The Future of Narcan

What's happening, what's at stake, and how to respond

In the bevy of bad budget news barraging us daily, you may or may not have seen this news:

In short, this is a significant cut to Naloxone distribution and training. First affected will be areas that fall fully under federal jurisdiction, including Tribal Nations. To be clear, most Narcan distribution is done at the State level using block grants from SAMHSA. If this were to be the only change to Naloxone access, most of us would not see an impact. However, with SAMHSA being subsumed by RFK Jr.’s HHS, we would be foolish to not prepare for this as the first of many changes.

So let’s talk about what this means.

Ok, but… what exactly is Naloxone/Narcan?

No shame if your understanding of Narcan is minimal. There is a lot of misinformation out there, as well as forces at work that would prefer this information not be widespread.

Here is a super helpful video from SAHMSA (that may eventually get taken down!)

Quick version: Narcan is an overdose reversal drug that targets opioid receptors to return people to normal breathing and consciousness in a crisis situation. The drug Naloxone has been around for decades, but in the last decade or so it was developed as a nasal spray, which empowered millions of lay people to get trained quickly and easily and to comfortably administer it. The result has been millions of lives saved, by first responders, social workers, friends, family, and strangers walking down the street. I have been a trainer for several years, and have administered it multiple times in my neighborhood.

Also noteworthy is that the 2016-2020 Trump administration was very pro-Narcan. But as we’ve seen, this administration is different. There is little we can presume, except that extremist, unscientific views that target scapegoat populations will continue.

So… what do we think is going to happen?

I have no idea. As I said, nothing feels off the table.

Extremely likely is that this cut will go through. Recipients of direct federal Naloxone aid and training will be cut off and need to pursue other sources.

It also seems likely that cuts will continue, given that SAMHSA is a federal agency, now directly in the hands of anti-science extremist RFK Jr., who has made clear his anti-harm-reduction views. This could be a huge blow to states that don’t have ample budgets and programs themselves to purchase Narcan. Strides have been made to bring down the cost, but nonetheless, Narcan needs to be prolific to be successful as an intervention.

Another likely scenario is that first responders may see this as an excuse to stop carrying Narcan—specifically police officers. EMTs will likely continue to have it, given their medical emphasis, but police officers have never shown unanimous support Many departments have stopped carrying it, or refused from the outset. As the primary infantry of the War on Drugs (which has always been a War on People Who Use Drugs), police officers are inherently conditioned to punish users, not to save them. If the commander-in-chief and his administration become anti-Narcan, the police are likely to follow.

And here’s the one we’re all thinking but perhaps afraid to say: Narcan may become controlled and/or criminalized for public use. Because hospitals and EMTs use opioids, Naloxone will always exist. However, the current ability for any person to be trained in it and purchase it at a pharmacy or receive it freely from a nonprofit may change. We unfortunately can’t take this possibility off the table.

Shoot. Ok… so what should we do?

1. If you haven’t been trained in Narcan use, do it now before it’s too late. Find a training near you. If you need help, message me. I will likely hold some virtual trainings soon, but DON’T WAIT FOR ME IF YOU DON’T HAVE TO.

2. If you don’t have Narcan yet, GET IT. Whoever trains you should be able to give you at least two doses. In most states you can buy it at a pharmacy. YOU CAN BUY IT ON AMAZON!! (For now.)

3. Don’t throw away expired Narcan! Naloxone has been proven effective even ten years after its expiration date. It may be less effective, but it’s better than not having any Narcan. And if it becomes harder, more expensive, or illegal to get, we will not want to have lost a huge portion of our supply that could still be life-saving.

4. Incorporate rescue breathing into your overdose response. There’s a myth that some overdoses take four or five doses of Narcan to reverse. In actuality, two is likely the maximum number needed in combination with rescue breaths. In a world where every dose counts, we could save a lot (and not force horrible withdrawals on people) by using fewer doses and giving rescue breaths to restore breathing.

   

5. Tell the truth about Narcan to everyone who will listen. Narcan saves lives. It does not enable or encourage opioid use. There’s only one thing Narcan enables:

   

I will leave us with a prayer that I like to lead when I host Narcan trainings at churches or among Christians. It’s a prayer of blessing to be recited over the doses that will be distributed, centering us in our spiritual commitments. It comes from Faith in Harm Reduction, who puts out consistent, amazing resources.

Blessing of the Naloxone

by Dr. Sharon Fennema

Creator of resurrection and light, we come to you with grateful

hearts for all the ways your love continues to rise up in our midst.

We give you thanks and praise for the Holy drug, naloxone, and the new

life that it can bring.

We know that we need each other to survive, so we ask you to

bless these kits, and all those who will use them, and all those who

will be in need of them.

Make them and us instruments of resurrection, that suffering will

be released, that injury will be transformed, that joy will arise, that

strength will take hold, that hope will take wing, and that death will

yield to new life.

Empower us to live into our vocations as people of

resurrection, bringers of new life, proclaimers in word and deed of

a new day rising. In the name of all that unfurls hope in our midst

every moment, we pray.

Amen.

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