Crypto News: Narcan is the first step

Hi, it's Tanaz from New York. After advisers to the Food and Drug Administration voted to make Narcan, an opioid overdose reversal medication, available over the counter, I became curious about the challenge of treating people who overdose. But first…

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Fentanyl is a synthetic opioid at the center of the ongoing overdose crisis in the US, accounting for more than 70,000 of about 108,000 overdose deaths in 2021. Making Narcan, also known as the generic naloxone, widely available could be a big step toward battling that grim statistic. For one thing, it can help family and friends of those who've unwittingly overdosed on fentanyl to intervene quickly to administer the drug, potentially saving lives.

It's increasingly common for people to be under the influence of many other substances in combination with fentanyl — and that can complicate emergency treatment. Among people at substance-abuse treatment centers around the country who tested positive for fentanyl, about 83% were also positive for at least one additional drug, according to an analysis of tests collected in late 2022 by Millennium Health.

That's a sharp increase from a few years ago. Polysubstance use is the practice of taking a cocktail of drugs intentionally or unintentionally. It's a growing and extremely dangerous problem. A majority of fatal overdoses involve more than one substance, according to the report.

"I see too much focus on fentanyl," says Eric Dawson, vice president of clinical affairs at Millennium Health who contributed to the report. "I think really what we have in the nation is a polysubstance use crisis."

One challenge posed by the increase in polysubstance use is that naloxone only addresses opioid overdoses. If someone is overdosing on an opioid like fentanyl in addition to a stimulant like cocaine, naloxone will only address the opioid overdose. The recommendation, however, is still to administer naloxone and to immediately call emergency responders, who can better assess the situation and provide more comprehensive care.

"It's very low risk [to administer naloxone] and very high benefit," says Leonard Kamen, a physical medicine and rehabilitation specialist at MossRehab in Pennsylvania.

Among those who tested positive for fentanyl under Millennium Health's analysis, almost half also tested positive for methamphetamine. The stimulant was the second most detected substance among those who were positive for fentanyl and presents its own unique treatment challenges.

"Meth causes people to be agitated. If someone is revived very quickly from an opioid overdose with Narcan, they can also become agitated," says Angela Huskey, chief clinical officer at Millennium Health. "But you should absolutely continue to give Narcan."

The unpredictability of the patient's response is another reason to call emergency responders when administering naloxone.

"Some will not want to call 911, because there's illegal activity going on," Dawson says. "You can imagine why they don't want to, but they need to." — Tanaz Meghjani

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