Carrying naloxone should be as common as knowing CPR, medical expert says

As drug-related overdose deaths increase during the COVID-19 pandemic, Dr. Mark Calarco, an expert in the addiction industry, thinks carrying around naloxone should become as common as knowing CPR.

All citizens should have quick access to naloxone, a drug used to treat opioid overdoses, in case they come across someone in the midst of an overdose, said Calarco, CEO and medical director of Addiction Labs, a toxicology lab specializing in substance use disorder and mental health treatment. Calarco also has served as medical director of American Addiction Centers in Brentwood, Tenn., since 2013 and has 27 years of experience in both clinical and laboratory medicine.

“It’s time to end this continuing tragedy. One of the ways to do this is by making naloxone (better known by the brand name NARCAN) — a safe, effective and use-specific antidote to opioid overdose — as common among bystanders as CPR,” Calarco wrote in an op-ed in “The Hill” on Aug. 31, which was International Overdose Awareness Day.

In 2018, nearly 70,000 Americans died of drug-related overdoses. This year, overdose-related deaths are up as much as 18 percent since the beginning of the pandemic. As much as two-thirds of those are considered to be from opioids.

Previously, the U.S. Surgeon General, Vice Admiral Jerome M. Adams, said that naloxone should be “within reach” of “patients taking high doses of opioids 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.”

Calarco argues that expanding who should carry naloxone may save lives.

“The chances are very high that you may be exposed to somebody who has an overdose,” he said. “We know that this is common. And so, to be a good member of society and to help other members of society, even if you don’t know them… if you save somebody’s life, that’s just good karma all around.”

Calarco said regular citizens can train themselves on the signs of an overdose through YouTube videos or other resources online, so they know when and how to use the drug. Some symptoms of an overdose include purple lips and fingernails, clammy skin, shallow breathing or not breathing at all, and pinpoint pupils, he said.

Even if someone administers naloxone to a person who isn’t experiencing an overdose, the drug is relatively harmless, he said.

“There is no danger in giving NARCAN needlessly. If a person isn’t overdosing, administering the drug won’t harm them. Not only is it a benign medication, you don’t even have to be directed by a first responder to administer it,” he wrote. “If using the nasal spray, simply insert the nozzle into the person’s nostril and press the plunger. That’s it. Call 911 and roll the person on their side to protect them against aspirating once they begin recovering, which should occur in 2-3 minutes.”

Calarco said administering naloxone helps buy time before paramedics can arrive.

“Some drugs like fentanyl are 1,500 times more potent than morphine and heroin. If you give them a dose of naloxone, you keep them from having brain damage, but the dose may not be sufficient to prevent them from relapsing into respiratory depression. That dose buys you time, just like CPR does (in a heart attack situation) while you’re waiting for the health care professionals to arrive. But if you don’t (administer the naloxone) within a very critical window period of the first 2 to 4 minutes, it can spell really bad outcomes afterward.”

Naloxone in its nasal spray form, called NARCAN, is FDA-approved and available for purchase without a prescription in every state, although state laws about its purchase may vary. According to Emergent BioSolutions, which counts NARCAN among its portfolio of medical products to support public health, 97 percent of insurance packages cover NARCAN. Nearly 50 percent of insurance plans provide access to NARCAN with no co-pay, and 75 percent of insurance plans have a co-payment of $20 or less, the company said.