Surgeon General Jerome Adams is urging more people in the U.S. carry a drug that can be administered by friends and family to reverse an opioid overdose and prevent death.
The announcement was made through a rare health advisory from Adams, considered the nation’s doctor. The last health advisory, in 2005, warned women against drinking alcohol while pregnant.
“Advisories are reserved for significant moments in public health, a time where we need to lift up an issue and encourage action to engage the public,” Adams said in an interview with the Washington Examiner.
The action underscores the urgency of the opioid crisis, which resulted in more than 42,000 overdose deaths nationwide in 2016 from drugs such as prescription painkillers, heroin and fentanyl. The Trump administration has said that tackling the crisis is a top priority, and Congress is working on crafting legislation that could come with additional funding to reduce the number of overdoses and help people with addiction receive treatment.
As part of his advisory, Adams recommended that people consider stocking the overdose antidote naloxone if they have a friend or family member who is at risk of an overdose. That could include someone who has been prescribed an opioid such as OxyContin and accidentally takes too many or someone who is discharged from addiction treatment or from jail, after which tolerance falls and relapses.
“It may not be who you think,” Adams said. “The mom who just had a c-section, the high school quarterback who had a knee injury, the college student who thinks he’s getting a pill to help him stay up at night when really the pill is illicitly manufactured fentanyl.”
Most first responders such as police officers or emergency medical technicians already keep naloxone, but because half of overdoses happen at home and administering the drug is time-sensitive, health officials in the Trump administration see an opportunity to save lives.
An estimated 2.1 million people in the U.S. have an addiction to an opioid, and 77 percent of overdoses happen away from a medical setting.
Naloxone kits come in the form of a nasal spray or an autoinjector that is roughly the size of a cell phone. The nasal spray is known as Narcan and is sold at a list price of $125 for a carton of two. The autoinjector is called Evzio and works similarly to the EpiPen, a device used for people having life-threatening allergic reactions. Evzio’s list price is $4,100 for a pack that contains two injectors and a recording device that teaches users how to administer it.
In most states, people can receive naloxone in a pharmacy without a prescription and health insurance companies will cover the cost of the medication with no copays for Evzio or at a cost of about $10 or $20 for Narcan. Health programs also offer discounts, and Medicaid coverage varies by state.
But some communities have raised concerns about affordability. Cities have struggled to pay for naloxone even as more of their residents face addictions and often rely on donations from drug companies. Adams said the Trump administration would be helping communities to make sure that people who need the drug can get it.
“One of my goals with this advisory is to make sure the cost of naloxone is not a factor in terms of individual ability to access it,” Adams said. “This is life-saving and we don’t want people to feel like they can’t save someone because they can’t afford it.”
Naloxone is not considered a treatment for addiction, and someone who has an addiction to opioids may need to be revived several times over several years before they seek treatment. Others may die after they are not revived in time, despite previous successful interventions.
Adams stressed that after administering naloxone someone should call 911 and that doctors and hospitals need to make sure that a patient is discharged with prescriptions to treat opioid withdrawal symptoms and that he has access to treatment facilities.
“This isn’t a panacea or the be all end all,” Adams said. “We know naloxone is the first step of an opportunity to connect people to care.”
Someone who has been injected with naloxone can wake up quietly or become violent or agitated because the drug not only takes away a person’s high but also puts him into immediate withdrawal, when he will face body aches, diarrhea, fever, sweating, and nausea.
A second or third dose may be needed if someone doesn’t awaken after two minutes, Adams said. Fentanyl, for instance, requires more naloxone doses because it is more potent than heroin and often drug users do not know that they have taken it. Adams said he was confident most people would have no trouble using the devices.
“I have given naloxone to people,” said Adams, a trained anesthesiologist. “The most plain way I can say it is I have no concerns about an individual from the community administering naloxone, and if it were to happen to me, heaven forbid, I would have no concerns about someone administering it to me.”
Adams has spoken openly about his family’s experience with addiction. His brother, Phillip, has a drug addiction and is being housed in a jail roughly 25 miles from the White House. Despite those experiences, and seeing during his travels how the opioid epidemic has ravaged the country, Adams said he believed the crisis is surmountable. He said he had been heartened by effective strategies being waged at the state and local levels.
“There is no one policy that’s going to solve this,” Adams said. “The biggest problem in my opinion is ignorance and stigma.”
