Surgeon General's advisory: More should carry antidote to counter opioid overdoses

ATLANTA — The U.S. Surgeon General issued an advisory Thursday urging more Americans to carry naloxone, which can reverse the opioid overdoses that kill a person every 12½ minutes in this country.

Dr. Jerome Adams said people at risk of an opioid overdose, as well as their family and friends, should keep the antidote on hand. Many police officers and emergency medical technicians already carry it.

This is the first surgeon general advisory in 13 years. The last, in 2005, dealt with alcohol use during pregnancy.

"Surgeon general advisories are issued when there is a major health problem and a need for a call to action," Adams said in an interview at the National Rx Drug Abuse & Heroin Summit, where he's scheduled to speak Thursday morning. "One of the things we're trying to do is help the public understand that we're losing a person every 12.5 minutes from an opioid overdose, and ... over half of these overdoses are occurring at home.

"So we have firefighters, we have EMTs, we have police officers carrying naloxone, but we can save so many more lives if we can empower the citizens, the loved ones, the family members to carry naloxone."

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Whether people realize it or not, Adams said, "folks are overdosing around them each and every day and they can help save a life."

Adams said he plans frequent talks about the advisory, including events designed to highlight it. He stressed that the opioid epidemic touches every community. During his flight to the summit, he said, a flight attendant told him her son — an honor student — died from an overdose. Nationally, an estimated 2.1 million people struggle with opioid addiction, and opioid overdose killed more than 42,000 in 2016 alone.

"It's all around us," he said. 

Adams, formerly Indiana's health commissioner, said he hopes more widespread naloxone availability will help stem the fast-rising rate of death from opioids such as prescription pills, heroin and fentanyl. The national opioid death toll doubled from 2010 to 2016 – with especially sharp increases in fatalities linked to the synthetic fentanyl, which is 50 times more potent than heroin.

“Every grain is like a powerful bullet that can kill a human being,” said U.S. Sen. Ed Markey, D-Mass, a speaker at the summit.

Adams said more than three-quarters of opioid deaths happen away from medical settings, so ensuring more people have naloxone, also known by the brand name Narcan, is crucial. While the antidote is not a long-term treatment, it can suspend the effects of overdose until help arrives.

Naloxone "is basically a tourniquet," said Dr. Jay Butler, Alaska's chief medical officer, adding that he usually carries a pencil box-sized naloxone kit. "We actually have made (kits) available through a state program, so they're free of charge."

All states have laws that encourage access to the drug, which comes in a shot and as a nasal mist, and most allow pharmacy sale without a prescription.

In Kentucky, where more than 1,400 people died from drug overdoses in 2016, specially trained pharmacists can dispense naloxone without a prescription. It’s also available through the Kentucky Harm Reduction Coalition.  

Naloxone, which can vary in price and sometimes costs more than $100, is covered by most insurance plans. It also may be available to the uninsured through local public health programs or at discounts offered by retailers or manufacturers. Adams said he's working with the two naloxone makers to ensure universal low- or no-cost access. 

Adams and other health officials reject criticism that naloxone enables addicts who continue using opioids even after repeated overdoses.

"You can think of (naloxone) as CPR. You can think of an Epi-Pen,'' Adams said. "We don't give you one shot at a lifesaving intervention and then just leave you. We treat you as if you have a problem that is going to take a long time to definitively fix.

"Addiction's a chronic disease," he said. "It's not a moral failing and there's not going to be a magic fix. It's important that we use naloxone as a bridge to definitive treatment and long-term recovery."

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