Today, the FDA announced that Narcan – an emergency medicine that reverses opioid-related overdoses – will now be available over the counter.
This action builds on our progress to reduce overdoses by expanding access to addiction care and reducing the supply of illicit drugs. https://t.co/NdGdUVnfgL
— President Biden (@POTUS) March 29, 2023
This is a big deal. NARCAN is extremely effective at reversing opioid overdoses. The more people are carrying it, the more likely a dose will be readily available when someone is in trouble.
That’s great news!
Holy cow! That IS a big deal, and yeah it WILL save lives! Every damn day and twice on Sundays.
*sigh* Brace for right-wing caterwauling about legalizing “narcotics.” What about the children?!?
@bbleh: Objectively speaking, the GOP likes it when people die.
This seems like a no brainer.
A drug that can save a life and has no effect on a person not on opioids.
Not something the average person needs nor does it effect them but can save a life.
And yes bbleh, the right wing will have a cow. Which right there should be a disqualifying reason for them to be considered part of humanity. If someone is going to have a cow every time they hear something they don’t like or understand they shouldn’t be allowed to be considered human. I mean anyone who has a cow really isn’t normal.
One of the more contentious conference sessions I’ve ever been at was when I saw this working paper showing evidence that increasing naloxone access in fact increases opioid mortality. Technically, the causal identification is based on the timing of state level rollouts of naloxone laws with a bevy of panel fixed effects to drain a lot of contemporaneous variation from the data.
Qualitatively, the story is an episode of “unintended consequences.” Increasing the availability of naloxone decreases the risk of using opioids. Being administered naloxone tells an opioid addict “this amount didn’t kill you, you can do it again or even more.” So even though there is plenty of encounter-level data showing that naloxone reduces mortality, the population story is very different. The paper offers some anec-data for that story, though panel-encounter data is unavailable.
I find both the technical and the qualitative stories very compelling, and so it’s hard for me to be very happy about this. Full disclosure: I have some remote professional connection to one of the authors, but it’s a relatively small group so everyone at least knows everyone else.
All that said, I still have naloxone in my own first-aid kit for festivals and events where drug use may occur. I recommend it to other safety-conscious people I know who attend such events. But it’s a complicated thing.
Ultimately what this policy change will do, in my view, is increase the safety of recreational drug use for more middle- and upper-class users who may accidentally consume fentanyl while increasing mortality rates for others.
Heard a radio interview with an anesthesiologist who described his standard practice for an abdominal surgery: two injection sites, one for Fentanyl and one for Narcan. When the surgeon wants the muscles relaxed he pushes in Fentanyl and when he wants them tensed, he pushes Narcan.
Noted the system works very fast and effectively, and the doses of each are tiny relative to previous drugs. IOW if they’d just stayed in the OR we would be far better off.
Anyhoo, this sounds like a great policy and I hope it eventually saves lives.
Narcan kind of does the opposite of reduce overdoses – what it reduces are overdose *FATALITIES*, which some regulators and journalists might remember from Mortal Kombat.
@bbleh: That was my second thought, right after “oh wow, yay, it’s about time, this will save a ton of lives”.
Then I figure it will be about 45 minutes before the same fucking people who can’t stop blaming Biden for opioid addiction and opiod deaths will start bitching about this.
@Keaton Miller: My friend’s son was prescribed Naloxone as part of his addiction treatment. It did work for that purpose but also had copious side-effects itself, to the point he eventually had to go into a facility to wean himself off of Naloxone. Several months later he died of an overdose (of exactly what, the coroner did not determine).
I have no takeaway, just ponder what was best for the young man as ultimately, nothing worked out for him after years of struggle (not just him, but the family).
Our addiction problems are vast and affect every corner of our society.
@craigie: which doesn’t stop them from caterwauling, however.
It’s bad faith all the way down.
Back in the 80s I had a couple of surgeries. Before the first one my legs were twitching, altho the injection I had received was supposed to relax them. Before the second one the same thing happened and when I mentioned it to the surgeon I was told that was an injection of fentanyl and I shouldn’t get it anymore.
So I am allergic to fentanyl. Demerol and codeine (another two stories). Just have to worry about the red wine intake, I guess. Heh.
The demerol story: Also in the 80s I was in the hospital for a pain in the abdomen. (nothing serious) At that time smoking was allowed only in the “lounge” in the corner. Well I got a shot of demerol and whenever I smelled cigarette smoke from that lounge I threw up. Three days of that and I was off cigarettes forever.
Still very sensitive to cigarette smoke.
Ryan Marino et al. on naloxone and the supposed moral hazard.
This is excellent. Opioid addiction now strikes me as a much more viable lifestyle choice.
@SpaceUnit: “I can quit any time!”
Awesome news. I wonder what the cost will be? FDA article doesn’t say, but hopefully it’ll be reasonably affordable. California plans to start producing our own naloxone soon, as a follow-up to the insulin announcement. Good news all around!
