Written by Donald A. Promnitz
The opioid crisis has spurred a nationwide effort to increase the availability of an overdose-inhibiting drug and a statewide law to get it to all patients with an opioid prescription.
Last month, the US Food and Drug Administration (FDA) advisors voted 12-11 in favor of recommending the co-prescription of naloxone to patients who are prescribed opioids like OxyContin. On the state level, former Gov. Jerry Brown signed a bill requiring prescribers to offer naloxone or another drug approved for reversal of opioid depression when certain conditions are present.
The bill, AB 2760, further requires education on overdose prevention and the use of naloxone. Failure to comply could result in the prescriber being referred for sanctions by the board regulating their license to practice. Drafted by Jim Wood (D-Healdsburg), AB 2760 received a â€œyeaâ€ from each voting member of the Assembly, though some abstained.
Initially approved by the FDA in 1971, naloxone came into prominence during the heroin epidemic of that same decade. Currently, it is carried not only in hospitals and ambulances, but also by virtually all types of first responder agencies. For example, the Fresno Police Department has 150 double doses of the drug in the event of an overdose.
When taking opioids, the userâ€™s breathing will begin to slow down, and if too much is taken, they can die by lapsing into respiratory failure. According to Dr. Patil Armenian, research director and associate professor of clinical emergency medicine at UCSF Fresno, Naloxone works by blocking receptors in the patientâ€™s body that the opioid drugs have bonded to so these receptors will no longer work.
â€œSo if somebody is having difficulty breathing, their breathing is slowing down from having too much opioid medication or drugs in their system, then it basically reverses that effect, so that they start breathing again,â€ Armenian said.
In the case of emergency room physicians like Armenian, naloxone is typically administered by injection. However, nasal spray versions of the drug like Narcan are becoming a go-to at the pharmacy, especially with AB 2760 in place.
â€œAnd thatâ€™s really for bystanders,â€ Armenian said. â€œFamily members of people who have been exposed. Cases like that.â€
Scott Shimamoto, Kaiser Permanente Fresno Areaâ€™s pharmacy director, said that his organization is working actively in reaching out to at-risk patients in order educate them on naloxone and make access easier. This includes advising patients to carry the medication with them and bringing a friend family member to their first pharmacy visit. However, he also stated that in order to optimize patient safety, they are working to avoid opioid prescriptions altogether.
â€œOur physicians work closely with patients on the potential options for pain management,â€ Shimamoto said. â€œAnd we provide education for members and patients about the risks associated with using opioids.â€