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Can OTC Narcan Help Fight the Opioid Crisis? · CareTalk: Healthcare. Unfiltered.

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  Opioid overdoses killed more than 100, 000 people in the U.
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  S.
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  last year.
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  That's more than traffic accidents and suicides combined.
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  Fentanyl is a major culprit, and it often turns a planned recreational high into sudden death.
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  Now, naloxone, which is the generic name for Narcan, is available over the counter.
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  Will the good drug stop the bad drug from killing people?
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  And should you carry Narcan yourself?
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  Welcome to CareTalk, America's home for incisive debate about healthcare business and policy.
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  I'm David Williams, president of Health Business Group.
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  And I'm John Driscoll, the president of Walgreens Health.
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  It's the source for trending healthcare industry news, links to the latest podcast episodes and highlights, and original blog posts that dive deeper into our podcast topics.
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  a chance to win your very own CareTalk baseball cap.
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  So David, we've been hearing about the opioid crisis for a long time.
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  There's Narcan news, Naloxone, it's going over the counter.
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  But let's step back and maybe you could give some context for how much of a burden.
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  Opioid overdoses and addictions really are today in the United States.
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  John, it's a terrible burden.
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  I would've thought a few years ago this would've been brought under control, but there's over a hundred thousand deaths, more like 107,000 deaths from opioids reported in 2022.
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  So if you compare that with suicides, which is another epidemic, that's 48,000 traffic accidents about 45,000.
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  So it's more than those two put together.
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  It has plateaued a bit in the last couple years.
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  If you look at this, though, you know, there's more deaths from, you know, from heart attacks or strokes, something like that.
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  But, uh, opioids is something that is avoidable.
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  And it also takes a lot of years off of life expectancy.
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  And I've personally been to funerals of people in their twenties.
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  You know, it's people that have many, many years and productive decades to go.
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  So it is a gigantic crisis, John.
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  No, it's, it's devastating.
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  And to your point, it's a people drift into opioid addiction and disorder.
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  Uh, sometimes intentionally, but because they're trying to get a greater high and in some cases accidentally, um, the particularly toxic forms of fentanyl, um, and some of the D.
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  I.
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  Y.
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  Drugs that people are coming up with mix opioids in and people get addicted or killed based on just one or a few incidents.
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  It's it's a what's remarkable is it's been on this upward tear.
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  In the US, uh, you've got the, the, the, the problem that we've talked about a lot earlier in terms of the misdiagnosis and prescription of pain pills, a misunderstanding of how people get addicted and frankly, the, the, the evil Sackler crowd at Purdue Pharma, really manipulating information Um, um, to give people the or to mask the true addictive power of painkillers combined with the continued epidemic of illegal drugs coming into the country where we've got the, the, a lot of the components being made in China and coming over the border in Mexico.
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  So it's this horrible convergence of mistakes that were in our.
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  the way people handle pain, um, along with an uncontrolled explosion of very low cost, highly toxic, addictive drugs.
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  Uh, but why, why, why, why, why is it plateauing, David?
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  Well, John, you know, this big increase that you talked about, a lot of it is driven by really, we don't think about drugs as technologies, but it is sort of, you know, fentanyl as a, as a technology.
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  There's of the 107, 000 deaths, about 75, 000 are related to fentanyl.
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  Now, in terms of the plateauing, I mean, one, you know, reason could be a It just can't get that much higher and also that people die.
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  You don't have a second chance at it.
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  But the, the positive view of it is that some, some things that have been done in the past couple of years have perhaps helped.
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  And one of them actually does have to do with a topic of our discussions day, which is Narcan or.
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  And in particular, what you see is that, uh, there was a nasal spray version of this drug approved in 2015.
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  It's been around for a long time, but it was an injectable before that.
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  But to slow down, David, what does Narcan do?
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  I mean, why, how would it be used?
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  Well, Narcan is something that actually quickly reverses an opioid overdose.
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  So it actually can just like...
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  Turn it off.
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  It can block the receptors that are for opioids.
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  So, uh, you can go from being high to not at all.
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  And in fact, it's an unpleasant sensation for somebody whose life you're saving.
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  That's like, you know, thanks a lot, but you know, but you can, you can actually, you actually save a life when you, when you do that, it quickly stops the toxic reaction of someone who might be passed out, eyes dilated, Um, From addiction and it's, it's actually naloxone as a, as an injectable, um, and even some of the nasal sprays before they became the injectable became a nasal spray.
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  It is a, it's like an on off switch or that, that, that response to the high.
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  Which is, which is bubbling over and it snaps people.
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  It's, it's, it's, it's, it's dramatic how effective that drug is.
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  So it's, what it's doing is, um, in terms of you asking about the plateauing.
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  So one possibility is there's more Narcan out there.
