By Susan Scutti and Robert Jimison, CNN
The US surgeon general issued an advisory Thursday recommending that more Americans carry the opioid overdose-reversing drug, naloxone.
The drug, sold under the brand name Narcan (among others), can very quickly restore normal breathing in someone suspected of overdosing on opioids, including heroin and prescription pain medications.
Dr. Jerome Adams emphasized that “knowing how to use naloxone and keeping it within reach can save a life.” To make his point, Adams relied on a rarely used tool: the surgeon general’s advisory. The last such advisory was issued more than a decade ago and focused on drinking during pregnancy.
Adams noted that the number of overdose deaths from prescription and illicit opioids doubled in recent years: from 21,089 deaths across the nation in 2010 to 42,249 in 2016.
America’s top doctor attributed this “steep increase” to several contributing factors, including “the rapid proliferation of illicitly made fentanyl and other highly potent synthetic opioids” and “an increasing number of individuals receiving higher doses of prescription opioids for long-term management of chronic pain.”
“Research shows that when naloxone and overdose education are available to community members, overdose deaths decrease in those communities,” Adams said. Naloxone is used by police officers, first responders and emergency medical techs to reverse opioid overdoses. Adams added that increasing both the availability of naloxone and effective treatment is critical to ending the opioid epidemic.
The surgeon general’s recommendation is an important public message that lifts opioid misuse and opioid overdose deaths from the margins and places these issues in the mainstream, according to CNN Chief Medical Correspondent Dr. Sanjay Gupta.
Gupta agrees with Adams and believes that naloxone can save lives. Still, there are challenges, he said.
“You’re basically saying, as a doctor, ‘I’m giving you this opioid for your pain, and by the way, you might kill yourself, so here’s this as well,’ ” Gupta said. “The next step in this would be truly defining who is high-risk and should be getting Narcan along with their opioid prescriptions.”
Outside of medicine, some see the Surgeon General’s Advisory as a pragmatic gesture.
‘A new reality’
“The surgeon general is addressing a new reality in a practical way by encouraging people to have access to naloxone and to know when and how to administer it,” Dallas lawyer Jeffrey Simon said. “I equate having naloxone at the ready to having a CPR kit at the ready: Both can save lives as emergency care if administered in time.
“No one would find it strange if a surgeon general encouraged more people to learn CPR or the Heimlich maneuver,” said Simon, whose firm, Simon Greenstone Panatier Bartlett P.C., has represented counties suing pharmaceutical companies for their alleged roles in opioid addiction.
Simon added that people are regularly encouraged to learn how to perform CPR or the Heimlich maneuver to render aid to someone — even a stranger — who might require assistance. Carrying and using naloxone is no different, he said.
However, a recent study suggested that state laws providing wider access to naloxone may unintentionally increase opioid abuse.
Access isn’t enough
With access to naloxone reducing the risk of overdose death, more dangerous drug use — including higher doses — may become more appealing, the researchers speculated based on the data. Such increased abuse may even lead to higher death rates, according to Jennifer Doleac, one of the study’s authors and an assistant professor of public policy and economics at the University of Virginia.
“Our research shows that expanding access to naloxone is not enough to reduce opioid-related mortality and may even increase opioid abuse,” Doleac said. “We found that effects were more beneficial in places where more drug treatment is available. So, if we are going to increase naloxone access, then it is also important to increase funding for drug treatment.”
The necessity of recovery treatment to end the opioid epidemic is a point on which seemingly all agree.
Simon said that “when we speak of opioid addicts, we need to remember that addiction is a disease. We want addicts to get into recovery, and if they die from an overdose, that can’t happen. Keeping them alive long enough for them to make headway with addiction treatment is crucial, and naloxone is often a key component to achieving that goal.”
Quoting a statistic cited by a deputy attorney general, Simon noted that more Americans under the age of 50 die each year from opioids than from any other cause, including heart attacks and choking.
“Unfortunately, it’s easy for anyone to overdose on opioids, so we are not just talking about saving the lives of addicts,” he said.
In the US, drug overdoses led to 632,331 deaths from 1999 to 2016, with 351,630 being opioid overdose deaths, according to the Morbidity and Mortality Weekly Report released Thursday by the CDC.
Across the nation, 63,632 people died from drug overdoses in 2016, with opioids accounting for about two-thirds of that total.
Still, the CDC found wide variation across the states. For example, New Hampshire, Ohio and West Virginia experienced the highest overdose death rates in multiple drug categories in 2016, while other states — primarily those in the Midwest and West — recorded the highest rates of psychostimulant-involved deaths. And in 2016, some states, including Maryland, Rhode Island and West Virginia, had higher rates of prescription opioid-involved overdose deaths than those involving heroin.
Deaths due to synthetic opioids such as fentanyl and carfentanil accounted for 30.5% of all drug overdose deaths in 2016, a 100% increase over 2015, the report noted.
There is an “urgent need” to implement a multifaceted public health approach, according to the authors of the government report. Suggested measures include increased naloxone availability, harm reduction services and recovery treatment.
Speaking at the National Prescription Drug Abuse & Heroin Summit in Atlanta on Thursday morning, Adams addressed the belief that providing naloxone “doesn’t make a difference,” since many people with drug addictions will just “go on and misuse substances again.”
His experience from traveling all over the country is that there are “countless examples” in which naloxone has changed an individual’s life for the better.
Adams noted that in 46 states, people who are or who know someone at risk for opioid overdose can get trained to use naloxone properly and may receive naloxone by “standing order” — without a prescription — from pharmacies or some community-based programs.
He also said that for many people, the “opioid crisis is not only pressing, it’s personal. My own brother, as many of you know, is serving a 10-year prison sentence for stealing $200 to support his addiction.”
On the plane to Atlanta, Adams said, a flight attendant told him about her son who died from an opioid overdose, while a few weeks ago, another mother, Missy Owen, shared her own tragic story. Her son, once president of his high school senior class, an honor student and a community volunteer, turned to opioids from his family’s medicine cabinet when he was overcome with stress and unable to sleep. Though he battled his addiction, he ultimately died from an overdose.
“No mother should have to bury their child — and especially not when there’s a life-saving medication that virtually anyone can access,” Adams said. “It is for this reason that I am issuing the first Surgeon General’s Advisory in 13 years.”