East Providence Fire Department Capt. John Potvin has seen the lifesaving effects of naloxone in action dozens of times throughout his more than 30 years as a first responder.
“It’s kind of like a wonder drug,” said Potvin, who serves as the director of emergency medical services. “Someone could be blue and unresponsive and when given the drug in a timely manner, they start to feel better almost immediately.”
Naloxone is a medication that can reverse the effects of an opioid overdose within minutes and comes in several forms, including the nasal version known as Narcan. The drug is safe because it will not harm someone if they are not overdosing, so emergency responders such as Potvin have been carrying it for decades.
Until recently, only authorized medical providers or those with prescriptions could get naloxone, but many states, including Rhode Island, implemented standing orders that allow pharmacists to provide naloxone to those without a prescription.
But now everyone can buy Narcan over the counter for the first time, and those in Rhode Island working to reduce drug overdose deaths say it’s cause for celebration.
The lifesaving drug is available for purchase in stores and online at several retailers, including CVS Health Corp., Walgreens Co., Rite Aid Corp. and Walmart Inc. The manufacturer, Emergent BioSolutions Inc., says Narcan has a suggested retail price of $44.99 for each two-dose package.
The U.S. Food and Drug Administration approved Narcan to become an over-the-counter drug in March as the country continues to grapple with the overdose crisis. The number of drug overdose deaths in the U.S. has been steadily climbing over the past several years. In 2021 more than 105,000 people in the U.S. died of overdoses, with approximately 80% of those deaths involving opioids, according to the Centers for Disease Control and Prevention.
In Rhode Island, the number of accidental drug overdoses has remained at “crisis levels” with 435 deaths reported in 2021 and 434 deaths in 2022 – one of the highest rates per capita in the country, according to data from the R.I. Department of Health.
Advocates throughout Rhode Island have celebrated the availability of over-the-counter Narcan because increasing access to naloxone is known as one of the most effective ways to reduce overdose deaths.
Brandon Marshall, a researcher and professor of epidemiology at Brown University, says a recent study on which he collaborated showed that distributing an additional 10,000 naloxone kits per year could stop 25% of all witnessed opioid overdose deaths in Rhode Island.
Several community groups and providers within the state have implemented programs aimed at improving access to naloxone. These include several “Grab and Know” stations that Potvin helped establish throughout East Providence that offer free Narcan and information packets. There are also “Safe Stations” across Rhode Island where people can speak with trained staff and connect with recovery or support services.
While many have benefitted from these efforts, Linda Hurley, CEO of CODAC Behavioral Healthcare, says a lack of access to care and lethality of the drugs are the biggest challenges in reducing the number of overdoses.
Some people, especially those facing homelessness, have no way of physically getting to providers, Hurley says. Drugs have also become increasingly concentrated with fentanyl, and a non-opioid sedative, xylazine, has been recently found in Rhode Island’s drug supply and is thought to contribute to opioid overdoses. Hurley says people typically need one or two doses of naloxone to reverse an overdose, but recently people have needed up to four doses.
“This helps because one answer to this crisis is to increase access and get people comfortable with naloxone,” Hurley said. “It’s important to have more availability and to have enough.”
Some have raised concerns about Narcan’s price, saying it’s too expensive for the people who need it most.
But Hurley says naloxone will still be available for free through community programs, including at several CODAC locations that have vending machines with free Narcan. CODAC also offers outreach care through its mobile unit. Emergent BioSolutions also indicates it would offer a lower “public interest price” for first responders, governments and harm reduction groups.
Narcan will also be covered under several insurers, including Rhode Island and Massachusetts Medicaid, as well as Blue Cross & Blue Shield of Rhode Island, according to Jeffrey Bratberg, clinical professor of pharmacy at the University of Rhode Island.
Bratberg says that in July the FDA approved another over-the-counter version of naloxone called RiVive, which is scheduled to hit the shelves in early 2024. Retail competition between RiVive and Narcan will likely lead to price drops that will boost the accessibility of both drugs and lead to fewer overdoses, Bratberg says.
“It only works when it’s available,” he said. “Each death has a ripple effect on the community, but they are preventable.”
Advocates also agree that over-the-counter Narcan can help educate people about overdoses and reduce the stigma surrounding substance use disorders.
“This is a real problem that affects every aspect of life. Everyone probably knows someone with a substance use disorder,” Potvin said. “This will hopefully highlight the importance of the issue and help us get more people on the road to recovery.”
