Surgeon General responds to opioid crisis by making first recommendation in 13 years

Vice President Pence Swears In New Surgeon General Dr. Jerome Adams
For the surgeon general, this is personal: His brother struggled with drug addiction. (Image: Chip Somodevilla/Getty Images News/GettyImages)

For the first time in 13 years, the surgeon general’s office issued a public health advisory on Thursday, calling for more Americans to carry the opioid overdose antidote naloxone.

In a statement, U.S. Surgeon General Jerome Adams urged friends and relatives of opioid users — not just the users themselves — to keep the drug on hand. “Knowing how to use naloxone and keeping it within reach can save a life,” wrote Adams.

“Each day we lose 115 Americans to an opioid overdose. That’s one person every 12.5 minutes,” he added.

The last public health advisory came in 2005 and warned about the risks of drinking alcohol during pregnancy. It was a follow-up to a 1981 advisory suggesting women limit the amount they drink.

Of the current advisory, Adams told STAT: “What makes this one of those rare moments is we’re facing an unprecedented drug epidemic.”

Although many first responders, including police, firefighters and emergency medical services, already carry naloxone, Adams says that’s not enough. “It is time to make sure more people have access to this lifesaving medication, because 77 percent of opioid overdose deaths occur outside of a medical setting, and more than half occur at home,” he said.

From 1996 to 2014, at least 26,500 opioid overdoses in the U.S. were reversed by nonmedical professionals using naloxone, according to the National Institute on Drug Abuse (NIDA).

The NIDA defines naloxone as “an opioid antagonist — meaning that it binds to opioid receptors and can reverse and block the effects of other opioids.”

“When naloxone hits the brain, it competes and shoves loose the opioids that are suppressing breathing,” explains Edward Bernstein, professor of emergency medicine at Boston University, on The Conversation. “Usually, within a few minutes breathing is restored.”

Naloxone is available as an injection or nasal spray under the brand name Narcan. In the past few years, every state has passed legislation making naloxone available without a prescription, though not every pharmacy carries it (CVS offers it in 46 states and Walgreens at all of its locations), and in Maine you have to be at least 21 to obtain the drug.

The price for certain versions of naloxone has gone up in recent years, but because of insurance, that cost has not been passed on to most consumers. The average out-of-pocket price for the Narcan nasal spray is around $135 (for two doses), though in response to the surgeon genereal’s advisory, CVS announced that it would offer it for $94.99 to those without insurance.

Prior to his role as surgeon general, Adams was the health commissioner for Indiana, where he managed to convince then-Governor Mike Pence to lift a prohibition on needle-exchange programs in response to an outbreak of HIV in parts of the state.

“No matter how uncomfortable syringe service programs make us, they are proven to save lives, both by preventing the spread of diseases like HIV and hepatitis C and by connecting people to treatment that can put them on a path to recovery,” Adams wrote at the time.

But since then, Indiana’s attorney general Curtis Hill has criticized the programs, saying: “Handing out clean needles encourages substance abusers to shoot up and, in many cases, shoot up more often.” (The research doesn’t support this claim.)

That same criticism has been levied against naloxone. CNN spoke to the author of a recent study that suggests access to the overdose-reversing drug may embolden addicts to take higher doses.

Study author Jennifer Doleac, assistant professor of public policy and economics at the University of Virginia, told CNN: “Our research shows that expanding access to naloxone is not enough to reduce opioid-related mortality and may even increase opioid abuse.”

Doleac added, “We found that effects were more beneficial in places where more drug treatment is available. So if we are going to increase naloxone access, then it is also important to increase funding for drug treatment.”

On that, Surgeon General Adams would agree: “To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder,” he said.

Although the opioid epidemic has been declared a public health emergency, federal funding for treatment programs has yet to reach the states. Here’s to hoping that will change in the months ahead.

What Do YOU Think?

Were you familiar with naloxone before learning of the surgeon general’s advisory? Do you think it will help reduce the amount of opioid-related deaths? Would you keep it on hand? Let us know in the comments below.

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