Dr. Larissa Mooney
America’s opioid addiction epidemic was one of the biggest health stories of 2016, as reflected in the intense media coverage the topic received — and it is no wonder why. The number of deaths involving prescription opioid medications and heroin continues to rise, having quadrupled since 1999. Some 91 Americans die each day from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention.
One key strategy in the battle to curb opioid overdose deaths has been the use of the drug naloxone, which emergency medical personnel and first responders have used for years to treat people suffering from an overdose. Use of naloxone, which blocks or reverses the effects of an overdose, has been shown to reduce the rates of death from overdose.
Dr. Larissa Mooney, a psychiatrist who specializes in treatment of substance abuse disorders, recently discussed the topic of naloxone and some of the issues surrounding its use. Mooney is an associate clinical professor of psychiatry at the David Geffen School of Medicine at UCLA and director of the UCLA Addiction Medicine Clinic.
For those unfamiliar with the medication, can you describe what naloxone is?
Naloxone is a medication that can rapidly reverse an opioid overdose. Opioids can be anything from common painkillers, such as oxycodone or hydrocodone to heroin. In an overdose, the person feels sleepy and eventually their breathing centers may shut down. Emergency room personnel have used naloxone for many years. Administered by injection or nasal spray, it works very quickly and can reverse respiratory depression within minutes. It is a very safe medication; the risks if given even to someone who doesn’t need it are minimal.
Recently, there has been a public health effort to widen distribution of naloxone in response to the opioid crisis and rising overdose deaths. Can you explain why?
Yes, there has been a push to increase distribution to make it more accessible to people, such as family and friends who might witness an overdose and be able to administer it outside of a medical setting. In communities where this has been done, they have demonstrated reduced deaths. There is a window of opportunity of usually several hours between when someone who has overdosed might just be looking sleepy and when he or she may die. In some of these situations, the person may never make it to the emergency room. Sometimes people are scared to call 911. Even when someone is treated with naloxone, it is still advisable to call 911 and have him or her treated by medical personnel.
During the past year, especially, a lot of attention has focused on the opioid addiction crisis in the United States. Can you provide the big picture?
In the U.S. we are facing an epidemic of opioid addiction and a rapid rise in overdose deaths across the country. This has created a lot of media attention and new funding from Congress for the treatment of opioid addiction. There was a time when physicians were told that pain was being undertreated and were directed to treat pain more aggressively. The messages about the risk of these medications was not fully understood or communicated. Now we are learning from research and practice guidelines that although these medications are very helpful for treating episodic acute pain, their efficacy for longer-term, chronic pain is more questionable. So long-term prescribing may come with more risks than benefits.
Why have some states, including California, approved legislation that allows naloxone to be obtained more easily, such as allowing pharmacies to furnish the drug to family members who may be in contact with someone at risk of an overdose death, or to patients themselves?
Part of the public health movement to make naloxone more widely available is to reduce and remove barriers to obtaining these life-saving medications for individuals who may be at higher risk of opioid overdoses. That could be someone on opioid therapy for chronic pain, someone with a prior history of overdose or someone receiving treatment for opioid addiction. More recently, in California, there has been legislation to allow pharmacists to provide naloxone even to individuals who do not have a prescription from their doctor. This will increase use of naloxone even more.
Is there some hesitation among family members and friends, or people who may be at risk of overdose themselves, to go to the pharmacy and ask for a naloxone prescription?
The pharmacists who are providing naloxone have to request permission to dispense the medication and have received additional training. Part of the training is to know how to have conversations with people requesting naloxone about the risks of opioid use and to reduce the stigma concerning the medication itself.
Has the improved availability of naloxone had any impact on combatting the problem of opioid overdoses?
In communities where there is increased availability of naloxone, there has been a measured reduction in overdose death rates from opioids. One concern is that by giving somebody naloxone they would be less likely to seek treatment or even more likely to use drugs because they now have a safety net. That has not been found to be the case. There is not any increase in heroin or drug use in communities where they have distributed naloxone. Together with efforts to distribute naloxone, however, it is also important to expand access to evidence-based treatments for opioid addiction.