Clap clap clap
@JDM: There was a lot of criticism of that paper when it came out. The underlying source of much of it, in my view, came from the different epistemologies and research methods of different fields and ultimately lots of people ended up talking past each other instead of engaging on the substance.
The critique you linked has some of that problem — at minimum points 1, 2, 5, and 6 don’t really have anything to do with the paper’s research question, methods, data, or findings. Point 7 does exactly what I’m talking about: trying to apply the epistemology of clinical research to population research. It’s a useful exercise, but often the kind of data that clinicians depend on for individuals is simply not available for populations — points 3 and 4 are indeed asking for data which does not exist systematically (or didn’t at the time).
Ultimately, it’s not a slam-dunk case by any means. I’ll say I’m not an expert on opioids — I simply think the paper makes a good point. I’m also susceptible to “unintended consequence” stories. In my view, a critique of that paper that hits a bit harder is this one at Health Affairs.
As someone upthread said: ultimately our addiction problems are complicated and deeply-rooted.
Am reminded of those papers that used face covering mandates as a proxy for actual mask usage 2020/2021/2022.
In those cases, there’s vast amounts of surveillance video that could be used to spot check actual compliance at various times (probably a large fraction of which is archived for unrelated reasons), at least when entering and exiting indoor public places, but AFAIK not much if any use of it has been made.
@Keaton Miller: The Doleac paper that eventually got through peer review pulled out any causal statements while the Packham paper that survived peer review has really fuzzy language on causality. I think the reviewers pushed hard on some of the identification challenges so their research is mostly associational at this time.
I recall a NPR story (yeah, I know) about being a first responder in an area of the US South that was deep in the grip of Oxycontin abuse. They’d been called several times over 24-48 hours to the same house to deal with an overdose. By the third or fourth time, the person took too much and died before they got there.
As Keaton Miller is pointing out, the data could be showing that ready access to anti overdose drugs might actually be allowing an increase in the number of overdoses. Turning that around for a different view, it could be that more people who overdose are surviving now, when they might not have before. Combine that with the apparent corollary that once someone overdoses and lives they are more likely to overdose again, and you get the data showing what Keaton says that paper shows. Maybe we might want to look at ready availability of Narcan as being there to save the small number of overdose survivors who decide to get their addiction treated and get clean, with the sad recognition that this is a small number of people compared to the pool of addicted people. Addiction is very difficult and multifaceted.
I can see how that paper was like tossing a lit bomb into the addiction treatment community, because they’re savvy enough to know exactly how the Right is going to spin that data to eliminate addiction treatment funding and go hard right into even harder criminalization.
@Keaton Miller: Gelman’s critiques hold pretty well too I think
Here, free Narcan kits are available at all pharmacies and have been for years. I carry two in my day pack at all times, got a couple more for the work first aid kits. I have only had to use one once, (OD in a bathroom stall at The Orange Evil).
@David Anderson: That’s fair — as I say, it’s not my specific area of expertise and I just saw the working paper version. I’m more of a structural guy anyway. :-)
What little they saw was that some areas have few or no programs in place to help people. Very little, if any, support. So a person surviving an overdose there would be more likely to die later than a person surviving an overdose in an area where they have help available. They wrote it up as if that was a problem with the method of surviving the overdose, but it isn’t; it’s a problem of help not being available in those areas.
And frankly, economists or not, they should’ve been able to figure that out. That makes me think they either didn’t want to figure it out (and it isn’t that difficult) or they aren’t very good at what they’re attempting to do.
@StringOnAStick: That is much of what my (dark) humorous response was supposed to suggest. It should increase overdoses, while reducing fatalities where it was available.
It’s risky to extrapolate the net effects, because there are clearly a lot of ways to “lie with statistics,” in a situation like this. If a person was saved three times, and then dies, do you look at the eventual death, or the extension of life past the first OD? Do you look at how there are now far more addicts, in treatment, who’ve been addicted for over a year? Or, do you note that this is because none of them died from an OD, when that would have killed X% of them in the past?
It’s always good to save a life, if you have no other information available – and no, it doesn’t make you responsible for every bad thing that happens after you save their life.
I was in law enforcement for 27 years, and I’ve never seen anything like Narcan. It brings people back from the brink of death nearly instantly. A negative side effect is that many of those same people want to fight with you because you screwed up their high, but I’d rather wrestle with someone who is going to live than to knock of the door of the family of someone who died.
@SomeRandomGuy: It’s always good to save a life, if you have no other information available – and no, it doesn’t make you responsible for every bad thing that happens after you save their life.
Thank you. I always find myself a little sick reading papers that carefully explain to me why it’s better according to this or that macro proxy measure to let someone non-terminal die rather than administering a cheap and effective treatment that saves their life.