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  Now it's being carried around by people.
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  It doesn't really require training, you know.
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  So you've got, in addition to an EMT who you'd expect to have it on an ambulance, a police officer, firefighter, social worker, you know, in the community.
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  And in fact, some drug users themselves.
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  carry it and it works.
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  Now, is that the explanation for the plateau or not?
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  Hard to say exactly.
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  There are some examples.
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  You know, there are differences from state to state, county to county, uh, in the availability of naloxone.
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  And there's three states in particular that have been cited Arizona, Utah and West Virginia.
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  Those are all very different states, just from a geographic, demographic, political Uh, perspective, and they've all seen drops in deaths, not just a plateau, and they've all been aggressive with Narcan, so there is some hope that it actually could be, uh, could be helpful, John.
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  I mean, it doesn't, it doesn't, it doesn't really address the epidemic of deaths of despair and illnesses of despair, alcoholism.
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  Drug abuse.
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  I mean, the fact that deaths of despair are rising among, um, white population pretty quickly, but it's affecting all populations and there Those are opioid addiction is is part of that and we're not really getting at the causes of that But it is a good sign that this Literally, you know, overdose reversal drug, um, for something that's so common is being made available over the counter.
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  Uh, and in some doctors are actually saying it should be in everyone's first aid kit, which again, seems kind of extreme to me, but the level of deaths and I'm sure the wide swath of illness outside of that, I think, I think it sort of reinforces the point of the doctors who are saying, Opioids are an epidemic that's showing up in every community in every demographic.
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  We need to provide Narcan and make it available pretty much everywhere.
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  So John, let's, let's start, uh, with this piece about, you know, it's not getting at the root cause and that, that's true.
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  You're not going to get rid of the underlying causes of, uh, despair and so on.
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  However, there is this concept of a harm reduction, and the idea is not just that, okay, even if you're not able to go and, say, deal with the root causes, or even get people into treatment and other sort of longstanding things, if somebody's having an overdose and you can save them, you know, you have an opportunity to put somebody into treatment or have some of these other things happen.
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  Goes without saying.
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  That if you don't save them from an overdose, you don't have that opportunity.
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  Another, so the Narcan is not the only example of harm reduction, even with an opioid.
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  So another example would be, there are these fentanyl test strips.
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  And you can test to see, hey, like if you're at a rave or something.
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  Someone's giving you some, some drugs, or you're buying them or whatever.
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  Uh, you can test is this laced with fentanyl or not.
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  So that's another example of that.
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  Um, harm reduction has been used elsewhere.
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  HIV and hepatitis is examples.
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  So, you know, condoms themselves are form of, of harm reduction, clean needles, that kind of thing.
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  And you see it can be historically has been sometimes.
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  Controversial.
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  So there were, you know, some Republicans talking about, oh, you know, the government's going to pay for crack pipes.
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  But if you see it under this overall harm reduction approach, it's okay.
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  So say what you're going to say, John, and then I'll talk about whether everyone should have it.
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  No, I think, I think that the, the, the principle of harm reduction is save the lives you can.
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  Reduce the disease burden and the pain and the, and the suffering for as many as you can.
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  If you can't eliminate an emerging social problem, then from a public health perspective, for goodness sake, harm reduction really reduces suffering.
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  And if we can reduce suffering on the path, to eliminating the problem.
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  That's really what harm reduction is.
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  It's not just when we talk about harm, we're really talking about deep suffering for these addicts.
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  And in the case of making Narcan or Naloxone over the counter and widely available, what we're creating is a situation where we actually have a shot when someone's in an overdose situation of bringing them back to life.
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  And that, that in itself It's a true life saving, life enhancing, uh, drug.
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  Uh, but I just wanted to underscore the fact that, uh, I'm in favor of harm reduction, but I also want to...
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  Continue to dig at the structural reasons as to why we have the so many addicts to opioids in the US today and, and the need to solve the problem, both at the supply side, the China, Mexico side as well on as on the demand side with so many people, a addicted or nearly addicted to these, to these, to these menacing and controlling drugs that'll kill people.
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  So, John, I actually have naloxone here.
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  I'm going to show it to you for those that are watching on, on YouTube, for it won't, uh, you won't be able to see it if you're on an audio channel, unless you're hallucinating on some other kind of drug.
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  Uh, but you can see I actually have it here and this isn't the OTC version.
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  This is a prescription version, but when you open it up, it actually shows you what to do in terms of identifying if somebody needs Narcan or not.
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  Interestingly, Mine has a prescription on the back and you can actually see I got it at my local osco pharmacy And from a physician, I don't I don't know and what one of the things that had been done Was the states could actually put something in which they call standing Uh standing order which means that a pharmacist can essentially prescribe it to anybody who comes in and my pharmacist actually mentioned Hey, this is available.
