Doctor: Pa. must boost availability of lifesaving opioid overdose reversal drug

Overshadowed by our tumultuous national elections and the COVID-19 crisis, Gov. Tom  Wolf recently signed his 13th renewal of Pennsylvania’s opioid disaster declaration with little notice or fanfare. That declaration is designed to fight our unrelenting opioid epidemic by reducing regulations, driving greater agency collaborations and facilitating initiatives intended to expedite assistance to those suffering from opioid use disorders. A core component of this effort is a “standing order” that provides instant access to naloxone (commonly known as “Narcan”) — upon request without a prescription.  

Simply put, naloxone is a lifesaving intervention for individuals suffering an opiate overdose.  

This unique medication works instantly to reverse the impact of opioids on the respiratory system. Available as a single-use nasal spray or as an intramuscular injection, naloxone has saved countless lives allowing a “second chance” for patients to find recovery. The need for the broad distribution of naloxone is unequivocal. Seventy percent of all overdoses occur in the home and it is now more likely for a bystander to be called upon to administer naloxone than cardiopulmonary-resuscitation (“CPR”). It is covered by insurance, in many cases without a copay.  

While being one of the first states to enact such a standing order, my experience suggests that naloxone availability remains problematic in Pennsylvania. Those perceptions have been reinforced by two recent studies that looked at the distribution of naloxone in the commonwealth (one statewide, the second specific to Philadelphia) and concluded that fewer than 45% of pharmacies had these products immediately available.  

If we are to save lives, we need to do better. To this end, the commonwealth must redouble efforts around wider distribution of naloxone. 

While there are no opioid addiction vaccines on this horizon, we do have effective reversal agents that halt potentially fatal overdoses. We have several therapeutics that, with counseling, can successfully treat opioid use disorders allowing patients the opportunity to rebuild their lives. If we have learned anything from the COVID-19 pandemic, it is the importance of bringing all available resources to the “front” and controlling the disease with effective treatments. For opioid use disorders, wide availability of naloxone is foundational. People cannot get sober if they are not alive. 

Unfortunately due to the intense stigma associated with opioid use disorders, we have been unable to realize these basic precepts dooming us to this prolonged and deadly epidemic. But all is not lost and there are additional interventions the commonwealth can deploy to reduce opioid overdose fatalities including:

• The state must urge and, if necessary, mandate, medical prescribers to counsel patients and co-prescribe naloxone with every written opioid prescription as already required by several states. Additionally, prescribers must urge patients and their family members to utilize the standing order and stock naloxone in their homes.

• Pharmacies need to participate in this effort by stocking and dispensing naloxone.  Before mandating such a requirement, pharmacists need to be educated that just like diabetic rescue products (ex; glucose tablets), dispensing naloxone saves lives and accordingly must be actively promoted in every pharmacy. 

• Our commonwealth must dedicate greater resources to educating the public around the standing order. This includes public service announcements that explain what the order does and how to access naloxone. Additionally, educational materials targeted to prescribers and pharmacists to drive greater distribution of naloxone needs to be aggressively initiated with results monitored.

As a physician on the frontlines of this epidemic, I regularly witness the high cost of the limited availability of naloxone. I see it in the rising death rate projections that cross my newsfeed. I hear it in shared stories from individuals in the depths of their addiction and I feel it every day with the countless patients seeking my help as they confront this challenging and deadly disease.  

Pennsylvania has been losing nearly eight residents every day to opioids for nearly a decade. The state needs to be applauded for putting many critical reforms in place on paper to meet this challenge. Now we must renew our efforts to ensure the promise of these reforms is delivered.  

Dr. Aviva Fohrer is founder and CEO of Thalia Medical Center, a substance use disorder outpatient center in Haverford.