While we have been consumed with the evolving COVID virus, the economy, and Afghanistan, drug overdoses were up 30 percent this year in the U.S., accounting for 93,000 deaths. From Los Angeles to the North Fork of Long Island, the tragic stories reported recently hit every neighborhood and socioeconomic group, as overdoses increased exponentially in all but two states.
Although 70 percent of U.S. deaths involve an opioid, the epidemic has taken an ominous turn due to illegal fentanyl cocktails, often concocted without a user’s knowledge. Fentanyl is a potent painkiller with a narrow margin of error, as it is 100 times more potent than morphine. The DEA reported 26 percent of tablets tested for fentanyl contained a lethal dose. To put its lethality in perspective, one kg (2 pounds, or a carton of milk) of fentanyl has the potential to kill 500,000 people, and just 2 mg can be fatal to one user.
Lockdowns and other pandemic restrictions have increasingly isolated those with drug addiction, and made attaining treatment difficult, which must be addressed. Continuing to debate this means we are failing at the long game of drug addiction; we need a short game fast.
The short game is a calm and raw discussion with loved ones (especially teenagers) that club drugs are always a bad idea, but today it’s a deadly game of roulette. The second part of this discussion is an Instagram-worthy post promoting Narcan (naloxone). It’s time to make drug discussions, overdoses, and using Narcan trend.
In Michigan this month, Warren Police were called to a home of a baby not breathing after getting into a mix of heroin and fentanyl. The baby was given Narcan, and her life was saved. Narcan kits have already saved 27,000 lives. All age groups are at risk, but especially the young, who may not access emergency care in time. In Kentucky, state data show overdoses grew by 49 percent, but the spike for young people (ages 15 to 24) was highest, with 90 percent more overdose deaths than the previous year.
To combat high-density overdoses, many towns are training residents to use Narcan. In Ohio, where drug overdoses set another record this year, Governor DeWine made a public plea encouraging all Ohioans to consider carrying naloxone to ‘help save a life.”
I remember heading to college with an EpiPen for my asthma and allergy to bee stings, as the window for lifesaving care was minutes. This is how we should view naloxone, which counters the effects of prescription painkillers, heroin, and other opioids. It comes in a nasal spray or as an injectable that can treat a known or suspected opioid overdose emergency with signs of breathing problems or not being able to respond. It was developed for first responders, but family and friends — with no medical training — can also use it (one should access emergency care and support post-administration). Naloxone costs around $20 per kit wholesale, and can be purchased from all major pharmacy chains with a $10 or $20 copay (CVS, Walgreens, and Rite Aid) without a doctor’s prescription in most states.
There is a growing stigma and fatigue with drug overdoses, leading to a reluctance by many to seek emergency medical help for victims. We can’t depend on first responders who are battling COVID and spread thin to be the only line of defense in this local battle.
There are certainly operational challenges in making naloxone ubiquitous. We must pass more laws making Narcan kits free to the public, while protecting citizens who deploy it under good Samaritan laws. Access to Narcan has been facilitated in 34 states (including Massachusetts), while 26 states have passed good Samaritan laws that protect bystanders who call for medical assistance. Data shows opioid overdose deaths decreased by 14 percent in states after they enacted naloxone access laws.
As for pricing and access, naloxone is a generic drug with a long history of use since 1961, and used to cost a few dollars. We are now experiencing shortages and opportunistic pricing schemes, given the urgent need. The good news is we have the COVID vaccine playbook to address naloxone shortages by providing incentives for manufacturing and distribution. Pfizer is one of the manufacturers, and just showed us its global might with its record-breaking mRNA vaccine launch. Pfizer and others could certainly help on this epidemic if we partner with them. On the distribution front, there are many options, as Amazon could offer it free to Prime customers, as could all major pharmacy retailers and the U.S. government (as the latter does currently with COVID vaccines).
By getting this rapid-acting, lifesaving medicine (as we would an EpiPen) into the hands of citizens, especially in hot zones, we are deploying a lifesaving tool where and when it is needed most: your neighborhood.
Meghan Fitzgerald is an adjunct associate professor with the Columbia University Mailman School of Public Health, and a healthcare investor. She is the author of “Ascending Davos: A Career Journey from the Emergency Room to the Board Room.” She lives in Aquinnah.