Making Narcan (Narcan) an over-the-counter product is welcome news for all. We need to be aware of what is naloxone and its strengths and limitations.
Narcan was approved by the FDA way back in 1971! It is a not a new drug, but the development of naloxone should have been a watershed moment in the history of opioids. It was the first ‘opioid’ that did not cause tolerance and therefore, no addiction. Indeed, it belonged to a new and exciting new class of opioids called ‘opioid antagonist’. As the name implies, opioid antagonists are the polar opposite of opioid agonists, drugs like morphine, oxycodone, methadone, fentanyl etc. The development of naloxone should have triggered the search for dozens of medications in this new class. Sadly, it did not happen.
Naloxone is such an amazing medication that it has been described by some as the ‘most perfect drug ever developed’. Given in time, naloxone will reverse the effects of every known opioid and restore breathing. The approval of naloxone came when the worst of the heroin epidemic of 1960’s/70’s was over. There was little or no enthusiasm for this medication and it was tossed on a shelf collecting dust.
We need to be aware of the limitations of naloxone. Not one article mentions this. Naloxone’s half-life is between 30 and 45 mins, which means the effects are gone in less than an hour. The other key limitations are that the drug can only be administered after an overdose has occurred and only by a person other than the patients. Narcan can only be given as a nasal spray or injected. Narcan is not like the Epipen. Patients experiencing an allergic reaction can self-administer epinephrine. A patient overdosing on opioids will not be aware of it to self-administer Narcan. Inspite of these limitations, the move by the FDA is welcome.
We cannot stop just at the level of naloxone. Based on the pharmacology of naloxone, the federal government developed naltrexone to take opioid antagonist to a new and exciting level. Naltrexone overcame the limitations of naloxone. Naltrexone is effective orally and its half-life its effective half-life is 24 hours. In a nutshell, naltrexone was the first anti-opioid ‘vaccine’ that protected patients from relapsing to opioid use. The development of naltrexone should have been another watershed moment, instead it was relentlessly attacked and discarded.
Naloxone and naltrexone are pharmacologically identical except for the half-life. Given the gravity of the opioid epidemic, the FDA and other Federal agencies should seriously consider giving naltrexone the same status a naloxone. State agencies should be allowed to issue a statewide prescription and high-risk patients should be able to pick a small supply of naltrexone tablets without a prescription and then see a doctor. This approach can be closely evaluated as was done with naloxone.
We are in a life and death battle with the growing opioid epidemic, and we would be doing a great disservice if we do consider every treatment and prevention option.
A response by Percy Menzies to the article below: