Narcan will soon be available over the counter. One psychiatrist says everyone should get it.

In the nine months between January and September 2022, it's estimated that nearly 80,000 people across the United States died from drug overdoses. More than two-thirds of those deaths were the result of opioids. The Food and Drug Administration last week approved over-the-counter sales of Narcan. It may take months before the opioid-reversal drug is made available without a prescription, but when that happens, it could mean many more people have access to it.

Dr. Amanda von Horn, an addiction psychiatrist at Tufts Medical Center, joined All Things Considered host Arun Rath to discuss what people should know about naloxone. What follows is a lightly edited transcript.

Arun Rath: I got the opportunity to see Narcan in use when I did a ride along with the Worcester Fire Department. This was about four years ago, and it looked like a miracle. The gentleman was essentially dead, they administered a nasal spray, and then he stood up as if nothing had happened. Tell us about how the existing regime works for Narcan being administered. Aside from medical professionals or first responders, like police or fire personnel, who has access to it?

Dr. Amanda von Horn: All individuals who have ever had a history of opioid addiction or are prescribed opioids either for pain or other issues should be offered naloxone or Narcan to prevent intentional or unintentional overdoses at home.

Rath: Tell us a bit more about the drug. I gave the basics of it, but how is it packaged, how is it administered, and how does it work?

Von Horn: Naloxone, which is the generic name for Narcan, is available through injection with a needle into the intramuscular tissue or as a nasal spray. These are both kinds of immediate-effect medications that will reverse opioid effects and, in the most severe cases, opioid overdoses.

Naloxone actually blocks the effects of opioids, and it reverses opioid overdoses by binding to opioid receptors and actually displacing the opioids that are present. So if somebody has used, let’s say, illicit fentanyl and is overdosing — not breathing, sedated, non-responsive, in the active stages of dying — administering naloxone will remove the opioids from that person’s receptors and reverse the overdose.

Rath: Tell us about how the nasal form is administered. Is that the type that will be available to people?

Von Horn: I believe that the nasal spray is what is going to be available over the counter. It’s a little device that sprays the medication into the nostril, and it’s absorbed by the mucosa. It has rapid onset in effect and can reverse overdoses through administration in the nose.

Rath: Is that as simple as it sounds? Is that something pretty much anybody could do in an emergency?

Von Horn: Yeah, absolutely. It’s a little device that has a kind of trigger that you insert one part into the nose, and you just press the button, and it sprays the medication into that nostril. You should do it in both nostrils, and each device has enough naloxone in it to do two doses.

Rath: As an addiction specialist and a psychiatrist, tell us about what it means in terms of accessibility. Because it sounds like, prior to this, people who needed Narcan would be able to get it. But I’m guessing accessibility is still an issue; there must be some reluctance to ask for it, or stigma.

Von Horn: Absolutely. We know that addiction is such a stigmatized disease, and even with the coverage in the media as of late, with the increasing overdose deaths, it’s still heavily stigmatized. People feel a lot of guilt and shame about having this disease, and it does prevent people from seeking care and even harm-reduction practices like naloxone.

My understanding of the availability of Narcan, prior to the FDA approval, was that anybody could request the medication through a pharmacy, but that it would not be free of cost. It may have to go through that individual’s insurance, which was a significant barrier for people who did not want this medication — which indicates that they may have an opioid use disorder — in their medical record. So that is a significant barrier.

Patients who have opioid use disorder are often prescribed it, and I’ve had experiences with patients where they’re used the Narcan that I’ve prescribed them to rescue friends and family members who may have also used opioids. So I believe that the FDA approval is going to reduce the stigma barrier by allowing anybody to walk into a pharmacy and purchase it, hopefully at a reasonable price. But it will not have to go through insurance, and it will be available to everybody.

Rath: I have to imagine, from your perspective, getting more of this drug out there has to be a good thing with the way things are going right now.

Von Horn: Absolutely. The more people who carry Narcan, the better — even if they don’t have an opioid use disorder or if they don’t know anybody who has an opioid use disorder, because this addiction is so prevalent that there may be use disorders and overdoses in any public area. It’s better to have it than not, [so you can] save the life of somebody who’s really struggling with this horrible disease.

Rath: From a public health perspective, what do we do to build upon this? What’s next in order to try to maximize what can be accomplished with this drug?

Von Horn: That’s a great question. I’d like to emphasize that Narcan is purely a harm-reduction tool. It saves the life of somebody who is about to actively die from their addiction, from their opioid use disorder, and it will save their life. But it’s really not a treatment for their opioid use disorder.

What I think needs to happen is expanded access to evidence-based treatment for opioid use disorder, the mainstays of which are methadone and buprenorphine. A controversial issue in our country is these supervised consumption facilities, which, in the literature, have been shown to reduce overdose deaths and connect individuals who are struggling with addiction to evidence-based care.

While the reduction in the barriers to obtaining naloxone or Narcan is definitely a step in the right direction, we also need to expand access to these other life-saving treatments — life-transforming treatments.