Opiates are a group of drugs that includes prescription painkillers and heroin — and in 2010, they were responsible for the deaths of nearly 20,000 Americans.
But even though the number of deaths attributable to opiates has increased in the past three years to epidemic proportions, we have the ability to reverse an opioid overdose through the timely administration of the medication naloxone. 1
Twenty-six states and the District of Columbia have passed laws to increase the availability of naloxone, and it is the mission of Shatterproof to increase the implementation of these laws and have similar laws passed in the remaining twenty-four states. 2
What are Opioids?
Opioids include illegal drugs, such as heroin, and prescription medications used to treat pain, such as morphine, codeine, methadone, oxycodone (Oxycontin, Percodan, Percocet), hydrocodone (Vicodin, Lortab, Norco), fentanyl (Duragesic, Fentora), hydromorphone (Dilaudid, Exalgo), and buprenorphine (Subutex, Suboxone).
Opioids work by binding to specific receptors in the brain, spinal cord and gastrointestinal tract. In doing so, they minimize the body’s perception of pain. However, stimulating the opioid receptors or “reward centers” in the brain can also trigger other body systems, such as those responsible for regulating mood, breathing, and blood pressure. 3
Opioids are incredibly lethal: in 2010, more than 16,000 Americans died due to an overdose of prescription painkillers, and 3,000 more related to heroin.
How does an overdose occur?
A variety of effects can occur after a person takes opioids, from pleasure to nausea, vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop. 4
Opioid overdose can occur when a patient deliberately misuses a prescription opioid or an illicit drug such as heroin. It can also occur when a patient takes an opioid as directed, but the prescriber miscalculated the opioid dose or the dispensing pharmacist made an error, or the patient misunderstood the directions for use. 5
Individuals who take opioid medications prescribed for someone else are also at risk, as are those who combine opioids — prescribed or illicit — with alcohol, certain other
medications, or even over-the-counter products that depress breathing, heart rate, and other functions of the central nervous system. 6
How can Naloxone reverse an overdose?
Naloxone, brand name Narcan ®, is the only known substance with the capacity to reverse an overdose. Naloxone was approved by the FDA in 1971 and has been used safely for over forty years with few major side effects. 7
The science is relatively simple: An opioid antagonist 8, naloxone also binds to the μ2 receptor, displaces the opiate, and takes its place in the binding site. 9 After administration of naloxone, respiration is able to commence within a matter of minutes. 10 The opiate, once it has been displaced from the opioid receptor, is kept at bay while the naloxone occupies the binding site.
Naloxone must be introduced to the body relatively quickly, as death from an overdose may occur within one-to-three hours of opioid ingestion; 11,12 and it is only meant to be a first line of defense during an overdose, as its antidote effect wears off after 20-90 minutes. 13
Therefore, Naloxone only buys time until a trained medical professional arrives to attend to the overdose, meaning it may need to be administered again due to a possible second cessation of respiration. 14 Naloxone can be delivered in a number of ways, from an intramuscular or intravenous injection, intranasal spray, or a recently FDA-approved auto injector. 15
The intranasal spray has made the drug much easier to introduce into the body, as there is now a safe and effective way to deliver naloxone without putting medical professionals at risk of exposure to contaminated needles or illnesses such as HIV or hepatitis.
Is naloxone safe?
Naloxone is remarkably safe, especially when used in low doses and titrated to effect. When given to individuals who are not opioid-intoxicated or opioid dependent, naloxone produces no clinical effects, even at high doses. Moreover, while rapid opioid withdrawal in tolerant patients may be unpleasant, it is not life-threatening. Naloxone can safely be used to manage opioid overdose in pregnant women. The lowest dose to maintain spontaneous respiratory drive should be used to avoid triggering acute opioid withdrawal, which may cause fetal distress. 16
What are some of the arguments against naloxone?
Some suggest that if naloxone were viewed as a safety net it would encourage people to use more opioids. Several studies have demonstrated that this is simply not true — increased naloxone access has shown no increase in risky behaviors associated with opioid ingestion. 18
What is the current status in the United States?
In 2001, New Mexico became the first state to amend its laws to make it easier for medical professionals to prescribe and dispense naloxone, and for lay administrators to use it without fear of legal repercussions. As of August, 2014, twenty-four other states (NY, IL, WA, CA, RI, CT, MA, NC, OR, PA, CO, VA, KY, MD, VT, NJ, OK, UT, TN, ME, GA, WI, MN and OH) and the District of Columbia had made similar changes.
Based partly on these changes, at least 188 community-based overdose prevention programs now distribute naloxone. As of 2010, those programs had provided training and naloxone to over 50,000 people, resulting in over 10,000 overdose reversals.
At the urging of organizations including the U.S. Conference of Mayors, the American Medical Association and the American Public Health Association, a number of states have addressed the overdose epidemic by removing some legal barriers to seeking emergency medical care and the timely administration of naloxone. These changes cover two general areas:
- They encourage the wider prescription and use of naloxone by clarifying that prescribers acting in good faith may prescribe the drug to persons who may be able to use it to reverse overdose
- They remove the possibility of negative legal action against prescribers and lay administrators.