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VOL. 132 | NO. 194 | Friday, September 29, 2017

NARCAN Useful Against Opioid Overdose

By Michael Waddell

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With the number of overdose deaths from opioids such as OxyContin, Vicodin and Percocet at all-time highs, a new nasal spray is now available to counteract overdoses, and it can be acquired at local pharmacies without a prescription.

In Tennessee and nationwide, prescription and illegal opioids are the main cause of drug overdose deaths. According to the Tennessee Department of Health, 1,631 Tennesseans died from drug overdoses in 2016 – the highest number of such deaths recorded in state history and up 12 percent from 1,451 overdose deaths in 2015 (72 percent that year involved opioids).

Also in 2015, Tennessee health care professionals reportedly handed out more than 7.8 million opioid prescriptions — more prescriptions than the number of people in the state — ranking Tennessee second in the nation for such prescriptions.

Naloxone, commonly referred to as NARCAN and traditionally administered by IV or injection, is the only drug available today to help immediately combat an opioid overdose and prevent deaths.

Naloxone, commonly referred to as NARCAN and traditionally administered by IV or injection, is the only drug available today to help immediately combat an opioid overdose and prevent deaths. (Submitted photos)

“NARCAN is an opioid antagonist that essentially reverses an opioid overdose,” said Thom Duddy, executive director of communications with Adapt Pharma, maker of NARCAN Nasal Spray.

The company’s nasal spray was fast-track approved by the FDA in November 2015 and became commercially available in 2016. It is the first and only FDA-approved nasal naloxone for the treatment of known or suspected opioid overdoses.

“When people are stopped prescribing an opioid, or maybe become dependent and they’re told to stop, they go to illicit compounds such as heroin or fentanyl on the streets because they don’t have access to the prescription drug anymore,” said Duddy, who pointed out that approximately 40 percent of drug overdose deaths nationally come from prescription opioids.

“A lot of times we think that it’s just the illicit IV drug user on the street that is overdosing and dying, but it’s also people that are in their homes that are using opioids and are also maybe using them in combination with another agent or maybe just mistakenly taking too many because they felt they were in more pain,” he said.

Synthetic opioid use is also on the rise, including fentanyl, which is commonly used as an end-of-life drug for cancer patients (most popularly used in a patch), and carfentanyl, an analog of fentanyl used in Canada predominantly for large-animal tranquilization.

“Those now have transitioned to the black market because people have figured out the chemistry behind it, and they create it and put it in with heroin or have it just as fentanyl,” Duddy said. “With the synthetic opioid, you don’t need the volume of drug for the potency – it is much higher at much smaller volumes – so it’s easier to transport across borders and state lines.”

Overdose deaths related to fentanyl spiked 74 percent from 169 to 294 from 2015 to 2016. The biggest increase in fentanyl deaths was seen in those aged 25 to 34, where the number deaths increased from 42 to 114 from 2015 to 2016.

“We are alarmed by the growing number of Tennesseans dying as a result of fentanyl, and by the changing demographic of those who died,” said Dr. David Reagan, the Tennessee Department of Health’s chief medical officer. “This tells us we need to put additional focus on prevention of substance abuse, particularly for those younger than 25, as we believe people are initiating their use of illegal drugs such as fentanyl before that time.”

Guidelines have been published by the Centers for Disease Control and the American Medical Association outlining risky opioid prescriptions. For example, a high dosage chronically prescribed over time should be accompanied by a prescription for naloxone or NARCAN.

“Also, if a patient is taking by prescription an opioid along with one for a benzodiazepine like Xanax,” Duddy said, “that increases the risk of an opioid overdose, so naloxone is recommended there as well.”

Naloxone, commonly referred to as NARCAN and traditionally administered by IV or injection, is the only drug available today to help immediately combat an opioid overdose and prevent deaths. (Submitted photos)

Two states in particular, Virginia and Vermont, have taken that guidance and passed legislation requiring physicians to follow the guidelines.

The passage of Public Chapter 596 in Tennessee last September allows authorized pharmacists statewide to dispense naloxone without a prescription to a person at risk of overdose or a family member. And House Bill 448 that passed in May requires the state’s Board of Education to set up guidelines for naloxone in schools. Five Tennessee high schools and four colleges are participating in a NARCAN schools program that offers free doses of NARCAN to all high schools and colleges in the U.S.

Meanwhile, Tennessee is leading a group of 41 attorneys general participating in a multistate investigation into reasons behind the opioid epidemic. Last week (Sept. 18-22), Tennessee Attorney General Herbert H. Slatery III announced a bipartisan coalition seeking information from manufacturers and distributors of prescription opioids.

The attorneys general want to determine whether manufacturers and distributors engaged in unlawful practices in the marketing, sale and distribution of opioids.

“The opioid crisis impacts all of us, and is a threat to families in every community in Tennessee and across the country,” Slatery said in a prepared statement. “We will use all resources available to identify and hold accountable those parties responsible. There is too much at stake not to attack this problem from all sides.”

The attorneys general served investigative subpoenas for documents and information on Endo, Janssen, Teva/Cephalon, Allergan and their related entities, as well as Purdue Pharma. They also sent letters to opioid distributors AmerisourceBergen, Cardinal Health and McKesson requesting documents about their opioid distribution businesses.

The 41 attorneys general hope to determine what role opioid manufacturers and distributors may have played in creating or prolonging the epidemic and determine the appropriate course of action to help resolve the ongoing crisis.

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