Can Surgeon General Advisory Affect Opioid Overdoses?

A Long Walk to Opioid Control?

Jerome Adams Calls on Communities To ‘Be Prepared’ and ‘Save A Life’

The opioid epidemic in America is so out of hand that the U.S. surgeon general’s office has issued an advisory: “Be prepared. Get naloxone. Save a life.”

Naloxone, a nasal spray marketed as Narcan, immediately reverses the effects of an overdose by binding to the brain’s receptors, effectively blocking the drug.

“I…am emphasizing the importance of the overdose-reversing drug naloxone,” Jerome Adams said in a statement. “For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life.”

It was the office’s first advisory in 13 years and comes after the number of deaths from opioids more than doubled between 2010 – a total of 21,089 – and 2016 – 42,249, the latest year for which statistics are available.

“Over the past 15 years, individuals, families, and communities across our Nation have been tragically affected by the opioid epidemic…,” Adams said in the statement. “This steep increase is attributed to the rapid proliferation of illicitly made fentanyl and other highly potent synthetic opioids. These highly potent opioids are being mixed with heroin, sold alone as super-potent heroin, pressed into counterfeit tablets to look like commonly misused prescription opioids or sedatives (e.g., Xanax), and being mixed (often unknowingly) with other illicit drugs like cocaine or methamphetamine. The resulting unpredictability in illegal drug products is dramatically increasing the risk of a fatal overdose.”

Adams further made his point by noting that the tragic loss of life from opioids transcends the streets and affects everyone, from blue collar to white collar, from poor to wealthy, from children to seniors. Nobody is immune from the addictive qualities of the likes of codeine, methadone, morphine and oxycodone.

“Another contributing factor to the rise in opioid overdose deaths is an increasing number of individuals receiving higher doses of prescription opioids for long-term management of chronic pain,” he said in the statement. “Even when taking their pain medications as prescribed, these patients are at increased risk of accidental overdose as well as drug-alcohol or drug-drug interactions with sedating medications, such as benzodiazepines (anxiety or sleep medications).”

The key is educating the public on the proper use of naloxone, a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while the user is on his or her back. Naloxone comes in two other forms. Evzio is a prefilled, auto-injection needle that is relatively easy to administer on the outer thigh. When activated, the device provides verbal instructions before, during and after the injection. The manually injectable form of naloxone requires professional training. All three have received approval from the U.S. Food and Drug Administration.

“Research shows that when naloxone and overdose education are available to community members, overdose deaths decrease in those communities,” Adams said in the statement. “Therefore, increasing the availability and targeted distribution of naloxone is a critical component of our efforts to reduce opioid-related overdose deaths and, when combined with the availability of effective treatment, to ending the opioid epidemic.”

In many states, naloxone can be issued to addicts or to friends and family members of addicts without a prescription. Walgreens said it supports the advisory and is dedicated to making naloxone readily available by stocking it in all of its pharmacies.

“By stocking Narcan in all our pharmacies, we are making it easier for families and caregivers to help their loved ones by having it on hand in case it is needed,” Rick Gates, Walgreens’ group vice president of pharmacy, said in a press release. “As a pharmacy we are committed to making Narcan more accessible in the communities we serve.”

Seamus Mulligan, CEO of Adapt Pharma, which manufactures Narcan, commended the effort.

“This effort, combined with the opportunity for patients and caregivers to obtain Narcan Nasal Spray without an individual prescription in 45 states, is critical in combating this crisis,” Mulligan said in the press release. “This action is an important milestone and we applaud Walgreens initiatives to improve access to Narcan Nasal Spray in communities across the U.S.”

Those taking pain medications should talk with their healthcare providers about naloxone and recognizing the common signs of an overdose, such as difficulty breathing and narrowed pupils. More information can be obtained by contacting the Substance Abuse and Mental Health Services Administration at 800-662-4357 or www.findtreatment.samhsa.gov.