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As Narcan Becomes More Accessible, Harm Reduction Experts Hope for Fewer Overdoses

In March, the FDA authorized over-the-counter sale of Narcan, a life-saving drug that was previously only available by prescription. Doctors and counselors weigh in on the difference it makes and the lives it could save.

Carolina Diaz | MediaLab@FAU

Oct 23, 2023

During a routine traffic stop in late 2022, Courtney Bannick, an officer with the local police department in the central Florida town of Taveras, accidentally ingested a deadly amount of fentanyl and began to overdose. 

“I was helpless--I couldn't help myself,” Bannick said, recalling the incident at a press conference earlier this year. Bannick told reporters that she does not recall exactly what had happened, but a spokesperson for the Tavares police Department said Bannick believes that “between the wind and loose powder of the narcotic located, that she was exposed that way.” She attributes her survival to the quick wits of her fellow officers and the Narcan they had readily available. 

In March, the FDA approved Narcan for over-the-counter sale in the midst of the opioid epidemic, following a year in which more than 73,000 Americans died from fentanyl overdoses.

The life-saving drug was previously only available with a prescription. The decision has been met with controversy from critics who believe it is enabling opioid use, while advocates believe that it is the next step in combating the raging opioid epidemic, which cost the US over $1.5 billion last year.

Opponents of over-the-counter Narcan argue that it promotes drug use, as it may lead users to think there is less risk involved in using drugs. “Some folks still think that if you prescribe Narcan, you are encouraging the use or abuse of opioids,” says Lisa Clayton, Associate Professor of Emergency Medicine at the Charles E. Schmidt College of Medicine at Florida Atlantic University.

John Canfield, an Ocean Rescue paramedic, has also expressed concerns about the impact of prescriptionless Narcan on attitudes about recreational substance use. He said that access to these kinds of resources can possibly suggest the idea that illicit substances are safe from “the big bad fentanyl.”

Advocates for the legislation see it as a way to get the life-saving drug into more hands. Prior to the legalization, said Dr. Charles Hennekens, a leading preventive medicine experts at FAU’s College of Medicine, Narcan was only prescribed to 1 out of every 70 patients taking opioids.  

Moreover, said Clayton, the extremely limited access to prescriptions meant that there was a counterfeit market in Narcan. “Sometimes people say, ‘You can buy this, ‘Narcan,’ and it’s simply just saline,” said Clayton.

Access to Narcan over the counter allows for those who cannot get a prescription the opportunity to not only have Narcan, but to assure they have the real thing as well. While generally supporters of the legislation see accessibility as a good thing, some harm reduction advocates remain critical to the approach of selling the drug in pharmacies everywhere.

I never would have sacrificed $40 for Narcan, even knowing it could save my life, because that is not how my addiction worked,” said Matthew F. Peterson, a licensed social worker and previous drug user. Peterson is an FAU graduate who served as president of the Collegiate Recovery Community during his studies. 

“The new law will save many lives for those who can afford the price tag,” Peterson said in an emailed response.

Narcan currently retails at an average of $44 for a pack of two nasal sprays. 

There may also be social barriers to this antidote to overdose. Studies have also shown that people with or surrounded by others with Substance Use Disorder (SUD) are reluctant to carry and administer Narcan out of fears of being stigmatized and the desire to avoid interrupting another user’s “high.”

Meanwhile, Florida officials warn against xylazine, a veterinary drug that was found in recent years to be mixed with fentanyl and other illicit substances. 

Naloxone is ineffective on sedatives such as xylazine,” warned Attorney General Ashley Moody at a press conference in April. 

The drug itself is not an opioid, but because it is typically mixed with opioids, the overdose symptoms are very similar which makes the work of first responders even more difficult.

Earlier this year, the Drug Enforcement Administration (DEA) announced a public safety alert to warn Americans about xylazine. “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Anne Milgram. 

Photo by Matteo Badini via Unsplash

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