There is a crisis that is killing thousands of U.S. Citizens a year and people are against a cure. The CDC reports that 107,941 people (more than the seating capacity of the Los Angeles Memorial Coliseum) die from opiate overdoses a year, which is about 250 lives lost a day, every single day. This isn't new information; opiate overdoses have been happening for as long as people have been using opiates. The risk is becoming more deadly now, though because of the recent increase of people using synthetic opiates. The devastating number of lives lost is 36 times the number of lives lost from the terror attacks on 9/11, every single year. One would think all hands would be on deck to stop this tragic loss of human lives, and it is not for some people. What if I told you that there is a medication that could significantly decrease this staggering statistic? Well, there is. But not everyone thinks that people should have access to it. There are some people who think that providing this evidenced based harm reduction measure causes people who use opiates to develop riskier practices because of having naloxone present. I am going to explain why we should support the harm reduction practice of providing the public with free and convenient access to the take home naloxone to save lives and that there is no evidence that there is increased risky use of opiates when it is present.
There is evidence that deaths involving opiate deaths are continually increasing. Synthetic opiates such as fentanyl have caused the death rates to increase by 317% between the years of 2013 and 2019. (CDC, 2021). Fentanyl is a synthetic opiate that is about 50 times more potent than heroin and one hundred times more potent than morphine. Fentanyl is used in health care settings to ease the pain of the most serious cases. This sharp increase of drug overdoses is an epidemic in the United States that requires immediate attention. We have a moral obligation to stop these senseless deaths, especially because there is a cure. This bleak data doesn't just include people who intentionally use illicit opiates. People die from unintentional medication overdoses as well. Someone could be prescribed medication for their pain and accidently use too much causing overdose and sometimes death. In 2022 there were 14,716 deaths contributed by prescribed opioid medication. Additionally, there is a sharp increase of opiate overdoses from people using Meth and cocaine due to contamination of their substance source. Meth and cocaine are "uppers". Some people intend to use these substances in conjunction with opiates, but most don't. They may think they are using their stimulants and don't wish to engage in the illicit use of opiates and overdose due to their product being contaminated by someone who sold or prepared their product. It is estimated that people who use stimulants such as cocaine and Meth contribute to about a third of all overdose deaths yearly, all while not intentionally using opiates. It would be optimal for these individuals to have access to some harm reduction products to make sure they are using their drugs of choice in a safer way.
There is hope because there is a medication to combat opiate overdoses deaths, called Naloxone, it is an opioid antagonist, which means that it binds to the opioid receptors and completely blocks the effectiveness of any opioids in the body, restoring breathing to a person that stopped or slowed breathing because of too many opioids in the system (NIH, 2024). Naloxone stays effective in the body for about sixty minutes, then wears off. Opiates typically stay in the body for longer, so it is possible for someone to overdose again despite not taking any more opiates. Some of these nuances as to how the medication works has caused some people to think that they are not safe to use for lay people. However, statistics find that more lives are saved due to people having access to naloxone. If people are given a chance at living through the medication naloxone, the chances of them making it for help at the hospital is greatly increased. I feel that people might be finding little bits of information like this and blowing it out of proportion because the real reason they don't want to give out free naloxone is because they have a stigma surrounding the people that this medication would benefit.
So, if there is an antidote to overdoses, why not have it available and the risk of overdose is so prevalent, the antidote should be easily and readily accessible. In 2022, the FDA had taken measures to help facilitate access to naloxone products and can be safe and effective for over-the-counter use. A measure called AB 2760 which required prescribers to offer a prescription for naloxone when certain conditions were present. This was signed into law in 2018, and there are barriers to this. Only about 4 percent of people prescribed will fill their order for it. Again, this can be related to the stigma surrounding naloxone. People do not want to be seen with it due to being fearful of being labeled as someone who willingly uses opiates. The people who don't want access to naloxone feel like the mere notion of having naloxone on hand would promote the substance user to be riskier with their opioid use. This slippery slope way of thinking causes people to literally die. Some people don't fill their prescription for naloxone because they would have to pay a copayment for it, so they decide to leave it. And what if they don't have other prescriptions to pick up? They are less likely to go out of their way to get it. Society must provide an easier way to ensure that people have easy access to medication that can help themselves and others. There are entire groups of people who believe that harm reduction measures such as naloxone distributions will lead to the collapse of society morals. Wouldn't the moral thing to do be to render aid to those in danger? People must realize that this is not the first harm reduction measure ever done. Harm reduction is all around us. We wear seatbelts and use car seats, these were not always mandated, and some people were against it being mandated when the laws began to change, now we see a 45-60 percent reduced risk of death due to this safety measures. Hard hats and steel toed boots are required at work sites. We have smoke alarms and CO2 detectors, now mandated in rental property and buildings. E wash our hands, medical professionals didn't even do this prior to evidenced based studies proving its effectiveness. Even smoking cigarettes with a filter makes this harmful habit a little less harmful. These are all harm reduction strategies that not everyone was initially for and now lives are saved because of following these everyday harm reduction practices. I think we need to step back and look at all the harm reduction strategies that save thousands of lives. They might have seemed absurd, annoying or oppressive initially, but now they are second nature and even appreciated. I think that take home naloxone could one day be viewed in the same light. If people know more about the history of harm reduction in other areas and how we all benefit from these safety previsions, they will have more insight as to how drug harm reduction can also help society.
