Pharma: January 2008 Archives


January 27, 2008

NPR has an interesting story about Narcan rescue programs. The idea is to package the opioid antagonist naloxone (Narcan) in an easy to administer nasal spray that users acn administer in case of heroin overdose. Based on the article, it's a bit hard to figure out what the impact is, but here are the uncontrolled statistics:
The nasal spray is a drug called naloxone, or Narcan. It blocks the brain receptors that heroin activates, instantly reversing an overdose.

Doctors and emergency medical technicians have used Narcan for years in hospitals and ambulances. But it doesn't require much training because it's impossible to overdose on Narcan.

The Cambridge program began putting Narcan kits into drug users' hands in August. Since then, the kits have been used to reverse seven overdoses.

New data compiled for NPR by researcher Alex Kral of the consulting firm RTI International show that more than 2,600 overdoses have been reversed in 16 programs operating across the nation.

Kral estimates that is at least 75 percent of all the reversals that have occurred so far among several dozen U.S. programs, many of which are new.

This is great, right? Well, not according to ONDCP:

But Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.

"First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," she says. "I just don't think that's good public health policy."

Madras says drug users aren't likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn't as likely.

Madras says the rescue programs might take away the drug user's motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras says.

OK, so this is pretty cold but maybe it's good cost/benefit analysis. Econ 101, right? If narcan produces a marginal decrease in the probability of dying of a given overdose but has a big negative impact on the abuse rate and thus presumably on the overall overdose mortality rate, then maybe it's good policy to restrict access (cf. risk homeostasis). It turns out, though, that (at least according to this article) there not only isn't evidence that Narcan increases the aggregate overdose rate, the (minimal) data there is suggests the contrary.

There is not much research on the effect of Narcan kits on drug abusers' behavior, but one small study suggests that overdose-rescue programs reduce heroin use and get some people into treatment.

There's not enough information here to tell whether Madras is just letting theory get ahead of the data, or whether her real objection is something else. That said, a lot of the resistance to various harm reduction measures seems to be based on not having the government appear to be (tacitly?) endorsing illicit drug use by taking steps to help users, so that may be what's going on here.