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FDA Turns to OTC Naloxone to Combat Overdose Crisis

In late March, the U.S. Food and Drug Administration (FDA) took a significant step in the fight against opioid overdoses by approving naloxone to be sold over the counter (OTC). Often sold under the brand name Narcan, this lifesaving medication can be used to reverse an opioid overdose.

More than 106,000 people died from overdoses in the U.S. in 2021, and it’s estimated that almost 70 percent of those deaths were caused by opioids, primarily fentanyl. With fentanyl now showing up in counterfeit pills and other drugs, we need increased access to naloxone now more than ever.

The FDA advisory panel unanimously recommended allowing naloxone to be sold OTC because it’s safe and effective at reversing opioid overdoses and doesn’t cause negative side effects. If someone is overdosing from a drug other than opioids, naloxone won’t reverse the overdose, but it won’t cause harm either.

Availability and Pricing Still a Concern

The goal of making naloxone available OTC is to increase access to this lifesaving medication. Naloxone was previously available mostly by prescription. This made it more difficult to obtain, especially given the strong stigma around substance use.

Starting late this summer, consumers should start to see naloxone in pharmacies, convenience stores, grocery stores and online. At first, it’s possible consumer demand might outpace manufacturers’ ability to create and distribute the medication.

Once naloxone is widely available, cost is likely to be the main barrier for it being on hand in an emergency situation. In April, the company that manufactures Narcan said the price for a two-pack of the medication will be less than $50. However, many experts believe that price will still be too high for the average consumer. The White House announced plans to meet with manufacturers about increasing access and decreasing cost.

“In my own clinical practice, there have been times when families have needed to pay $30 for a copay for Narcan, and this has been too expensive for them,” said Dr. Scott Hadland, an addiction specialist at Mass General for Children in Boston.

Another factor in the cost of naloxone is that multiple doses of the 4 mg medication are often needed to revive someone during an opioid overdose due to the strength of the opioids available in today’s drug market.

LIUNA District Councils, Local Unions, signatory employers and health and welfare funds could all play an important role in making naloxone more accessible and affordable for LIUNA members. For example, health and welfare funds that already cover naloxone may continue to do so at a cost that’s less expensive than the OTC price.

The LHSFNA supports the inclusion of naloxone in all workplaces as part of the first-aid kit. On construction sites, naloxone can also be located near where people are most likely to use opioids and potentially overdose, such as in bathrooms and in their vehicles. Local Union halls and training centers are also encouraged to keep naloxone on hand. Once naloxone is on site, employers should ensure that supervisors or other designated employees know the simple steps for administering this medication and the other steps to take in the event of an opioid overdose.

Expanding Harm Reduction Measures

Increasing access to naloxone is one example of harm reduction practices that are becoming more widely accepted as federal and state agencies look for ways to fight back against opioid overdoses.

Critics argue that harm reduction resources like naloxone and fentanyl testing strips enable drug use, but the simple fact is that harm reduction saves lives. To successfully reduce overdose deaths, comprehensive programs to address the underlying causes of substance use disorders and help people find treatment must also be part of the solution.

Removing the prescription requirement should help family members and friends take a more active role in preventing opioid-related deaths when someone they know is struggling with a substance use disorder. The FDA decision may also help normalize seeking help for opioid addiction and reduce the stigma associated with substance use disorders.

For more information about opioids and substance use disorders, visit the LHSFNA’s Drugs and Alcohol page. LIUNA signatory contractors and other LIUNA affiliates can also order the Fund’s Answering Your Questions on Opioid Abuse and Addiction pamphlet.

[Nick Fox]

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