The people who believe that free naloxone available to the public causes people to use more opiates or use them in a riskier way are wrong. This practice does not encourage riskier substance use and people don't use more just because there is naloxone present at the time of use. There is absolutely no evidence that having naloxone present contributes the increase of opioids used (Tse, Wai Chung, et al.) In a study that interviewed individuals about changes in use when naloxone was present, they all denied that they engaged in risker use because of having naloxone available, although, they did give antidotal instances of increased risky use because of take him naloxone. (Lai, Jeffrey T et al.) The fact of the matter is that people who use opiates don't want Naloxone to be used on them. In a study that interviewed individuals previously revived with naloxone, it was reported that being revived with naloxone was very unpleasant. (Lai, Jeffrey T et al.) Being revived with naloxone is very painful and feels like going into a rapid opiate withdrawal. (Moustaqim-Barrette A et al.) Some symptoms of opiate withdrawal are extreme body and joint pain, abdominal pain, runny nose, diarrhea, nausea, difficulty concentrating and irritability. It's for these reasons that people spend so much time finding opioids to help alleviate these symptoms. Besides being extremely uncomfortable and painful, there are multiple other reasons people who use opiates don't want naloxone used on them. People who use drugs typically spend a lot of time and resources to obtain their drugs of choice. The time and effort put into that would automatically be wasted if they suddenly lost their high because of naloxone. So, the notion of people who use drugs to just use naloxone so freely seems highly unlikely. I have worked in a detox and during admission process people frequently come in under the influence of opiate drugs. At times they seemed that they may have taken too much, as evidenced by falling asleep with difficulty to arouse, head nodding, and breathing slowly. On occasion I was tempted to use naloxone on them and call 911. Prior to making the decision to treat them with naloxone i would try everything including threatening to use it on them. And to my surprise the person that was difficult to arouse seconds earlier, straightens out and answers questions at the mere mention of possible naloxone use. They beg for it not to be used, even to the point of crying and begging. Because of what I have seen, I don't believe that people would be taking the risk of using it differently just because naloxone is available.
The citizens in the United States could learn from other countries who have adopted some impressive harm reduction measures. In an article by E. Holmen et al., the program that Sweeden has made these programs work. Sweden made a new way for people to survive opioids overdoses. Community partners have made commitments to make sure that naloxone is available for people who use drugs. They found these services also helped the people who were reluctant to activate emergency services due to fear of legal issues. Some people who have benefitted from overdose reversal from naloxone expressed that they preferred not to seek help after overdoses was low. This is not a problem in the United States due to bystander Good Samaritan laws, but people who are scared or uninformed will still have those concerns. By allowing people access to this take-home naloxone, it has taken off some of the hospital systems' hardship. Sweeden found that people that had access to naloxone had an increased safety by allowing the community to help individuals. People who would not have otherwise been able to service live to see another day and there is potential for them to change their lives. New policies are in the works that improve life for drug users, but they are still a low priority. Aside from assuming that naloxone causes people to use it in a riskier way, people also object to naloxone being handed to the public because of opiate overdoses being a serious problem that has to be handled by professionals and not by lay people. (Alexander R Bazzazi) Giving naloxone only requires a short amount of training and substance users are good at recognizing and responding to overdoses. Another issue at hand though is that the people that are around to witness an overdose are more likely to be impaired themselves. I feel that the action of passing out naloxone is also an opportunity to share information. Every naloxone kit passed out, they can be educated about administering and other safety issues. They can learn about other ways to stay safe such as Fentanyl Test strips, clean needles and other supplies.
