Providers: expanded Narcan access can save lives
FDA announces Narcan nasal spray can be sold OTC without a prescription
Ryan Gagne often gets asked about Narcan.
As CEO and founder of Live Free Recovery Services in Keene and Manchester, Gagne said the public has become more familiar with the life-saving medication in recent years.
He recalls an older man coming to him recently, trying to secure Narcan for a fellow churchgoer, who the older man suspected had a substance-use disorder.
“Having access to (Narcan) gives people a little power in their lives,” Gagne said, “so they can navigate the situation, rather than wait for an ambulance.”
Narcan — the brand name of naloxone hydrochloride, first approved by federal regulators in 2015 — blocks the effect of opioids in the brain and other areas of the body, and reverses symptoms of an overdose, such as slowed breathing, low blood pressure and unconsciousness.
In most of New Hampshire, Narcan has been made easily accessible in response to the ongoing opioid epidemic. Narcan is usually offered free-of-charge through community organizations, such as substance-use treatment centers and local support service providers.
To expand Narcan’s reach nationally, the Food and Drug Administration announced last month that the 4-milligram nasal spray can be sold over-the-counter without a prescription.
It is now available at pharmacies in New Hampshire as an OTC drug. Following this news, the NH Department of Health and Human Services also planned to implement 700 “Nalox Boxes” in highly visible public locations throughout the state that will be accessible at any time.
So far in 2023, almost 50 percent of overdose cases in Manchester happened in public spaces, and bystanders administered Narcan 24 percent of the time before the arrival of emergency personnel, according to DHHS data.
Nalox Boxes are opioid rescue kits, which contain doses of naloxone nasal spray, a breathing mask and instructions to use the items inside the box.
Hard-hit New Hampshire
Even if this expansion of access to Narcan doesn’t drastically affect New Hampshire, support service providers agree this could still be helpful for those with substance-use disorder and their families.
“We’ve seen over the last five years, the majority of overdose scenes where the ambulance is dispatched, a bystander has already given a dose of Narcan,” said Dr. Jonathan Ballard, chief medical officer for the state health department. “That means the person is revived sooner and has a greater chance of survival. What is important is to have it in the hands of bystanders, families and others.”
New Hampshire continues to be one of the hardest-hit states by the opioid epidemic.
Data show 480 confirmed fatal overdoses in 2022 and four pending toxicology reports that were likely overdoses. This is the highest number of overdose deaths recorded in New Hampshire since 2017, when there were 490 confirmed deaths, and at least a 10 percent increase over the 436 deaths recorded in 2021, according to statistics from the chief medical examiner’s office. As per latest data from the office, so far there have been 17 confirmed opioid overdose deaths in 2023, and 69 cases are pending toxicology.
DHHS attributes the increase in deaths to a potent form of synthetic fentanyl, which is now being found in most illicit substances such as heroin and other street drugs, and can be lethal the first time it is used.
Gagne noted that opioid overdoses are the number one cause of death for people between 18 and 45 years old in the United States, and that age range is heading even lower to the younger teen population. Teen fentanyl deaths more than tripled since 2019, and increased more than five-fold among Black teens, according to FAF data.
Most Narcan in New Hampshire is distributed through The Doorway — a staterun “hub and spoke” system aimed at linking people to substance-use disorder treatment and support services in their community. Keene hosts one of 10 locations statewide.
The state has, according to Ballard, spent more than $1 million on Narcan in the past six months, providing tens of thousands of doses.
Ballard said there is a standing order at every pharmacy in the state with his name on it, so that any person with insurance could obtain Narcan. But, he said, very few people get Narcan from pharmacies.
“I don’t see a lot of people buying over-the-counter when they can already get it for free from The Doorway or a community agency or a pharmacist through my standing prescription,” Ballard said.
‘Available for everyone’
The cost for over-the-counter Narcan has not yet been announced, according to the FDA. Generic naloxone can cost between $20 and $40 per dose, while Narcan can cost about $130 to $140 for a kit that includes two doses, according to information provided by Drugs.com, an online pharmaceutical encyclopedia.
Sam Lake, executive director of the Keene Serenity Center, said acquiring Narcan with a prescription can be complicated and expensive for those without insurance, but he hailed the decision to provide the lifesaving drug over the counter.
Narcan “should be available to everyone,” he said. “When someone is reaching out for naloxone, they need it now.”
In 2020, 11 percent (96,000 people) of New Hampshire’s population was uninsured, according to data from the National Center for Coverage Innovation.
Providing public access to Narcan through New Hampshire’s new “Nalox Boxes” could be helpful for those who feel too stigmatized to ask for help, according to Laurie Butz-Meyerrose, a clinician at The Doorway at Cheshire Medical Center in Keene.
The Nalox Boxes will be installed with other emergency devices such as defibrillators in public spaces to provide access to naloxone at all hours. The state health department will partner with the state’s regional public health networks such as the NH Harm Reduction Coalition and Recovery Friendly Workplace locations to distribute the boxes, according to a DHHS news release from last week. The community partners will be tasked with monitoring the boxes and requesting refills as needed, the release notes.
While a few people believe providing access to Narcan only enables addiction, Gagne believes the reverse is true: Surviving an overdose could lead to a person making a dramatic change in their lives.
“These are people’s kids, fathers, wives.
They are human beings, and we should treat them that way,” he said.
Butz-Meyerrose shared the story of a patient who, upon being discharged from a treatment center, declined Narcan, so clinicians put a box in his backpack. The man left the treatment center, went back to using opioids, and began to overdose. He fell over and dropped his backpack.
“The Narcan rolled out and someone who was with him used it and saved his life,” she said.
“This (opioid overdoses) is not going away right now, and there’s no quick fix for this. This is all about harm reduction. It’s all about saving people’s lives,” she added.
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