Narcan Over the Counter - From Near Death Back to Life- By Maureen Rossi
Heroin overdose and death are real problems in our society. How to prevent people from using heroin is the million dollar question with no answer on the horizon. However there has been significant progress in counteracting the effect of a heroin overdose. That success comes with naloxone (commercially Narcan) which is an effective way to reduce deaths from overdose.
Narcan has been used by medical professionals for years to reverse the effects of narcotic overdose and recently it has become availale for use in the comunity. Training in the administration of Narcan is becoming more mainstream and that’s a good thing say those like Art Flescher of the Suffolk County Department of Health who treat and advocate for the addicted. “In 2012 we had 354 reversals with Narcan, 2013 we had 475 and in 2014 we had 493,” said Flescher.
Flescher has provided about one-hundred Narcan training programs and handed out over 2,500 Narcan kits.
Narcan is administered for the complete or partial reversal of opioid overdose. According to RXLIST.com, Narcan may be administered intravenously, intramuscularly or subcutaneously. “The most rapid onset of action is achieved by intravenous use,” the site explains. Those given Narcan during an overdose generally respond quite rapidly. They are literally dying and revived, immediately back to life with a blast of the Narcan nasal spray or Narcan injection.
Most people do not understand that death from an overdose doesn’t occur in a few minutes or even an hour. Experts say it could take up to three or four hours from onset to death thus providing a large window of opportunity to revive someone who is dying.
According to Drug Free.com, drug overdose is a serious public health concern and opioid-related overdose has increased as a health threat. “A life-saving law took effect on April 2, 2006 making it legal in New York State for non-medical persons to administer naloxone to another individual when trying to prevent opioid/heroin overdoses.
In 2012 Suffolk County participated in a pilot program training and equiping ems personel with naloxone.The county expanded the program to include police. The Suffolk County Police Department was the first law enforcement agency in New York State to be trained to administer Narcan.
However, at the time of the 2006 law, training was taking place all over Suffolk, not by police officers but by parents and regular citizens. A few doctors would provide free trainings and provide an injectable kit and a prescription. Suffolk County Police Department and emergency personal carry nasal Narcan which is more expensive. Many lives have been saved.
Once parents, grandparents, siblings realized they could or should obtain it, they began to do so by the hundreds. Narcan was hope for a family that felt kidnapped by the disease of addiction, their kit became a tool they hoped they would never use.
With the overwhelming data documenting the success of Narcan legislation has been passed making it available over the counter. What does this mean? The availability of Narcan over-the-counter by pharmacists without a prescription was part of a package of about twenty-four laws that Govenor Cuomo signed in 2014.
Pharmacists will provide Narcan to the public. CVS was the first pharmecy to make a big public campaign in 2014 announcing that they would now make Narcan available to the public. The cost of a Narcan kit is anywhere between $20 - $40 depending on the area and manufacturing costs.
Long Island Council for Drug Addiction and Disease (LICADD) is a non-profit that has been servicing Long Islanders for the past sixty years with the primary mission of helping individuals and families that struggle with substance use and related issues. Brittany Becker, MS, MHC of LICADD supplied this and other critical data to Smithtown Matters.
According to county records, there were 375 fatal overdoses (145 heroin and 230 prescription drug) in 2013 on Long Island; more than one a day,” she explained.. She said in 2014 fatal heroin overdoses only dropped slightly to 137 but fatal prescription overdoses dropped to 204. Those numbers are particularly meaningful to the one-hundred and seventy-one families that would have been devastated by the loss of their sick and addicted loved ones.
“This decrease, however, does not indicate that the opiate crisis on Long Island is disappearing,” she lamented. “The decrease of fatal overdoses we’ve seen on Long Island are directly connected to increased access to Narcan, the antidote to opiate overdose,” Becker apprised.
Anthony Rizzuto is the Provider Relations Representative for the Seafield Center. “People are definitely using it”, said Rizzuto. He added that the police in Nassau County became certified and started doing trainings in 2012, to date they have trained approximately 6000 people.
Rizzuto said it should it be readily available at every pharmacy in state. “However my concern is that there has to be some training with it, if you introduce Narcan into someone that is overdosing from Opiates or Opioids you can pull it (the opiate) off the receptor and save their life. This only buys you a window of time to get them to the hospital,” he declared. Unfortunately, Rizzuto says one factor most people don’t know is that if all they do is bring them back, they are still at risk of succumbing as the Opiate lasts longer than the Narcan,” he warned. There have been instances where people have died after being resuscitated and released from the hospital.
So can you walk into a Smithtown drug store or Pharmacy and get Narcan? Our
small sampling said no, but it could be ordered in 24 hours. Rite Aid in Kings Park was trained (simple training that takes but a few minutes) but had to order it. CVS on Main Street in Smithtown was trained and said they would have to order it if a customer wanted it. Walgreens in Smithtown declined to respond.
With regard to Narcan administration big pharmacies are evaluating their role. CVS seems to be taking the lead “Naloxone is a safe and effective antidote to opioid overdoses and by expanding access to this medication in our New York pharmacies by the use of a physician’s standing order for patients without a prescription, we can help save lives,” said Tom Davis, RPh, Vice President of Pharmacy Professional Practices at CVS/pharmacy.
“We support expanding naloxone availability and we applaud the State of New York for its leadership in the fight against drug abuse and addiction.” “While all 7,800 CVS/pharmacy stores nationwide can continue to order and dispense naloxone when a prescription is presented, we support expanding naloxone availability without a prescription (as its done in NYS) and are reviewing opportunities to do so in other states,” Davis said.
Locally the pharmacists Smithtown Matters spoke with said the Narcan can be ordered and would be available the very next day.
While there seems to be agreement that Narcan is useful and very effective there is controversy surrounding post-Narcan resuscitation. At present no policies or procedures exist for those who have been revived. In the last years a cadre of addiction experts have held panels and meetings all over Long Island to discuss what needs to be done after a patient is brought back. The first Nassau and Suffolk bi-county Opiate Seminar was held in the fall of 2015.
“We have a window of opportunity being missed after a Narcan resuscitation where we can get the addict help,” said Flescher. He said follow up after resuscitation is critical. He feels it’s an excellence chance to get the addict the help they need.
Steve Chassman is the Director of LICADD. He said he’s been working with Suffolk County for about five years now. “We get the names and numbers and try to connect for a follow up with Narcan recipients, we make three diligent attempts,” he explained. He admits, however, it’s been a huge challenge as often the contact information is erroneous, the person who called for help is generally the phone number ascertained. “Ideally we need to get the patients’ number, Phase I, we keep them alive (with Narcan), Phase II, we need to get accurate data on the IP (Identified Person) to attempt to get them help,” he added.
Suffolk County offers a webpage with listings of Narcan Trainings. Those trainings are free and provide kits to attendees. http://www.suffolkcountyny.gov/DEPARTMENTS/COUNTYEXECUTIVE/SUFFOLKCOUNTYSUBS