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What Exactly Is Narcan and How Does It Work?

The opioid epidemic is getting more and more attention across America as the realization of just how serious this public health crisis has become. Case in point: U.S. life expectancy has decreased thanks to an increase in opioid overdoses. And women, in particular, should care about this issue, since women may have a higher risk for addiction.

Thanks to more coverage in the news (like that of Demi Lovato's recent apparent overdose), people are starting to learn more about what actually happens when a person overdoses on opioids. And considering 42,000 people died in 2016 of opioid overdoses, you may even know of someone who has. Enter: Narcan, a controversial drug that can save lives.

What is Narcan?

"Narcan, or naloxone (its generic name), works as an opioid antagonist," explains Jamie Alan, R.Ph., Pharm.D., Ph.D., assistant professor of pharmacology and toxicology at Michigan State University. That means it can reverse the effects of opioid drugs like heroin and morphine.

"It binds to the opioid receptor more tightly than opioid drugs, so Narcan will displace these drugs when given," says Alan. The result? "Narcan can reverse some of the lethal effects of opioids, such as the decrease in respiration that ultimately leads to death."

Though the drug can be administered as a shot into the muscle (kind of like an Epi-Pen used for allergic reactions), it works well as a nasal spray, which has become the most common form of the drug since it was approved by the FDA in November 2015.

And though Narcan has been around since the 1970s, you're hearing about it a lot more now. "Its use as an antidote has skyrocketed as the opioid crisis has worsened," explains David Neubert, M.D., an emergency department physician at NYU Winthrop Hospital, an affiliate of NYU Langone Health. "While abuse of other drugs was often more common, opioid overdoses are rapidly becoming the most common cause of fatal overdose in the U.S."

What's more, Narcan can be administered by anyone and is being issued to civilian responders, meaning that more people are aware of it. "It's an extension of similar initiatives such as CPR education, placement of automated external defibrillators (AEDs) in public locations, and 'stop the bleed' programs that have been shown to save lives by rapid intervention by trained civilians," says Dr. Neubert.

Plus, the laws around where you can get Narcan and who can administer it are changing. "Narcan has always been used in a hospital setting, and has been available as a prescription drug for a while," says Alan. But currently, you can get Narcan without a prescription in 44 states (although in some states you have to go through training before you can buy it). If you are curious about where you can get Narcan, you can look on their website, but it's generally sold at pharmacies like CVS and Walgreens. In the other states, you'll need a prescription from your doctor (which you can ask for if you have opioids at home) in order to obtain the medicine from your pharmacy. 

Why is Narcan so controversial?

Narcan has the potential to save lives, so why do some people seem to be against its wide distribution and use? "Unfortunately, drug abuse and overdose have a negative stigma," says Dr. Neubert. In fact, some people believe that treating overdoses with Narcan gives drug addicts more chances than they "deserve" and can just lead to future overdoses.

But think about it this way: "You do not vilify patients with cardiovascular disease, who are resuscitated with the use of a defibrillator, for having made poor lifestyle choices," Dr. Neubert points out. "That would be unthinkable. Yet people discuss withholding Narcan from patients who have a mental health issue that is very difficult to control once addiction grips them." (Related: How Exercise Helped Me Beat My Addiction to Heroin and Opioids

It's true that Narcan can't solve the problem on its own, but it can keep someone alive long enough to have a chance at treating their addiction. "We need to invest in better interventions once a person is saved with Narcan that will help them with long-term psycho-social support and care options needed to help them overcome addiction," adds Dr. Neubert. "These interventions are still being fine-tuned and developed, which is why we see patients that overdose more than once." In order to combat the opioid overdose epidemic, more money needs to be invested for further research in these areas moving forward, he says.

But even some within the medical community think that Narcan could be doing more harm than good. One study showed that after Narcan became widely available, ER visits related to overdose and arrests related to opioids increased, and the rate of overdose deaths nationally stayed stagnant. This is a favorite data set of those who are anti-Narcan—seemingly proving that if addicts know they can be saved from an overdose, they're less likely to seek help.

The only problem? These figures don't necessarily mean that Narcan isn't saving lives. They could just mean that more people are addicted to opioids than before.

And for what it's worth, it's not just drug addicts abusing opioids or heroin off the streets who have their lives saved by Narcan. "I have had many patients over the years that have been 'brought back to life' by Narcan," says Aaron Wilson, M.D., chief medical officer at Sierra Tucson. "Some of them mistakenly took more than the prescribed amounts of their prescription opiates, some took previously prescribed amounts from their medicine cabinets not realizing they had lost their tolerance for opioids. All of these people are alive today because of Narcan." (FYI, here's everything you should know before taking prescription painkillers.)

What do you need to know?

If you know someone with an opioid addiction, it's an option to have Narcan on hand. "Administration is fairly straightforward, and there are training courses available should you decide that you want to obtain Narcan and want to be ready to administer it," says Alan. But it's important to note that after administering the medication to someone experiencing an overdose, they need to go straight to the hospital for further treatment, or you can call 911.

There aren't many harmful side effects. While those who have overdosed may experience withdrawal symptoms like chills, nausea, and body aches as it takes effect, "Narcan has a very low risk of side effects if you administer it to someone who is not overdosing on opioids, or has instead overdosed on benzodiazepines or alcohol," says Alan.

It's unlikely that you'll get in trouble for using it. "In several (but not all) states, there are good Samaritan laws that will protect you if you administer Narcan if you are acting in the best interest of the patient," Alan notes. In other words, if you are using opioids illegally, or the person experiencing an overdose is, a good Samaritan law would protect you as well as the person overdosing from being prosecuted for any drug-related offenses if you call 911 or go to the hospital. Be sure to look up your state's laws and regulations, or talk to a doctor or pharmacist.

It's not a cure. "Please know that while Narcan can save someone's life in an acute overdose, this drug will not 'cure' opioid addiction," says Alan. "The best course of therapy, in the long run, is to make sure your loved one gets into rehab and gets the physical, mental, social, and spiritual help that they need to overcome the addiction."

Bottom line: Addiction is a disease, and it requires treatment. "This is no different from being treated for a disease like high blood pressure, and should be treated as such," Alan says. "One dose of a drug does not cure high blood pressure, just like one dose of Narcan will not cure addiction."

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