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April 12, 2023

Narcan will soon be sold over-the-counter, but not in 28 CT towns

YEHYUN KIM / CT MIRROR Jess Morris, the mobile outreach worker at Perception Programs, a behavioral health services nonprofit, converses with a person who came to the van to receive harm reduction supplies and ask about the effects. The supplies provided for free include fentanyl testing kits, wound care kits, and Narcan.

In the past five years, over 7,000 people in Connecticut died due to opioid overdoses.

That’s enough to overflow the Hartford Yard Goats’ Dunkin’ Park or fill the main theater at the Bushnell more than twice.

“I literally have lost count on how many people that I know, love, have worked with my family that have died from this,” said Jess Morris, the mobile outreach worker at Perception Programs, a behavioral health services nonprofit. “I’ve responded to more overdoses off the clock than on.”

Every day of the week, Morris drives the organization's van to various locations where she provides services such as wound care kits, safe sex supplies, recovery support referrals and opioid use treatment, among other things.

One of the things Morris distributes is naloxone, an opioid antagonist that has successfully reversed more than 2,000 overdoses statewide since 2016. Morris administered 78 of them.

Either as an injection or nasal spray, naloxone is currently available with a prescription through a physician or pharmacist, without a prescription at pharmacies that have a standing order, or through a community health organization like the one Morris works in.

But starting in late summer, a brand of nasal spray naloxone, Narcan, will be available over-the-counter after approval by the U.S. Food and Drug Administration last month.

Access may be difficult in rural areas

Despite the FDA approval, some people in Connecticut may still have a difficult time obtaining Narcan over-the-counter.

Currently, 28 towns in the state, mostly rural, don’t have a store that is eligible to sell over-the-counter medication, according to permit data from the Department of Consumer Protection.

In these towns, since 2018, there have been at least 104 opioid overdose deaths.

And while a store with Narcan could be just a town away for those with access to transportation, it’s not as simple for individuals with opioid use disorder that are also experiencing homelessness or those that don’t have access to a car.

Until then, one of the most direct ways to access naloxone is through a pharmacy, since they're conveniently located in many neighborhoods, providing quick and direct access to residents.

Yet, there are 45 towns where a pharmacy with a certified pharmacist is not available to prescribe and dispense naloxone or solely dispense it through a standing order.

And in these towns, since 2018, there have been at least 149 opioid overdose deaths.

Emergent BioSolutions, Narcan's manufacturer, will set the price of over-the-counter Narcan and is already facing pressure from officials, such as U.S. Sen. Blumenthal, urging it to make it affordable.

For friends and family of drug users

“Narcan is not for people who use drugs. It is for people who may encounter someone who uses drugs … You can’t ‘Narcan’ yourself,” said Morris.

But a bystander, such as a friend or family member, could. And CDC data shows that almost 40% of overdose deaths involving opioids or stimulants occurred with someone else present, creating a need for widespread availability of naloxone among non-drug users.

“That is definitely part of my spiel all the time: You don't use alone. If you have to use alone, use the Never Use Alone Hotline or one of those apps [NORA] or wear your Narcan so that if you fall out and somebody comes upon you, they will be more likely to administer it for you,” said Morris.

Morris used to have an active opioid use disorder, using the opioid-based painkiller Percocet in amounts far larger than recommended. In 2012, she decided to go to treatment.

"I was just sick and tired of living the way I was and being sick and chasing not being sick. I wasn't even being high. It was just to get out of bed and function. And so I went to treatment," said Morris.

Since then, Morris has been in long-term remission for over a decade. Besides being a certified community health worker, she runs a blog about topics related to substance use and harm reduction, is organizing a network that provides support for people that experience or are at risk of experiencing vicarious trauma through their work, and her story is appearing in a federally sponsored documentary about opioid use.

CT legislation aims to increase access to naloxone

Before the FDA approval, there were four bills regarding access to naloxone that made their way out of the Public Health Committee and could be considered in the full General Assembly in the coming weeks.

One of the more expansive bills is Senate Bill 9, which would do two things. It would create the Opioid Antagonist Bulk Purchase Fund to provide grants to certain entities that purchase large quantities of opioid antagonists, such as naloxone, in bulk at a discounted price. Those able to access the fund include municipalities, local or regional boards of education, district or municipal departments of health and law enforcement agencies.

The bill would also create a pilot program to create harm-reduction centers in three undetermined municipalities in the state.

A harm reduction center is a place where individuals can safely take controlled substances under the supervision of health care providers who can provide treatment if necessary. These centers rely on a harm reduction approach that acknowledges that some cannot fully abstain from using drugs and that minimizing harm is the most effective approach. 

A different bill, Senate Bill 1163, would allow funds from the Opioid Settlement Fund to be used to provide municipal police departments with opioid antagonists such as naloxone. 

While this is a win for advocates who say it will help in cases where a bystander without naloxone calls 911, Morris suggests taking further steps and having a rapid response team of trained volunteers, such as ORRS, the Indiana University School of Public Health’s Opioid Rapid Response System. If emergency services are unable to reach the person overdosing in time, they send trained citizens who have the ability to administer naloxone.

“They [ORRS] have volunteers in whatever area they're serving all around the town to cover all the space. If an overdose is called, it's kind of like Uber, where you put your app on when you're available, you turn it off when you're not, they reach out to whoever is closest to go,” explained Morris.

Another approach being considered is similar to Morris’ day-to-day job. Senate Bill 1102 would allow pharmacies to operate a mobile pharmacy that would provide naloxone and train people on how to use it, among other services. The bill states that mobile pharmacies must operate in underserved communities, opening up opportunities for towns where there is a lack of access to naloxone.

A more administrative approach not directly related to naloxone is being considered in House Bill 6698, which would create the Office of the Chief Drug Policy Officer. The office would collect information regarding services to individuals with substance use disorder and would also be the point of contact for the expanded statewide peer navigator program. The statewide peer navigator program would allow any community to use funds from the Opioid Settlement Fund to create a team of peer navigators who will provide nonmedical care and services to people with substance use disorders. 

Related bills include providing devices that would destroy unused opioid drugs, the use of “digital therapeutic devices” for people with substance use disorders, and the use of vending machines or secured boxes to provide access to naloxone.

The next step for these bills is to be considered by the chamber in which they originated and to face either the Finance or Appropriations Committees if there's money involved.

Regardless of the bills that pass, Morris will continue to distribute naloxone to both users and non-drug users.

"One death is too many, but one death impacts so many people. It is so widespread, like trauma, you know ... so many lives are impacted forever by that death," said Morris.

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