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  You want me to look up?
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  whether your insurance covers it, and it did for no cost.
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  And so I have it at my home.
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  I tell my kids where it is when I go on vacation.
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  I take it with me because somebody could, you know, incident, you know, accidentally ingest opioids.
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  So I have it.
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  I think it does make sense to have, John.
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  Um, they say that they'll now that it's going to be over the counter.
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  It'll be more available because maybe there's less stigma.
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  You can just go pull it off the shelf.
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  And I do think, yeah, it adds another place to, to get it.
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  And insurance does reimburse in many cases for the OTC version.
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  But still in my case, I didn't have to put any money out of pocket and get reimbursed.
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  It was just, it was just covered.
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  So now that it's on the shelf, I think that's great.
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  Um, that's why people are talking about it right now.
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  I don't know if that's the best way to get it or not though.
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  And how does, how does it work?
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  I mean, just walk me through how you'd identify someone who'd need it and what you'd do.
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  Well, so it actually does tell you in the package inserter in the case here, just when you flip it open about, about what to do.
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  And it talks about seeing somebody that you suspect might be on opioids.
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  And you can tell often if they have shallow breathing or no breathing, they don't respond.
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  to their name or being shaken.
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  Sometimes it's not, I know you mentioned sort of, uh, dilated eyes.
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  It's actually more like a pinpoint, like a pinprick, pinprick, uh, pupils.
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  So that's one way to look at it.
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  And then you give them, uh, you put the thing in their, in their nose and you just give them a, give them a squirt.
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  If it, it may just reverse the, uh, the opioid overdose at that point.
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  If it doesn't, they may have something else.
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  So you're supposed to call 911.
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  Also, there's a second one in the, uh, that comes in the package and you can use it in the other, uh, nostril in case it's, uh, uh, it's really severe.
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  So that, that's how it works.
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  Pretty, it's pretty straightforward.
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  It's not, there's no real side effects from it.
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  If it's not working, uh, it's not going to harm anybody, uh, either.
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  So it's, it's pretty straightforward.
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  I've, I've got it.
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  Thankfully, I haven't, I have not had to use it.
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  And David, do you, how did, how are we actually going to solve this opioid problem?
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  Yeah, well, I think it's, you know, so one thing we're going to do is we talk about deaths of the despair.
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  There's also can be despair from a public health standpoint.
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  And you could just put your hands up and say, there's really nothing you can do.
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  Now, what you can see with, uh, with this is sort of like a.
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  It's like a layered approach, and we know this isn't going to solve it, but, you know, so you've been working on somebody for a while, and then they have one slip up, and well, you know what, you might be able to save them with, with Narcan, and then you have a chance to try some of these other interventions.
• 13:48
  So I think it's, this is one thing, um, you know, in the armamentarium, along with the, the test strips, even some people have been talking about supervised drug consumption sites, there's maybe something you can do on the, on the supply side, Maybe in the broader public health, maybe in the broader economy.
• 14:05
  I don't know, but we have, David, if you don't have any answer, you avoid the question.
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  I think the answer is, this isn't about solving the problem socially.
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  It's about solving the problem with the human in front of you.
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  I think that's what this is.
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  And, and I, I'm frankly, kind of, I'm excited that we're providing more and more When, uh, Um, uh, of these life saving vehicles over the counter, I think it's really smart to do it, which they're doing a lot of through pharmacists, uh, because we, we have to, we have to kind of deal with opioid addiction and addicts, um, and harm prevention.
• 14:39
  In the community, and that's where where pharmacists and pharmacies can be super relevant.
• 14:45
  I guess what's next on the horizon for this, David?
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  Is this just a or is this just a stop?
• 14:52
  I mean, it's a very powerful stop gap solution, but what's next?
• 14:56
  Well, I think what comes next is when you have the widespread deployment of naloxone, then you're going to be able to measure What works and what doesn't so does it make sense to give it to everybody should you train people for it?
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  How much of the difference does it make should it be in every school, etc.
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  So we'll learn what works From that standpoint.
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  So I think that's specifically pragmatically.
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  What's next?
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  I won't try to answer the big question that she put to me before that I couldn't answer about how we're gonna deal with the opioid epidemic overall But I do have an out John which I'm gonna say that's it for yet another episode of care talk We've been talking today about the opioid epidemic And a glimmer of hope in the form of OTC Naloxone, also known as Narcan.
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  I'm David Williams, President of Health Business Group.
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  And I'm John Driscoll, the President of Walgreens Health.
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  Please get to know this really important drug and understand how it might fit within your personal first aid kit.
• 15:51
  Whether you like what you heard or you didn't, please subscribe to CareTalk on your favorite service.