AILSA CHANG, HOST:
Mike Selick has a lot of experience administering the lifesaving medication naloxone. His work involves helping people who are experiencing drug addiction, including addiction to opioids. And the most recent time he had to reverse an overdose was in his own neighborhood. Selick was walking his dog when he saw someone lying in the grass across from his driveway.
MIKE SELICK: They were breathing very poorly and shallowly. I think a lot of people had already seen it but just assumed the person was asleep or drunk or something. So if I hadn't had a lot of experience recognizing overdoses and reversing them over the years, I probably wouldn't have thought anything of it.
CHANG: Selick dialed 911 as he ran into his house, just like he has every time he has reversed an overdose. Once inside his home, he grabbed Narcan. That's a nasal spray form of naloxone which is used to rapidly reverse an opioid overdose.
SELICK: I sprayed one into one of his nostrils and watched his breathing. Luckily, this person was breathing poorly but on their own, so I didn't actually have to do rescue breathing.
CHANG: Selick has been doing community outreach since 2010 to people who use drugs. Now he works for the National Harm Reduction Coalition, and he says overdose happens because opioids affect the part of your brain that controls breathing. People end up suffocating and dying from the lack of oxygen.
SELICK: You wait about two to three minutes before administering the second dose, so he was still out. I administered the second dose. The person woke up pretty much immediately. They were up a little confused and talking.
CHANG: And that was the moment when emergency responders arrived. They were able to talk to the person Selick treated and took them to the hospital in an ambulance.
SELICK: I've called 911 before and had it take 45 minutes for rescue workers to show up. If you're not breathing for 45 minutes, you're dead.
CHANG: Which is why he says it's so important to get Narcan in the hands of bystanders - people like friends, siblings, parents, coworkers, roommates, anyone who is around people who use drugs. The CDC estimates that nearly half of overdose deaths in 2021 had potential bystanders, people who could have prevented a death if there was Narcan on hand.
SELICK: All of the evidence has shown that the people who respond first are not uniform first responders. They are people in the community.
CHANG: Now, first responders have had access to naloxone for decades. And in 2015, the FDA approved its use more widely in the form of Narcan as a prescription drug. And then just last week the FDA approved Narcan for over-the-counter sales, something that advocates have been pushing for for years. That will make the drug more widely available than it ever has been before, which Selick says is a great thing.
SELICK: Harm reduction is all about keeping people alive. If somebody overdoses and nobody responds, there's no chance for a tomorrow. There's no chance for better outcomes. And people have lost the loved one. We want people to survive.
CHANG: To hear more about the significance of the FDA's decision to make Narcan available for over-the-counter sales, we reached out to Nabarun Dasgupta. He's a senior scientist at the University of North Carolina and has been studying opioid overdose prevention and addiction treatment since 2002. Welcome.
NABARUN DASGUPTA: Thank you for having me.
CHANG: So Narcan, the nasal spray form - it's really simple to use, right? Like, almost anyone can learn very quickly how to administer it. Am I correct?
DASGUPTA: Absolutely. It's a motion that most people have already done. You put something in your nose. You press the plunger, and it fires out the naloxone into your nose. There's really not very many ways to screw it up.
CHANG: OK. That's very reassuring to hear. Well, with this latest development, we're hearing that the price of the nasal spray to the average consumer could land anywhere between - what? - like, $35 and $65. What do you think of that price? Like, do you think it might deter people from going out and buying it because it's still kind of expensive?
DASGUPTA: What we know works in public health is if the price of the antidote is cheaper than the price of the dope, right? If we're talking about $10 for a dose of fentanyl or heroin, then the price of the antidote needs to at least be on par with that and ideally much less.
CHANG: Right.
DASGUPTA: So we have a long way to go.
CHANG: OK, that makes sense. But what if the price of over-the-counter Narcan never drops to $10?
DASGUPTA: I think we really have to look at this as a broader naloxone market where having the first over-the-counter product is going to hopefully entice other pharmaceutical companies to come to the table with cheaper devices, cheaper nasal sprayers, cheaper nasal swabs, maybe something that dissolves inside the cheek. There's a lot of ways to deliver naloxone into the body that are going to be cheaper than this first product. So we should stay tuned.
CHANG: OK. And then when it comes to actually physically procuring it, do you get the sense that Narcan will be something that I could just grab off the shelf at the pharmacy? Or would I have to go up to someone and have a whole conversation with a pharmacy employee to get me the nasal spray and then maybe worry about being judged for requesting it? What do you think?
DASGUPTA: That's a very real risk - that the stigma that already exists within the health care system against people who use drugs is going to get perpetuated in the way that Narcan is available. It wouldn't surprise me to see it locked up behind the counter because of its price. It's also a fairly large box, and so pharmacy space is at a premium. And I would be surprised if pharmacies were able to have inventory of large amounts of this antidote. There's this amazing vision of having the nasal spray available at every gas station in the country, right? It sounds like such a good idea.
CHANG: Yeah.
DASGUPTA: But if you go into a gas station, you don't see any other products that are in the 40 to $50 range.
CHANG: Right.
DASGUPTA: So I'm skeptical that that's going to be where it goes. What I do think is going to happen is that - vape shops and head shops are surprisingly ubiquitous in our country, and they do sell products in that price range. They also attract a clientele who may be at higher risk for overdose. So I think that is an unusual partner for public health in many ways but the kind of innovation that can happen when something is over-the-counter and we can see all the new places that we can put this product to get it in the hands of people who really need it.
CHANG: Well, what about the effect of all of this on the supply of free naloxone? What I'm talking about is, you know, right now a lot of community groups are able to provide this drug for free. And if a lot of the supply of this drug is now getting routed to pharmacies, do you think the supply of free naloxone will diminish?
DASGUPTA: This is a real concern. Over the last decade and a half, we've had four national shortages of naloxone. Any time you have a monopoly on a pharmaceutical product, it's a recipe for disaster. So to prevent that, what we have done in the last year is to shore up the supply chain for the free and low-cost generic liquid injectable naloxone, the formulation that a lot of our harm reduction programs are relying on.
CHANG: OK. Well, I know that we've gone through several reservations about expanding availability of Narcan to pharmacies to be bought by just average consumers. Do you expect, despite these reservations, that making naloxone way more widely available as this over-the-counter nasal spray is going to make a big difference ultimately in lives saved?
DASGUPTA: That's our hope, right? I mean, we're at a sad point in our country's history where we need the antidote to be available this widely. A lot of our prevention, a lot of our policy that should have prevented this kind of overdose death volume hasn't worked. It's time for new solutions. We need new ideas, and we need to make these tools available.
CHANG: That is Nabarun Dasgupta, a senior scientist at the University of North Carolina. Thank you very much for joining us today.
DASGUPTA: My pleasure. Take care.
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