Today thousands of people across the country and around the world commemorate International Overdose Awareness Day.
For too many of us, this is a day of grieving for those we have lost. But it is also a day of hope, in recognition of the tens of thousands of lives that have been saved from overdose, and a call to further action to end the overdose crisis.
Harm Reduction Coalition affirms that we will not end the overdose crisis until we place people who use drugs, along with their families and friends, at the center of our policies and strategies. We do this by ensuring that people who use drugs and their loved ones have access to information, tools and support, without judgement, stigma or fear of arrest.
Naloxone remains our single most powerful tool in preventing opioid overdose deaths. Naloxone is a safe medication that counteracts the effects of an opioid overdose. The rapid expansion of access to naloxone – by harm reduction programs, public health, drug treatment and recovery organizations, family support groups, pharmacies, Veterans Affairs medical facilities, prisons and jails, and law enforcement and first responders – represents a dramatic public health innovation responsible for saving countless lives. But our work is unfinished: in the United States, the death toll from prescription opioid and heroin overdoses continues to rise, claiming over 24,000 lives in 2013.
We are in a state of emergency. We can no longer accept incremental progress; we must demand urgent action to save lives.
Harm Reduction Coalition therefore calls for immediate action in five areas to achieve rapid scale-up of naloxone:
- Funding: We call upon Congress to fully fund the President’s request for $12 million in Fiscal Year 2016 to the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide grants to states to support broader naloxone access. States must have the flexibility in use of these grants to areas where naloxone will have the greatest impact, including community-based programs reaching people who use drugs and their loved ones; funds should not be restricted to provision of naloxone to first responders. In addition, federal agencies – including the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Health Resources Services Administration (HRSA), SAMHSA, and the Department of Justice (DoJ) – should use all available current resources to support broader naloxone access.
- Cost: We are deeply concerned by the rising costs of naloxone, including dramatic price increases by manufacturers in recent years. These price increases threaten to severely limit the distribution of naloxone, particularly by community-based programs reaching those most vulnerable to opioid overdose. When price increases limit naloxone access, they directly increase the likelihood of more overdose deaths. We call upon all current naloxone manufacturers, along with developers of new formulations, to price their products responsibly to ensure the broadest possible distribution, and to support all available mechanisms – including discounts, rebates, donations, and bulk purchasing arrangements – to ensure that harm reduction and public health programs have adequate supplies of naloxone.
- Access: Despite promising models and emerging practices, access to naloxone through the healthcare system remains limited and inadequate. Health care professionals, clinics and hospitals have a vital role to play in ending the overdose crisis. Prescribers – particular those who prescribe opioids, along with those who manage patients with substance use disorders – must take an active role in screening and educating their patients and their families about opioid overdose and prescribing naloxone. Professional associations and medical societies, along with CDC and HRSA, can advance naloxone prescribing by developing simple guidance, education and training, resources, and clinical decision support tools. Public and private payers have a critical responsibility to ensure that naloxone is covered on drug formularies without unnecessary restrictions, barriers or cost-sharing.
- Availability: A handful of states and communities are working to make naloxone available in pharmacies through arrangements which include standing orders and collaborative practice agreements. These efforts should be disseminated more broadly to ensure the widest possible availability of naloxone. In addition, the Food and Drug Administration (FDA) should develop, facilitate and expedite regulatory pathways to allow naloxone to be sold over the counter. Manufacturers should be incentivized to bring an appropriate over-the-counter naloxone product to the market by 2018.
- Awareness: Despite over a decade of rising deaths, there has not yet been a national awareness campaign to educate the public and those most at risk about the signs and symptoms of opioid overdose, how to respond to an overdose, and use of naloxone. Countless anecdotal reports suggest that lack of awareness and knowledge is a critical factor in many otherwise preventable overdose deaths. HHS and CDC must develop and disseminate a broad national awareness campaign, providing information on how and where to obtain naloxone.
Harm Reduction Coalition recognizes the efforts of the White House and Congress, along with state and local lawmakers and officials, to respond to the prescription opioid and heroin crisis. We also recognize that a comprehensive response to the crisis requires additional efforts to expand access to medication-assisted treatment (e.g. methadone and buprenorphine) for opioid use disorders, realign law enforcement efforts towards public health goals, and combat the stigma of drug use and addiction.
One thing is clear: we have not yet done enough, and we must act quickly. Too many lives depend on it.