By Stephanie Thomas
With opioid use on the rise, the risk of overdose is real and present for every addicted individual. The most recent numbers suggest a terrifying prospect for future overdose predictions: More than two million Americans rely heavily on opioids, which include prescription painkillers, heroin and its synthetic counterpart, fentanyl.1
It’s no wonder recovery advocates celebrate the accessibility of Narcan, an easy-to-administer opioid antidote that can prevent death during an overdose. Still, there are some concerns.
The Latest in Our Nation’s Opioid Epidemic
As it stands today, drug overdose already claims more young and middle-aged adult lives than any other disease or tragedy in the United States.2 And while opioids in general are the drivers of this crisis, fentanyl is the heavy-hitter.2
Fentanyl may look a lot like heroin, but it is not heroin. Fentanyl is 100 times more powerful — read: more deadly — than heroin has ever been.3 The real problem here is that many people don’t set out to take fentanyl.
Instead, they might follow a typical opioid addiction story — one where the person first becomes dependant on prescription painkillers after a routine surgery and eventually, when the body adapts and pills are no longer strong enough to provide relief, they move on to heroin.4 Heroin is often where dealers hide fentanyl.3
To fully understand the epidemic, consider this: Synthetic opioids, like fentanyl, killed 3,000 people in 2013. Last year that number rose to 20,000.2 To say our first responders are overwhelmed would be an understatement.2 If ever there were a need for quick, effective reversal of opioid overdose, this is it.
How Does Narcan Work in Cases of Opioid Overdose?
Here’s what overdose looks like inside the body of an opioid addict: heroin, prescription painkillers and/or fentanyl attach themselves to the area of the brain that controls breathing. When overloaded, breathing slows and then stops.5
Narcan — also known by the generic name naloxone — works as a fast-acting antidote by replacing any opioids present in the brain and allowing the patient to begin breathing normally again.6 Beyond its lifesaving capabilities, Narcan also offers three key benefits: a proven record of overdose reversal, zero possibility of abuse and no side effects if it turns out opioids are not actually present.6
Narcan Nasal Spray is FDA-approved and can be administered with a single shot into the nostril. With little risk and new methods of application, Narcan can now be given by truly anyone — from paramedics to family and friends to passers-by.7
Advocates Say: Narcan Saves Lives
From 1996 to 2015, just under 27,000 people were revived by Narcan.8 And no doubt the number of lives saved will continue to climb as the US Department of Health and Human Services named access to naloxone a top priority in fighting opioid addiction.7
Studies also show a strong connection between community distribution of Narcan and lower rates of death by opioid overdose as well as fewer ER visits related to opioids.7 And for Roger Crystal, creator of Narcan Nasal Spray, the antidote not only provides another chance at life but also a dose of reality that might finally encourage lasting change.9
As someone who has experienced addiction firsthand, Jonathan Goyer explained it this way: “Being saved by Narcan offered me that opportunity to reflect on my life. Narcan kept me alive until I wanted to live.”10
Critics Say: Yes, Narcan Saves Lives, but . . .
Plenty of questions remain. A few of the biggest ones include:
- Does Narcan encourage people who struggle with addiction to use even more?
A detective with the Quincy, Massachusetts, police department talks of officers who are called on to revive the same person time and again.10 Harold Jones, founder of Sober.com, views Narcan as a “safety net.”9 The journal of Addiction Science & Clinical Practice reports that both doctors who prescribe opioids and responsible policymakers worry about what they call the “risk compensation” of Narcan.7
The legitimate concern stands: Does Narcan remove the fear of death? Goyer, referenced above, pointed out the folly in this line of thinking when he said, “The problem is that there’s many addicts who don’t care if they live or die.”10 Beyond this, researchers speculate that people who are addicted to opioids would prefer to avoid the withdrawal period caused by Narcan revival.7
To date, studies show no proof of this perceived safety net factor. And researchers in the field of addiction believe the known benefits far outweigh any unknown risks.7
- Will forced opioid withdrawal send an individual to an immediate, strong need for drugs?
Narcan Nasal Spray contains a larger dose of naloxone in a higher concentration than previous methods of delivery in hopes that it will be more effective. As a result, recipients may be more likely to enter withdrawal. This, of course, is better than the alternative. Still, we don’t know, on a large scale, what forced withdrawal might trigger in the days and weeks following an opioid overdose.7
- Does Narcan always work?
The short — and scary — answer is no. Here’s why: A face-off between Narcan and fentanyl can seem almost like the quintessential tiny sixth-grader trying to stand up to the biggest high school bully around. Paramedic crews describe attempting resuscitation with nearly 15 doses of Narcan and still failing.1
There’s also the basic reality that oftentimes a person who deals with addiction may use multiple types of drugs — something first responders are encountering more and more these days.11
While Narcan is reliable against prescription opioids and heroin, it can’t be counted on to combat all forms of overdose and definitely not overdoses containing high amounts of fentanyl.
There’s No Easy Answer
While Narcan’s continued ability to halt overdoses without consequence remains to be seen, this much we do know: The opioid epidemic isn’t going away. Overdoses will occur, Narcan or no Narcan.
You can equip yourself with knowledge that may prove lifesaving in the future. If you or your loved one struggles with an addiction to opioids, please consider the information below:
- Narcan is not the answer. Getting help is.
If you or someone you love battles an addiction to opioids, please don’t sit back and hope for Narcan to come to the rescue. Instead, reach out for help today.
- Proper treatment following Narcan is key to preventing another overdose.
During the withdrawal period brought on by Narcan, the strong urge to use may be tempered by a daily dose of methadone or buprenorphine, which you or your loved can request in the ER.7
And, once released, seeking comprehensive addiction treatment immediately is the best way to keep moving in the right direction. A survivor who quickly surrounds himself with care may be less likely to overdose again.7
- If you want, you can easily obtain a Narcan home kit and receive training.
You can purchase Narcan Nasal Spray at your local pharmacy or visit a community-based program for a kit and detailed information on how to administer it. While keeping naloxone nearby is not a failsafe for all instances, it certainly offers some peace of mind and the opportunity to save a life should you need to.
You may also want to consider carrying Narcan if you or your loved one recently experienced a long sober period where the tolerance for opioids might now be lower. Researchers identify this as a “high-risk” season because overdose can occur more easily in the case of relapse.7
1 Katz, Josh. “Drug Deaths in America Are Rising Faster Than Ever.” The New York Times, June 5, 2017.
2 Katz, Josh. “The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years.” The New York Times, September 2, 2017.
3 Bond, Allison. “Why Fentanyl Is Deadlier Than Heroin, in a Single Photo.” STAT, September 29, 2016.
4 “Opioid Crisis.” National Institute of Drug Abuse, June 2017.
5 “Information sheet on opioid overdose.” World Health Organization, November 2014.
6 Crockett, Alison, et al. “Opioid overdose: preventing and reducing opioid overdose mortality.” United Nations Office on Drugs and Crime, June 2013.
7 Kerensky, Todd, and Alexander Y. Walley. “Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know.” Addiction Science & Clinical Practice, January 7, 2017.
8 “CDC Report: Narcan Kits Save Nearly 27,000 Lives.” Community Anti-Drug Coalitions of America, June 25, 2015.
9 Sutherland, Sarah. “Narcan: Saving Lives or Enabling Addicts?” Advance Health Network, November 8, 2016.
10 Stoffers, Carl. “Narcan: It Saves Lives. Does it Enable Addicts?” The Marshall Project, August 14, 2015.