New Mexico this month became one of nine states to pass legislation requiring an opioid prescription lasting five days or longer to come along with a prescription for another drug that might save the user's life: Narcan, a nasal spray whose active ingredient, Nalaxone, blocks the effects of an opioid and can bring a drug user back from a potentially fatal overdose.
Thom Duddy, vice president of communications for Emergent BioSolutions (the company that makes Narcan) visited New Mexico this month to speak about the progress of the drug, which has helped bring the national overdose death rate down from the peak levels of the opioid epidemic a few years ago.
On Tuesday, (June 26) Duddy interviewed with The Taos News, explaining why Narcan isn't going anywhere anytime soon as is a critical tool in fighting the ongoing drug epidemic that has swept the nation.
Narcan has been extremely effective in driving opioid overdose death rates down, but what role does it play in the long-term treatment for an opioid addict?
Opioid use disorder is a very complex disorder. It takes some people many attempts at long-term recovery, but I think the role Narcan plays is that you can’t have someone recover if they’re not alive.
Narcan is all over the country – in police stations, hospitals, jails and prisons. Where is it being used most effectively?
It’s probably having the greatest impact with law enforcement having access to it because they’re usually on the scene first.
How has your organization ensured that people who have access to Narcan know how to use it properly?
Our device was designed in collaboration with the National Institute on Drug Abuse (NIDA), and it was designed for people like you and me – nonmedically trained people. It actually doesn't require any training. It doesn’t require any assembly. It’s a self-contained device. What we do with law enforcement is we develop what’s called a role call video, where within eight minutes, they can watch this video, understand the signs and symptoms of how to recognize an overdose and how to use Narcan nasal spray. They do it at role call meetings in the early mornings or during evening shift changes.
Our newsroom listens to a police scanner all the time, so we often hear calls for overdoses where Narcan is now being administered. It seems to be effective, but does it ever fail to bring someone back from an overdose?
Naloxone is extremely effective and it’s been well established. It's an old drug and it’s the active ingredient in Narcan nasal spray. It’s been available since 1971. The key to the successful reversal is dose and timing – making sure you have the appropriate dose and the timing of delivering that dose. If you can catch somebody before four or five minutes of an overdose and you can get them administered Nalaxone (or Narcan), you have a pretty good chance of success.
Is Narcan effective at reversing overdoses caused by other drugs?
No, they are only an opioid antagonist, so they will not work on Benzodiazepine, for example, or methamphetamine.
It seems like your company has successfully pushed Narcan out to most parts of the country and into the hands of the right people. What’s the next?
We’re having some innovations around the delivery system to make it even more user-friendly and maybe increase the number of doses per delivery system, so that’s what we’re working on right now.
Does it become a problem for an addict wanting to get clean if they know that there is a drug close at hand that will bring them back from almost any overdose?
If somebody’s responsible enough to have Narcan and you are responsible enough that you don’t want to die or your friend to die, to have Narcan there, then that's already a good sign. Because, especially with the street-level drug, you don't know what's in it. You have no idea how much is now Fentanyl. When we first started, it used to be heroin laced with Fentanyl. Now we’re seeing Fentanyl laced with heroin (heroin being the lighter drug). So these drugs are becoming more and more potent, and if someone’s responsible enough to understand, “I don’t know what’s in here, but I need to take this because unfortunately I’m suffering from opioid use disorder," then that's a good thing.
Is Narcan still effective on the more potent Fentanyl-laced batches of heroin that you describe?
Yes, it works on all opioids, whether it’s a synthetic opioid or an organic opioid.
Can you speak about the opioid epidemic and where we sit today versus the peak of the epidemic a couple years ago?
New Mexico has improved in the death rate. Listen to these numbers: In the first five months of 2019, there were 420,000 opioid prescriptions in New Mexico. Now, trending toward a million, with a population of two million people, that’s why the state has become so assertive with prescriptions.
Overprescribing of opioid pain medications has been a major part of the problem across the country. Do you feel that hospitals and doctors in New Mexico have become more responsible about seeking alternative solutions for pain management for their patients?
Yes, and specifically, you are now one of nine states where Naloxone is co-prescribed with opioids. We do see the prescriptions come down when that happens. Where we see that in particular is with short-term prescriptions. The long-term prescriptions are still persistent, but with three-to-five-day pain management – like when you get your wisdom teeth out – we try to just get through it with ibuprofen or acetaminophen, and then if you need something stronger, we can maybe get you prescription-strength acetaminophen or ibuprofen. And if that doesn’t work, maybe we can put you on an opioid for a day.
What were you really trying to get across when you visited New Mexico this month?
We just completed a survey of illicit drug users, as well as regular opioid prescription users. Most of these folks don’t have any idea that they’re even at risk for opioid overdose and they met the CDC criteria for being at risk for an overdose – using a very strong potent dose of an opioid, or they were taking an opioid and a benzodiazepine or they had been treated for a substance abuse disorder in the past. We're trying to create more awareness and get across that it's not about the person, it's about the prescription. These are risky opioid prescriptions, not risky behaviors. Now you can walk into any pharmacy in New Mexico, without a provider’s prescription, and get Naloxone – under their insurance, if you have it.
Q&A conducted by Reporter John Miller