Yes We Narcan

Back in the day, Naloxone, brand name Narcan, was something only medical professionals could administer. The drug, which reverses the effects of an opioid overdose, was introduced to the body intravenously.

What was once a drug that was strictly the purview of first responders, Narcan has, in recent years, become available as a nasal spray that most anyone can provide for a friend, family member, fellow traveler or person on the street.

Across the county and the state. programs are springing up around the newly simplified way to save someone in the throes of an overdose.

Narcan is already being used in Santa Fe County by Emergency Medical Services. But this month the county Community Services Department and the county fire department launched a new service to reach patients who have recently suffered an overdose, considering the increased risk of death from subsequent overdoses that are often much more lethal than the first. The pilot program, funded by a grant from the state Behavioral Health Division of the New Mexico Human Services Department, will distribute Narcan nasal spray to opiate users after an overdose, as well as their friends and families, and train them to use it properly.

"People who have overdosed once are at high risk for a second overdose," says Rachel O'Connor, director of the Santa Fe County Community Services Department. People are also more likely to die of an overdose if it occurs during the early stages of recovery. O'Connor says that while overdose rates in the county have dropped slightly in recent years, the influx of new drugs such as fentanyl makes overdoses ever more lethal.

"We've set specific goals … to reduce the rate of drug overdoses and related deaths in Santa Fe County. Narcan can help with that," says O'Connor.

In rural areas, it can take up to 20 minutes for first responders to arrive to some of the remote corners of the fire department's 2,000-square-mile jurisdiction, Santa Fe County Fire Chief David Sperling tells SFR. Each minute that passes could be the difference between life or death.

"If we can ensure that family, friends, those who are nearby know what to do in the event that someone overdoses, and have access to some of the tools like Narcan that can successfully reverse an overdose, it's really like positioning first responders close to people who are opiate users," Sperling says.

Not that there's much to teach.

Recognizing the signs of an overdose is the hard part, and once that's done, the nasal spray is about as easy to administer as an over-the-counter allergy spray, like Nasonex.

In addition to the county program, a bill to require counseling for anyone prescribed opiates for a period of longer than five days passed the Legislature this session. Under the new law, providers must also prescribe Narcan to those patients. Those new requirements took effect on June 14.

Thom Duddy, vice president of communications for Emergent BioSolutions, the manufacturer of Narcan, took a media tour through New Mexico this week to discuss the new law and the epidemic it's meant to address.

"Secondary to HIV, I think it is the most serious public health threat we have today," Duddy tells SFR. "We lose approximately 180 people a day to overdose deaths in this country. The epidemic has surpassed HIV deaths; it has surpassed automobile accident deaths in the country."

A state law passed in 2017 requires all law enforcement officers to carry two doses of Narcan at all times.

But when it comes to the post-overdose response, the county fire department, which includes emergency medical responders, is uniquely positioned to effectively reach at-risk individuals.

"Because of our EMS role, we are often in people's residences and making contact with them at their homes," says Sperling. "People by and large trust firefighters."

O'Connor points out that when it comes to community-based interventions, the fire department is more likely to gain the trust of those who need help most.

"They are a caring presence in our community," O'Connell says of firefighters, "as opposed to people's perceptions of law enforcement at times. So people aren't afraid of getting a call from the fire department saying, 'We want to help.'"

New Mexico has historically had one of the highest rates of opioid deaths in the country, according to the Centers for Disease Control and Prevention. In 2005, the state led the nation in overdoses per capita, and now ranks 16th as the opioid crisis has worsened in Southern and Midwestern states like Ohio and West Virginia.

But it's not a sign that New Mexico's crisis is abating. Rather, the state has simply not gotten as bad as fast as other places in the country have. Between 2005 and 2017, the most recent year of available data, New Mexico has seen an increase in drug overdoses per capita, according to the CDC.

Pharmaceutical companies have been widely reported to have spurred the opioid crisis, and New Mexico joined 47 other states in lawsuits against Purdue Pharmaceuticals, the manufacturer of OxyContin.

Is another pharmaceutical company like Emergent BioSolutions the right champion in the fight against overdoses? Duddy, who says he carries the product himself, doesn't see his firm as the solution, and access to Narcan is only the first step.

"It enables someone to start breathing again," Duddy says. "It enables them to stay alive. The next step is that we have to get them access to treatment."

Pharmacies charge between $125 and $130 for two doses without insurance, but insurance holders pay an average copay of $17 for the same, and Duddy says that Emergent has committed not to raising prices.

"Price increases are typical in the pharmaceutical industry," Duddy says. "We haven't done that. We weren't going to do that, we haven't done that yet, and we're not planning on doing that. If people don't have access to these products, they die. We believe that we can still make money and go from there."

SFR also asked how the company would cope if the crisis were solved. Emergent's profits stem directly from the existence of the opioid crisis, so if there was no crisis, there would be no more demand for Narcan. But, Duddy says, people still overdose when taking opioids as prescribed, so demand will likely always exist; that's part of the reason for New Mexico's new law requiring counseling. But barring that, Duddy says he would welcome the end of the crisis.

"I would love nothing more than to then be out of this business," Duddy says. "We've got lots of other products in development. But it took awhile for us to get into this crisis, it'll take us a while to get out of it. If the epidemic gets solved and we don't sell any more [Narcan], we're all OK with that."

But one does not have to sell Narcan to see its benefits.

"Within the last three years that we have taken efforts to distribute Narcan throughout our ranks," including among volunteer departments, says Sperling. "Again, this is on the recognition that you want people as close as possible that have the tools they need to save lives."