drug charges.

These are all great successes, but as the US War on Drugs stumbles through its fourth decade, there are still opponents of naloxone’s expanded distribution among police, firefighters, and friends and family of users, on the grounds that it causes risk compensation behavior, an idea that is not supported by any scientific evidence.

In fact, there is even some evidence to suggest that the experience of surviving an opioid overdose thanks to naloxone can deter future abuse somewhat. Karla Wagner, an assistant professor at the University of California San Diego’s School of Medicine, offered, “Somebody who is opioid-dependent who receives naloxone is going to go from overdose and not breathing to opioid withdrawal in a very short amount of time, and that’s not a pleasant feeling. So when you talk to people who have had their overdose reversed, they’re not eager to do it again.”

The common anti-naloxone argument is an old and tiresome one rife with victim-blaming; The opposition mainly argues that if given a safer means of abusing drugs, addicts will abuse drugs more, or that the perceived safety net of an anti-overdose drug will inspire people who otherwise wouldn’t do drugs to abuse them. Their ilk are found among people who oppose needle exchanges in public places, reasoning that making the world a safer place for everyone comes secondary to heavy-handed attempts to deter and punish those who, in many cases, have already chosen to punish themselves.

The idea that overdoses should exist as a deterrent to drug use, and that the negative health repercussions of abusing substances are deserved, appears to be a central tenet to most of the opposition of a wider implementation of naloxone. Naloxone is a drug that has a remarkable track record as a lifesaving opioid antagonist, has no potential for abuse, and is believed to be notably cost-effective and relatively inexpensive. Most vocal opponents of naloxone oppose its implementation for reasons that are patently unverifiable or purely speculative.

The Ohio department of Health’s Project DAWN (Deaths Avoided With Naloxone) seeks to expand access to the drug and increase awareness of overdoses, their symptoms, and their potential treatment with naloxone.

In a world where opiate abuse and overdoses are on the rise, particularly among women, it is duly important that we act immediately to prevent needless deaths as a result of drug abuse where the benefits exceed the costs. Massachusetts mayor Thomas Koch said of naloxone implementation, “It’s easy for the cynical person to say, ‘Oh, they’re druggies, they’re junkies, let them die.’ But when you put a name and a face and a family to that, then it’s a different story. Some people who go down this road will never come back, but if we can bring them back, there’s always hope.”

It shouldn’t matter that the people whose lives will be saved by naloxone are primarily drug users, and it shouldn’t matter whether or not naloxone results in some risk-compensation behavior (even though it likely doesn’t). Considering the alternative–not having emergency access to overdose reversal medication and the relative lack of drawbacks–it’s almost certainly worth a shot.

d

Duni Arnold
Duni Arnold is the Junior Editor of Issues for The Flounce and lives in Fairbanks, Alaska. Her subjects of specialty include women’s issues, race, social justice and policy. On a typical day she can be found oil painting, scribbling music, studying economics and browsing the interwebs on her laptop with her dog Star at her feet.
  • http://www.theflounce.com AlexisO

    I’ve only recently started hearing about this and I don’t believe keeping it on-hand is going to enable.That’s like saying keeping bandaids available will encourage us to injure ourselves.

    • MrsMeowsington

      Basically. It just doesn’t make sense.

  • Frances Mary

    “Somebody who is opioid-dependent who receives naloxone is going to go from overdose and not breathing to opioid withdrawal in a very short amount of time, and that’s not a pleasant feeling. So when you talk to people who have had their overdose reversed, they’re not eager to do it again.”

    This is not really accurate. We are actually careful with the dose we administer (and distribute, as we in Vancouver do distribute naloxone kits to injection drug users) because we don’t want to send people into full-on withdrawal. If you administer too much naloxone, you put people into withdrawal, setting them up to seek out more opiates to relieve the withdrawal symptoms. At first, while the naloxone is in their system, the opiate will have no effect, but as the naloxone wears off (which it does rather quickly – 30 to 90 minutes after administration), they will OD again.

    As a nurse who, on average, saves at least one person per shift with naloxone, and who has heard countless stories of individuals saving each other with the take home naloxone kits, I cannot emphasize enough how essential it is to make the medication as available as possible.

    • MrsMeowsington

      Thank you for this info! I appreciate it. I did not mean to suggest that medical responders put overdosing patients into full-on withdrawal with the naloxone, but how Mrs. Wagner intended her statement is uncertain.

  • Blahblee

    I also think critics of the take-home kits easily forget that the naloxone is not administered by the drug addict themselves–it’s always someone close to them who ends up delivering the shot, as it would be with someone who falls over from taking too much insulin. And even insulin shots and glycogen shots are abused–holy shit, I know one guy who overdoses on insulin regularly and smashes his head on the floor so often that his wife has placed a dog bed on the wooden floor next to his chair.

    • MrsMeowsington

      Wow, that’s nuts. I’d never heard of anyone intentionally abusing insulin before, although I considered that it was possible. Just goes to show, I guess.

      Thanks.