In 2021, 1,286 people in Minnesota died from drug overdoses, according to the Minnesota Department of Health, a 20 percent increase from 2020.

On Wednesday, the U.S. Food and Drug Administration announced that Narcan nasal spray, a drug that reverses opioid overdoses, would soon be available over the counter.

Opioids can cause overdoses by decreasing the urge to breathe, the respiratory drive. During an opioid overdose, people can stop breathing altogether and, if not helped in time, die. But, if Narcan is administered, it goes into the body and removes the opioids from the receptor, engaging breath and saving lives. 

Heather Blue, associate professor of pharmacy for the University of Minnesota Duluth and emergency medicine pharmacist at St. Luke’s Hospital, said making Narcan available over the counter will increase accessibility. She spoke with MPR News host Cathy Wurzer about it. 

How do these drugs work?

So when we think about how opioids cause overdose, they sit on the opioid receptors in our body. And while that can provide euphoria and kind of that high, and as well as pain control, part of that opioid receptor can actually decrease your respiratory drive and that urge to breathe. 

So what we see in opioid overdoses is our patients will not breathe, they will not be breathing adequately, or they will stop breathing altogether. When naloxone, or as you mentioned, the brand name Narcan, is administered, it goes into the body and then kind of rips the opioid off of that opioid receptor. 

Then the patient is able to have that drive to breathe, be able to take breaths, as well as it doesn’t cause some opioid withdrawal. But what we want that naloxone to do is to allow the patient to be able to breathe, and of course, then prevent a fatal overdose.

How might this decision by the FDA help increase access?

I think making it over-the-counter will really increase the accessibility of the medication for patients as well as patients family members to obtain this and to be able to prevent those fatal overdoses. I should also point out as we’re talking about accessibility, that it’s not the patient, or the person that is experiencing the opioid overdose that’s going to be administering this medication, it is going to be the friends, the family members or the rescue workers that will be administering this medication. 

When it was just a prescription medication, there was some concern of whether or not that prescription should be written for the person that would be most likely to use that versus the patient that wanted to have it available. By going over-the-counter, we’ve really taken that away and made it available for family members, anyone who wants to have naloxone on hand to hopefully again, reverse that fatal overdose.

How available is this drug right now in rural areas? 

So being that naloxone was only available with a prescription, it really limited where that medication could be. And we know that in our rural Minnesota areas that we do have places that are pharmacy deserts, that it’s a long ways away for some of our residents to be able to have a pharmacy.

We don’t know exactly where this naloxone over-the-counter will go, but this announcement by the FDA does make it available [and] could be as similar as ibuprofen or acetaminophen, available in stores, grocery stores and gas stations even. 

That can definitely increase the accessibility in our rural areas. Instead of having to go to a doctor and get a prescription or go to the pharmacy to pick up your naloxone, it could be available when you fill up your gas tank.

What about the cost?

That’s definitely been kind of the piece today as this announcement comes out. Because we had gotten to a point where insurance companies were covering the prescription naloxone fairly well, and so usually what happens when a medication goes over the counter, a lot of private insurances will not cover over-the-counter products. 

It is really unknown right now where that coverage will lie. And again, that’s a decision made by the insurance companies, and then where the price point is. So even if it’s not covered by insurance, making sure that it is still affordable for patients that want to have this should be available.

Some doctors and researchers contended that easy access to Narcan could enable continued opioid abuse and maybe worsen the crisis. Are those concerns still out there in the medical community?

Oh, absolutely. I would say those concerns are still out there. But I would also categorize them as they also are feeling some of the stigma seen around both this product as well as the opioid use disorder in general. As we look at the studies, we can see that when naloxone is available, and some of their harm reduction strategies such as safe-use places, the use of opioids does not increase. We see those fatal overdoses decrease. 

We need to be thinking at a broader kind of the next step, right? So this naloxone will reverse an opioid overdose. However, it doesn’t take care of the opioid use disorder, it doesn’t think about preventing an additional overdose experience. And so while that stigma still stands within health care practice, I think there are an equal amount of studies showing that it doesn’t increase that engagement. However, it does save lives. Then we can move forward into thinking about how we can treat opioid-use disorder in a more holistic way.

How do you recommend that folks educate themselves about how to use this?

Naloxone use is very easy, even just a quick Google search and you can find YouTube videos. The packaging will have education, the current prescription packaging has pictures and diagrams as well as walking you through with words.

It should be administered when a patient is suspected of opioid overdose death, or opioid overdose. So that looks like them being really lethargic, sleepy. Again, they’re not able to breathe well, they you may see some blue lips, a blue color to their skin.

For the nasal form, which again will be over the counter, all you have to do is insert that into the patient’s nostril, press the little trigger that gives the spray and so even if they’re not breathing adequately, they can absorb that medication within their nose and then that again is going to go and kick that opioid off the receptor. 

The other piece that I think it’s really important that people know is that often the opioid that’s causing the overdose hangs around in the body longer than the naloxone. So even if you have the naloxone available, and the patient does start to breathe again, that patient needs medical attention. 

They need to be brought to the emergency department because once the naloxone leaves the body there is that chance that the patients will have an additional overdose. And so they may require additional naloxone. It’s really important that people just know that piece of that, while we have more naloxone available, it does not take the place of further health care needs for that patient as well as getting connected to some of the community resources and treatment for opioid use disorder.

To hear the full conversation, click play on the audio player above.