Programs that make take home naloxone available are rooted in the harm reduction models. In the past 5 years, new programs have come about where California, through the California Department of Health Care Services (DHCS), gives community centers such as hospitals and nonprofits free naloxone. One of the programs is through the CA bridge program that has individuals embedded in the Emergency Departments throughout the state that meet with people who use drugs and educate them on the use of naloxone and make sure they are provided with it to take home with them. The theory of harm reduction is an acknowledgement that people are going to use drugs even with the prevention and treatment options that are available to them. The goal of harm reduction is not to stop people from misusing substances but to keep them from death or other serious emergency and long-term health problems. There is evidence that the health of the "unpopular population" is not a priority for many of the law makers and people that have access to make policy changes (Alexander R. Bazizi et al.) Due to the population that this medication will help, there is not as much support as ther e would be otherwise. The public seems to place an inappropriate amount of pressure for proof on researchers instead of allowing the evidence to speak for itself.
Increased availability of naloxone is linked to fewer fatalities caused by opiate overdoses in the communities that have it easily accessible. Ther is evidence that this lifesaving measure is not only saving lives but saving money. According to the National Library of medicine, the average national hospitalization cost of overdoses should the individual be admitted was $7803 (Rioux, William et al.) A kit of Naloxone costs about 35 dollars, much less than the cost of opioid overdose admission. When lay people are giving naloxone to keep on hand if they ever encounter someone experiencing an opioid overdose, there is evidence that the public health risk is decreased. 'Knowing how to use naloxone and keeping it within reach can save a life" (Lai, Jeffrey T et al.) I think this measure should be akin to someone having Band-Aids or first aid kit, just in case they come across someone in need. In more than forty percent of overdoses reversed with naloxone, it was a bystander that administered the dose. (CDC, 2024) Giving out free naloxone to individuals is not a moral hazard and nor is it a risk to community safety. Bystander availability to carry take home naloxone is legal and should be encouraged despite community concerns about risky use or morality. "The 'moral hazard' argument gained momentum with the release of an economic study in the United States about the population level association between take home naloxone provision and emergency room visits, crime, and opioid-related morality". (Doleac & Mukherjee, 2018, 2021) There is still a stigma surrounding people who use opioids or have opioid use disorder having access to naloxone, but there is no evidence to prove that there is any harm related to it. (Lai, Jeffrey T et al.) People who use drugs are just as important as anyone else and they should be afforded with important evidenced based services and medications to be healthy and safe. I don't think it should be up to others to decide who should be provided access to life saving medication just because of stigma. People who use drugs should be kept alive even if their choices aren't endorsed by everyone. Dead people don't recover and that is what we should keep in mind.
Works Cited
There is evidence that deaths involving opiate deaths are continually increasing. Synthetic opiates such as fentanyl have caused the death rates to increase by 317% between the years of 2013 and 2019. (CDC, 2021). Fentanyl is a synthetic opiate that is about 50 times more potent than heroin and one hundred times more potent than morphine. Fentanyl is used in health care settings to ease the pain of the most serious cases. This sharp increase of drug overdoses is an epidemic in the United States that requires immediate attention. We have a moral obligation to stop these senseless deaths, especially because there is a cure. This bleak data doesn't just include people who intentionally use illicit opiates. People die from unintentional medication overdoses as well. Someone could be prescribed medication for their pain and accidently use too much causing overdose and sometimes death. In 2022 there were 14,716 deaths contributed by prescribed opioid medication. Additionally, there is a sharp increase of opiate overdoses from people using Meth and cocaine due to contamination of their substance source. Meth and cocaine are "uppers". Some people intend to use these substances in conjunction with opiates, but most don't. They may think they are using their stimulants and don't wish to engage in the illicit use of opiates and overdose due to their product being contaminated by someone who sold or prepared their product. It is estimated that people who use stimulants such as cocaine and Meth contribute to about a third of all overdose deaths yearly, all while not intentionally using opiates. It would be optimal for these individuals to have access to some harm reduction products to make sure they are using their drugs of choice in a safer way.
