After years of continuously rising opioid overdoses, the US Centers for Disease Control and Prevention reported that overdose deaths decreased 3% in 2023, the first annual decrease since 2018. A new study shows how the increased administration of naloxone by non-medical laypersons – or bystanders with little to no medical training – could be one factor contributing to this decline.
Making naloxone, a drug used to reverse opioid overdose that’s commonly known as Narcan, more widely available has been part of concentrated efforts to increase layperson intervention.
The new study, published Monday in the journal JAMA Network Open, says that from June 2020 to June 2022, emergency medical services reported 744,078 patients receiving naloxone across the US. The researchers found that EMS-documented naloxone administration rates fell 6.1% in this period, but the percentage of people who got naloxone from a layperson before EMS arrival increased 43.5%.
“The fact that we saw an increase of 43.5%, we can tell that public health efforts are working,” said Chris Gage, lead author of the study and EMS Research Fellow with the National Registry of Emergency Medical Technicians.
Naloxone, which is commonly used as a nasal spray, reverses an overdose by blocking the effects of opioids. The medication restores breathing within two to three minutes in people whose breath has slowed or stopped due to overdose, often with just one dose. However, experts recommend calling 911 any time someone is overdosing, since they may need medical attention even after getting naloxone.
“There’s no real medical training required,” Gage said. “It’s pretty much as easy as spraying Afrin up someone’s nose. Just showing people that they could do something to potentially save someone’s life is the ultimate goal.”
The latest CDC data continues a recent downward trend in fatal overdoses in the US, which have fallen as much as 10% over the past year. The new research’s “significant increase” in layperson naloxone usage underscores the drug’s evolving role in public health strategies to address the opioid crisis, putting the medication in the hands of bystanders who can help save lives before emergency workers arrive.
“People who reverse overdoses are very likely to reverse more than one overdose,” said Dr. Nabarun Dasgupta, a senior scientist at the University of North Carolina at Chapel Hill who was not involved with the new research. “The evidence base for the effectiveness of naloxone is really focused on getting naloxone into the people who use drugs and the people who are around them.”
Only 3.4% of the 744,078 naloxone recipients in the study got the drug from a layperson, and Gage hopes that the number will continue to increase. Naloxone became available over the counter in September 2023 with a suggested retail price of about $45 per two-dose carton.
“Naloxone is a life-saving medication,” Gage said. “We’re in the middle of an opioid epidemic. Now that it’s over-the-counter, there should be even more access for people to be able to get this. If someone knows someone that has opioid addiction, they could potentially give a life-saving medication.”
Despite its increased availability, barriers still keep some opioid users from accessing naloxone.
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“Narcan nasal spray has been a multibillion-dollar monopoly for the better part of a decade,” Dasgupta said. “That’s changed over the last year and a half, but … states are paying more for naloxone than they should.”
He added that more education should be offered on what may be in the drugs that opioid users consume.
“There is a rapidly growing paradigm of drug-checking where we are able to analyze on the spot what is in an actual drug sample,” Dasgupta said. “What we find is, most drug supply is highly contaminated. We often see people throw away their drugs or make a decision whether to take that or not.”
Gage said the new findings can help inform policies and practices aimed at reducing the effects of the opioid epidemic.
“If more laypeople are giving the administration of naloxone, then hopefully that means that these people aren’t dying,” he said.