With increased reports of fentanyl overdose deaths across the nation, the U.S. Food and Drug Administration’s (FDA) recent approval of over-the-counter (OTC) Naloxone Nasal Spray will allow more people in need to access the life-saving medication.
The California Department of Public Health reported more than 7,000 deaths related to any opioid overdose in 2021.
San Bernardino and Riverside Counties were reported as having some of the highest number of deaths related to opioid overdose in the state.
According to the latest available data from Riverside University Public Health, “From January 2019 to April 2022, there were a total of 2,442 county-wide fatal overdoses. Fourteen percent of all fatal overdoses in Riverside County occurred among people experiencing homelessness.
San Bernardino County has experienced steady increases in overdose deaths during the last few years. In 2018, there were 30 fentanyl overdose deaths in the county. In 2019, that number rose to 74 and then to 227 in 2020. In 2021, there were 309 fentanyl overdose deaths in the county.
The San Bernardino County Department of Public Health issued a health advisory last fall to address the dangers of fentanyl due to the increase in overdose deaths in the county. The advisory was intended to raise awareness of a “significant threat to public health” when one is identified, as well as issue recommendations to eliminate or mitigate the risk.
What the FDA approved
The FDA approval is for Narcan, a 4 milligram (mg) naloxone hydrochloride nasal spray for OTC, nonprescription, use. This will be the first naloxone product to be approved for use without a prescription.
Naloxone is a medication that quickly reverses the effects of an opioid overdose and “is the standard treatment for opioid overdose,” according to the FDA.
“Of the various harm reduction strategies, Narcan is one the most accepted strategies — from friends/family to medical providers to public safety, though it wasn’t always as accepted and there still is stigma associated with using Narcan to save lives — especially on those with substance use disorder/unhoused,” Wendy Hetherington, branch chief of Epidemiology & Program Evaluation, wrote in an email. “By making it available OTC at a neighborhood pharmacy it opens the possibility of becoming more widely accepted.”
Narcan nasal spray was first approved by the FDA in 2015 as a prescription drug. Members of an advisory committee met in February 2023 to discuss Narcan nasal spray for OTC. The members voted unanimously to recommend it be approved for marketing without a prescription.
“Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price,” FDA Commissioner Dr. Robert M. Califf said in a press release.
Hetherington said she hopes with the approval of the OTC drug, that the price will be low and people will be able to buy it straight from a shelf. She also shared that there are several organizations across the Inland Empire that provide Narcan for no costs such as Inland Empire Harm Reduction and DAP Health.
Narcan does not work on methamphetamine
“The hope is that this will reduce the number of overdose deaths. It is important to note that methamphetamine, which is not an opioid, is involved in the majority of overdose deaths in our region and Narcan does not work on reversing overdoses related to methamphetamine,” Hetherington explained. “Because of this, we do need to employ different harm reduction strategies. We won’t be able to completely address the overdose crisis without also addressing methamphetamine and the reasons why people develop addiction.”
The National Harm Reduction Coalition defines hard reduction as utilizing a variety of strategies including managed use, using safer techniques and abstinence to “promote the dignity and wellbeing of people who use drugs.” Harm reduction focuses on understanding the structural inequities that may contribute to someone’s use of drugs such as poverty, racism, homophobia, classism, etc.
More on harm reduction
Harm reduction strategies include using person-first language that remove stigmas surrounding someone who may use drugs. This method also emphasizes the use of “participant-centered services” and engaging with participants directly to empower them to share information with one another and reduce harm.
“With harm reduction it is important to have a wide variety of tools and strategies available. What works one day for someone may not work the next. The goal of harm reduction is to reduce misery and provide opportunity. Narcan is one tool and a very important one but it shouldn’t be the only harm reduction strategy,” Wetherington stated.