Narcan still critical a year after being approved for over-the-counter use
Since last March, Narcan, a nasal spray variant of naloxone has been made available over the counter, a federal move that has since widened accessibility to the medication.
Narcan serves one function: to reverse an opioid overdose.
“Having people, especially lay people, being able to safely and affordably administer Narcan is a huge asset to the community,” said Keith Singleton, deputy chief of Quality EMS. “I think that as time has passed, almost everything we’ve tried so far has failed in this war — this epidemic of drugs.
“This is one option proven to be safe, easy to administer and it has been proven time and time again that lay people can administer it.”
In his time as a paramedic, Singleton said he has administered Narcan countless times.
Some people who are revived refuse to be transported to the hospital for a variety of reasons, he said, including concerns over footing a hospital bill. People may also be unaware that under Pennsylvania law, they can’t be charged for experiencing a drug overdose.
Choosing to stay home is not necessarily safe, he said, but the risks can be minimized if there is a second person with them who has access to Narcan.
“There is a big fear that the Narcan will wear off if they’re alone, and that’s a problem (if they refuse) hospital observation,” Singleton said. “But if they’re at home with somebody who knows how to use Narcan, that risk can be mitigated.”
In cases where people choose to stay home after being revived following an overdose, Singleton said paramedics leave them with free Narcan, which Quality EMS receives from the Butler Country Drug and Alcohol Program.
Compared to when he worked in Allegheny County, Singleton said the number of overdoses he responds to in the area served by Quality EMS are lower, at three or four a year.
In his previous role, Singleton said he would respond to overdoses as frequently as twice a week.
“Generally, (overdoses) would come in waves, when a bad batch of heroin would hit the streets,” he said. “The drugs would either be fentanyl, laced with fentanyl or be stronger than what people were used to.”
Jessica Zavilla, who is the executive director of alcohol and drug treatment center Trilogy Wellness’ Butler branch, said providing Narcan to everyone is critical.
The organization receives Narcan from the sheriff’s office, she said, and is given to patients as well as to businesses and community members.
“You never know,” Zavilla said. “You could be at a restaurant, and if in the public restroom, somebody at that restaurant has an overdose, having Narcan readily available could help them.”
“I think a lot of people think that we only give (Narcan) to drug addicts, but that’s not true,” she said. “Anyone could encounter it. A child could encounter it. Maybe you’re prescribed pain management medication ... anybody could come into contact with any kind of opioids.”
Zavilla said she has never had to administer Narcan, but keeps it in her car, home and family members’ houses.
Making it accessible is a “step in the right direction,” Singleton said. Before being available over the counter, Narcan was available by prescription.
“Some forward-leaning physicians, if they prescribed pain meds, would also be giving Narcan, just in case,” Singleton said. “Because people overdose on legal prescription opioids all the time.”
When he’s off duty, Singleton said he doesn’t carry first-aid supplies, but noted that he “wouldn’t hesitate” to carry Narcan if a family member were prescribed opioid medication.
A number of “false tropes” exist about Narcan, Singleton said, including the misconception that the medication enables drug use or prolongs addiction, or that, in order to wipe out addiction, people with opioid use disorder should be simply be “cut off” from the life-saving medication.
“(Narcan) is a life saving intervention,” he said. “It saves people from dying and it gives them the opportunity to move to the next step of recovery. It’s definitely a Band-Aid in that it doesn’t solve the problem of addiction, but it stops the person from dying, and that’s a step in the process of recovery.
“People are not able to go into recovery if they’re dead.”
When it comes to addressing the opioid epidemic, Singleton said first responders can only do so much, but that Narcan is an essential step in the recovery process.
“As a paramedic, nothing has been tried at our level,” he said. “We are reactive as opposed to proactive. The only thing we are able to do is pick up the pieces. The proactive stuff is reigning in drug companies, pharmaceutical corporations and physicians over prescribing the drugs that lead people to take heroin down the road.”
“Because no one in the morning wakes up and decides ‘I’m going to try heroin,’” he said. “They get (an opioid prescription), they get over prescribed and when that prescription stops ... they go to another pharmacist and once they’re out, the street is they’re only option.”
