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Question on the limitations of harm reduction in the face of the growing supply of fentanyl.

The article in the Wall Street Journal brings up the question on the limitations of harm reduction in the face of the growing supply of fentanyl. Fentanyl has now become the dominated and the most lethal of all drugs of abuse. It is not uncommon to find supplies of cocaine, crack, meth, heroin etc. laced with fentanyl.

The article makes a good point on the limitation of naloxone as the primary tool to keep patients alive by reversing an opioid overdose. Fentanyl is so incredibly potent (it is measured in micrograms) and fast acting that there may not be time enough to administer naloxone. In face of this problem what else can be done?

Let us start with acknowledging the limitations of naloxone. It cannot be self-administered by a patient. It must be given by a person other than the drug user. Secondly, naloxone can only be administered after the patient has overdosed. There are suggestions of administering the naloxone as an injection. In all likelihood, the naloxone injection will have to be in a pre-filled dosage form.

We are advocating a prevention strategy of distributing naltrexone tablets as a prophylactic measure for high-risk patients. I have talked about this in previous postings. It is high time we accord the same status to naltrexone as naloxone and give it the same level of access. A prevention strategy has several practical benefits. It will certainly relieve some pressure from first responders who must administer the naloxone. Making naltrexone available at community pharmacies will give pharmacists a critical role in educating patients and their families about opioid use disorder and prevention measures. Most importantly, it will give patients hope that can be protected by the effects of opioids even when surrounded by opportunities to use opioids.

The new slogan should be: I AM ON NALTREXONE AND I CARRY NALOXONE.

Percy Menzies, M. Pharm. is the president of Assisted Recovery Centers of America (ARCA), an integrated treatment center for addictive disorders and mental health based in St Louis. He can be reached at:

1 Comment

R Willis
R Willis
May 03, 2022

It should be a point of embarrassment that so few "treatment professionals" educate patients on the benefits of prophylactic naltrexone. Highly effective, inexpensive and widely available. Must be tough being a generic.

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