There is hope because there is a medication to combat opiate overdoses deaths, called Naloxone, it is an opioid antagonist, which means that it binds to the opioid receptors and completely blocks the effectiveness of any opioids in the body, restoring breathing to a person that stopped or slowed breathing because of too many opioids in the system (NIH, 2024). Naloxone stays effective in the body for about sixty minutes, then wears off. Opiates typically stay in the body for longer, so it is possible for someone to overdose again despite not taking any more opiates. Some of these nuances as to how the medication works has caused some people to think that they are not safe to use for lay people. However, statistics find that more lives are saved due to people having access to naloxone. If people are given a chance at living through the medication naloxone, the chances of them making it for help at the hospital is greatly increased. I feel that people might be finding little bits of information like this and blowing it out of proportion because the real reason they don't want to give out free naloxone is because they have a stigma surrounding the people that this medication would benefit.
So, if there is an antidote to overdoses, why not have it available and the risk of overdose is so prevalent, the antidote should be easily and readily accessible. In 2022, the FDA had taken measures to help facilitate access to naloxone products and can be safe and effective for over-the-counter use. A measure called AB 2760 which required prescribers to offer a prescription for naloxone when certain conditions were present. This was signed into law in 2018, and there are barriers to this. Only about 4 percent of people prescribed will fill their order for it. Again, this can be related to the stigma surrounding naloxone. People do not want to be seen with it due to being fearful of being labeled as someone who willingly uses opiates. The people who don't want access to naloxone feel like the mere notion of having naloxone on hand would promote the substance user to be riskier with their opioid use. This slippery slope way of thinking causes people to literally die. Some people don't fill their prescription for naloxone because they would have to pay a copayment for it, so they decide to leave it. And what if they don't have other prescriptions to pick up? They are less likely to go out of their way to get it. Society must provide an easier way to ensure that people have easy access to medication that can help themselves and others. There are entire groups of people who believe that harm reduction measures such as naloxone distributions will lead to the collapse of society morals. Wouldn't the moral thing to do be to render aid to those in danger? People must realize that this is not the first harm reduction measure ever done. Harm reduction is all around us. We wear seatbelts and use car seats, these were not always mandated, and some people were against it being mandated when the laws began to change, now we see a 45-60 percent reduced risk of death due to this safety measures. Hard hats and steel toed boots are required at work sites. We have smoke alarms and CO2 detectors, now mandated in rental property and buildings. E wash our hands, medical professionals didn't even do this prior to evidenced based studies proving its effectiveness. Even smoking cigarettes with a filter makes this harmful habit a little less harmful. These are all harm reduction strategies that not everyone was initially for and now lives are saved because of following these everyday harm reduction practices. I think we need to step back and look at all the harm reduction strategies that save thousands of lives. They might have seemed absurd, annoying or oppressive initially, but now they are second nature and even appreciated. I think that take home naloxone could one day be viewed in the same light. If people know more about the history of harm reduction in other areas and how we all benefit from these safety previsions, they will have more insight as to how drug harm reduction can also help society.
The people who believe that free naloxone available to the public causes people to use more opiates or use them in a riskier way are wrong. This practice does not encourage riskier substance use and people don't use more just because there is naloxone present at the time of use. There is absolutely no evidence that having naloxone present contributes the increase of opioids used (Tse, Wai Chung, et al.) In a study that interviewed individuals about changes in use when naloxone was present, they all denied that they engaged in risker use because of having naloxone available, although, they did give antidotal instances of increased risky use because of take him naloxone. (Lai, Jeffrey T et al.) The fact of the matter is that people who use opiates don't want Naloxone to be used on them. In a study that interviewed individuals previously revived with naloxone, it was reported that being revived with naloxone was very unpleasant. (Lai, Jeffrey T et al.) Being revived with naloxone is very painful and feels like going into a rapid opiate withdrawal. (Moustaqim-Barrette A et al.) Some symptoms of opiate withdrawal are extreme body and joint pain, abdominal pain, runny nose, diarrhea, nausea, difficulty concentrating and irritability. It's for these reasons that people spend so much time finding opioids to help alleviate these symptoms. Besides being extremely uncomfortable and painful, there are multiple other reasons people who use opiates don't want naloxone used on them. People who use drugs typically spend a lot of time and resources to obtain their drugs of choice. The time and effort put into that would automatically be wasted if they suddenly lost their high because of naloxone. So, the notion of people who use drugs to just use naloxone so freely seems highly unlikely. I have worked in a detox and during admission process people frequently come in under the influence of opiate drugs. At times they seemed that they may have taken too much, as evidenced by falling asleep with difficulty to arouse, head nodding, and breathing slowly. On occasion I was tempted to use naloxone on them and call 911. Prior to making the decision to treat them with naloxone i would try everything including threatening to use it on them. And to my surprise the person that was difficult to arouse seconds earlier, straightens out and answers questions at the mere mention of possible naloxone use. They beg for it not to be used, even to the point of crying and begging. Because of what I have seen, I don't believe that people would be taking the risk of using it differently just because naloxone is available.
The citizens in the United States could learn from other countries who have adopted some impressive harm reduction measures. In an article by E. Holmen et al., the program that Sweeden has made these programs work. Sweden made a new way for people to survive opioids overdoses. Community partners have made commitments to make sure that naloxone is available for people who use drugs. They found these services also helped the people who were reluctant to activate emergency services due to fear of legal issues. Some people who have benefitted from overdose reversal from naloxone expressed that they preferred not to seek help after overdoses was low. This is not a problem in the United States due to bystander Good Samaritan laws, but people who are scared or uninformed will still have those concerns. By allowing people access to this take-home naloxone, it has taken off some of the hospital systems' hardship. Sweeden found that people that had access to naloxone had an increased safety by allowing the community to help individuals. People who would not have otherwise been able to service live to see another day and there is potential for them to change their lives. New policies are in the works that improve life for drug users, but they are still a low priority. Aside from assuming that naloxone causes people to use it in a riskier way, people also object to naloxone being handed to the public because of opiate overdoses being a serious problem that has to be handled by professionals and not by lay people. (Alexander R Bazzazi) Giving naloxone only requires a short amount of training and substance users are good at recognizing and responding to overdoses. Another issue at hand though is that the people that are around to witness an overdose are more likely to be impaired themselves. I feel that the action of passing out naloxone is also an opportunity to share information. Every naloxone kit passed out, they can be educated about administering and other safety issues. They can learn about other ways to stay safe such as Fentanyl Test strips, clean needles and other supplies.
Programs that make take home naloxone available are rooted in the harm reduction models. In the past 5 years, new programs have come about where California, through the California Department of Health Care Services (DHCS), gives community centers such as hospitals and nonprofits free naloxone. One of the programs is through the CA bridge program that has individuals embedded in the Emergency Departments throughout the state that meet with people who use drugs and educate them on the use of naloxone and make sure they are provided with it to take home with them. The theory of harm reduction is an acknowledgement that people are going to use drugs even with the prevention and treatment options that are available to them. The goal of harm reduction is not to stop people from misusing substances but to keep them from death or other serious emergency and long-term health problems. There is evidence that the health of the "unpopular population" is not a priority for many of the law makers and people that have access to make policy changes (Alexander R. Bazizi et al.) Due to the population that this medication will help, there is not as much support as ther e would be otherwise. The public seems to place an inappropriate amount of pressure for proof on researchers instead of allowing the evidence to speak for itself.
Increased availability of naloxone is linked to fewer fatalities caused by opiate overdoses in the communities that have it easily accessible. Ther is evidence that this lifesaving measure is not only saving lives but saving money. According to the National Library of medicine, the average national hospitalization cost of overdoses should the individual be admitted was $7803 (Rioux, William et al.) A kit of Naloxone costs about 35 dollars, much less than the cost of opioid overdose admission. When lay people are giving naloxone to keep on hand if they ever encounter someone experiencing an opioid overdose, there is evidence that the public health risk is decreased. 'Knowing how to use naloxone and keeping it within reach can save a life" (Lai, Jeffrey T et al.) I think this measure should be akin to someone having Band-Aids or first aid kit, just in case they come across someone in need. In more than forty percent of overdoses reversed with naloxone, it was a bystander that administered the dose. (CDC, 2024) Giving out free naloxone to individuals is not a moral hazard and nor is it a risk to community safety. Bystander availability to carry take home naloxone is legal and should be encouraged despite community concerns about risky use or morality. "The 'moral hazard' argument gained momentum with the release of an economic study in the United States about the population level association between take home naloxone provision and emergency room visits, crime, and opioid-related morality". (Doleac & Mukherjee, 2018, 2021) There is still a stigma surrounding people who use opioids or have opioid use disorder having access to naloxone, but there is no evidence to prove that there is any harm related to it. (Lai, Jeffrey T et al.) People who use drugs are just as important as anyone else and they should be afforded with important evidenced based services and medications to be healthy and safe. I don't think it should be up to others to decide who should be provided access to life saving medication just because of stigma. People who use drugs should be kept alive even if their choices aren't endorsed by everyone. Dead people don't recover and that is what we should keep in mind.
Works Cited
