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The Drug That Saves Addicts: FDA Will Discuss Making Naloxone Over-the-Counter

Naloxone is a cheap, safe drug that could save countless people from overdosing on heroin and other opiates. So why isn't it in every first-aid kit?

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Fortunately, in Kinzly’s case, his friend had naloxone and knew how to help. “He said that he looked over and noticed I was turning gray and my lips were bluish. I had what he called a death gurgle. He loaded the Narcan into a syringe and injected it into my upper arm.”

Kinzly woke up, filled with shame over his relapse when he realized what had happened. Because naloxone reverses the effects of narcotics, it can cause withdrawal symptoms in addicted people. The symptoms are unpleasant but not dangerous.

“I certainly didn’t feel great, but I sure was grateful,” he says. “I was very embarrassed [but] I was incredibly grateful that I was going to have another opportunity to get clean again and watch my son grow up.”

Before his own overdose, he’d saved four people with naloxone and has since saved 10 others.

While doctors initially feared that naloxone carried the risk of causing seizures, this hasn’t been seen in the field. Naloxone distribution programs use lower doses than ER docs and EMTs typically do, finding that this saves lives without producing the intense withdrawal symptoms that might prompt users to seek and take more drugs. The drug is harmless if given in error for the wrong type of overdose. And because it's an opiate-receptor antagonist, or blocker (not to be confused with methadone and other opiate agonists, or substitutes), overdosing on naloxone itself is almost impossible.

Another fear has been that since naloxone is short-acting and some opioids have longer-lasting effects, people would be revived only temporarily and would need hospitalization for monitoring. While users are always advised to call 911 immediately—and many states are making “Good Samaritan” laws to exempt them from prosecution for drug possession if they call for help—at least one study found that refusing further medical care doesn’t increase the risk of death.

So what’s the catch? As with needle exchange, there’s moral discomfort among drug warriors who apparently feel that the wages of drug use should be death. Bertha Madras, the deputy drug czar under President George W. Bush, told NPR in 2008 that providing naloxone might sap users' motivation to get treatment because "sometimes having an overdose, being in an emergency room, having that contact with a healthcare professional, is enough to make a person snap into the reality of the situation and snap into having someone give them services."

Anything that reduces the risks of drugs, from this overdose-as-teachable-moment perspective, will keep addicts using longer and—why not?—even encourage children to start using. Yet in reality, of course, there’s no evidence that saving addicts’ lives prompts teens to take up drugs—and none that providing clean needles or naloxone deters recovery.

Indeed, Kinzly’s reaction to being revived—a recommitment to recovery—is common. And he might not have lived long enough to have it if he'd had to wait for an ambulance. Many people immediately seek treatment after surviving overdose. Also frequently reported by naloxone programs are people who kick addictions because the person who saved them was a sober example, showing them it was possible. In addition, the empowerment and self-esteem that comes from learning to help others and actually saving lives with naloxone can spur positive change.

So that’s why, just as I once called for recovery activism in support of needle exchange, I now believe we need it  to push naloxone. People in recovery—simply by existing—show that addiction isn’t necessarily forever and that valuable, productive people can suffer from and beat back addiction. We need to stand with those who are not yet ready so they can survive long enough to hear that message of hope.