Boom in overdose-reversing drug is tied to fewer US drug deaths
NEW YORK — Prescriptions of the overdose-reversing drug naloxone are soaring, and experts say that could be a reason overdose deaths have stopped rising for the first time in nearly three decades.
The number of naloxone prescriptions dispensed by U.S. retail pharmacies doubled from 2017 to last year, from 271,000 to 557,000, health officials reported Tuesday.
Dr. Ardis Fisch, director at SaVida Health, a suboxone clinic in Pittsfield, said that many of the patients she has treated have been revived by Narcan, the brand name for the nasal spray naloxone.
"A good percentage of the patients who come in, one of the first things we ask is, 'Have you overdosed?' and they say, 'Oh, yeah, and I've been Narcaned,' " she said. "I've seen people who have been saved and I've seen people who saved others."
The United States is in the midst of the deadliest drug overdose epidemic in its history. About 68,000 people died of overdoses last year, according to preliminary government statistics reported last month, a decline from the more than 70,000 in 2017.
In Massachusetts, opioid-related deaths have declined for two years in a row. In 2018, they dropped 4 percent — or by 82 people — according to a Department of Public Health report released in February. There was a 2 percent decline from 2016 to 2017, when the epidemic was at its peak.
"One could only hope that this extraordinary increase in prescribing of naloxone is contributing to that stabilization or even decline of the crisis," said Katherine Keyes, a Columbia University drug abuse expert.
About two-thirds of U.S. overdose deaths involve some kind of opioid, a class of drugs that includes heroin, certain prescription painkillers and illicit fentanyl. Naloxone is a medication that can reverse opioid overdoses, restoring breathing and bringing someone back to consciousness. It first went on sale in 1971 as an injection. An easier-to-use nasal spray version, Narcan, was approved in 2015.
Local, state and federal officials have embraced naloxone as a lifesaving measure. Some cities and states have standing orders that allow pharmacies to give it out without a doctor's prescription, and officials have tried to put it into the hands of virtually anyone who might encounter a person overdosing, including drug users, police and even librarians.
Centers for Disease Control and Prevention researchers noted that there were fewer than 1,300 naloxone prescriptions dispensed in 2012, meaning the number grew more than 430-fold in six years.
Health officials said pharmacies should be giving out even more.
"We don't think anybody is at the level we'd like to see them," said Dr. Anne Schuchat of the CDC.
The CDC report is based on data from IQVIA, a company that tracks health care information, and it looked at prescriptions from more than 50,000 retail pharmacies across the country. It included prescriptions written by doctors for specific patients and those filled under the broader standing orders.
The report offers only a partial picture, though, since only about 20 percent of naloxone was sold to retail pharmacies in 2017, according to an earlier government report.
Still, it's the CDC's first close look at where most retail dispensing is happening. The agency provided data for about 2,900 of the nation's 3,100 counties and parishes.
The researchers found that it was most common in cities, and in the South.
Experts said the findings likely reflect a number of factors. More naloxone likely is prescribed in places where more people are using opioids and where policies increase access.
For example, of the 30 counties with the highest rate of naloxone dispensing, 11 were in Virginia. Virginia has a lower overdose death rate than most other states, but it allows anyone to buy naloxone without a prescription and has taken other steps to encourage its use.
Fisch said she believes that there is good availability of the overdose-reversal spray in Berkshire County. The Healthy Steps program at Berkshire Medical Center has the drug and training available, as do several other Berkshire organizations and fire departments.
When 2018 fatal overdose numbers were released, several firefighters from Berkshire County attributed the decrease in deaths to the medication, which EMTs carry with them when responding to calls.
While people working in the industry and those familiar with these organizations might know of the medication's availability, Fisch wonders if the average person would know how to find it.
She said that she has seen a pharmacy in another county hang a sign indicating that Narcan is available for free without a prescription. She would like to see that happen in the Berkshires.
Another barrier to getting Narcan can be insurance, Fisch said.
Some people who don't have addiction issues, but know people who do, have said their insurance won't cover the cost of naloxone.
"If you use your insurance, it may be hard because they don't have opioid-use disorder, but they want to have it on hand for their daughter," she said. "The person who's using shouldn't necessarily have to be the one who's getting it."
The CDC recommends that naloxone be prescribed to patients who are getting high-dose opioids and are at risk for an overdose. It noted that only one naloxone prescription is written for every 69 high-dose opioid prescriptions.
Another finding: The number of high-dose opioid prescription painkillers dispensed fell to about 38 million last year, from nearly 49 million the year before, according to the report.
That also likely contributed to the decline in overdose deaths last year, Schuchat said.
Berkshire Eagle staff writer Haven Orecchio-Egresitz contributed to this report.
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