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Overdose-reversal drug naloxone now available in Florida without an individual prescription

First responders in Florida have administered naloxone for years. The drug can block opioids from receptors in the brain, temporarily reversing the respiratory effects of an overdose.
Published Jul. 25, 2016

For paramedics, saving someone who has overdosed on opioids can come down to naloxone, a powerful drug that temporarily blocks the effects of the overdose.

First responders in Florida have administered naloxone for years. But under a measure approved by the Legislature this year, patients and their families can now quickly get the drug from a pharmacy.

Naloxone, sold under the brand name Narcan, isn't available over the counter. But patients and their families no longer have to get an individual prescription from a doctor to access the drug.

Instead, they can purchase an autoinjector or intranasal version of naloxone through their pharmacists if the pharmacy receives a so-called blanket "standing order" from a doctor.

"This gives better access to patients who didn't have that access before," said Michael Jackson, executive vice president and CEO of the Florida Pharmacy Association. "This medication can save lives."

CVS will begin to stock naloxone in all 878 of its Florida pharmacies this month, a company spokeswoman said. The national pharmacy chain sells an autoinjector version of the drug for $45 and the intranasal spray for about $90.

Opioids such as heroin, morphine and prescription pain relievers can slow breathing. In an overdose situation, a person isn't breathing enough to stay alive.

Narcan normalizes breathing. The drug can block opioids from receptors in the brain, temporarily reversing the respiratory effects of an overdose.

Raf Vittone, deputy chief of medical services for Polk County Fire and Rescue, said the effect is a complete reversal, sometimes "to the point where you've upset the patient because you've taken them out of their euphoria."

Tampa Fire Rescue Lt. Ryan Bradford said he has seen patients react similarly.

"They can be very unhappy with the fact that we took away their high," he said. "They don't realize how close they were to death."

Bradford cautioned that how well naloxone works depends on a variety of factors, including whether the patient is also on another drug or the level of opioids in his or her system.

He stressed the drug's effects are only temporary — and that anyone who administers it should call 911.

It can have some side effects, including catapulting someone into withdrawals if the dose is too high.

Still, Pinellas County Sheriff Bob Gualtieri said that in, many respects, Narcan is "a magic drug." It doesn't get people high, he said, and has no effect on people who aren't overdosing.

Gualtieri said the new policy could be especially meaningful in rural areas where paramedic response times are slower. (In Pinellas, he said, the average response is about three minutes).

As of February, naloxone is available to the public in 42 states, according to the Prescription Drug Abuse Policy System. But many states have only expanded access in recent years, in part because of a misconception that access to Narcan encourages drug use by making it safer, said Khary Rigg, an assistant professor at the University of South Florida who specializes in substance abuse.

"Harm-reduction laws are highly stigmatized," he said, offering the view of opponents: "Drug users are bad. Drugs are inherently bad. We shouldn't be rolling out these laws to make drug use safer."

Rigg said that mentality is part of the reason many states are slow to pass "good Samaritan" laws that protect those who call 911 in overdose situations, start needle exchanges that can slow the spread of disease, and, in this case, launch measures that widen access to naloxone.

"All this crazy draconian thinking is sort of the reason Florida has been slow to embrace these sorts of things," he said.

Florida approved a so-called good Samaritan law in 2012. The Legislature gave the green light to a needle exchange program this year, but it is only a pilot and limited to Miami-Dade County.

Florida was also slow to implement a prescription drug monitoring program, which helped shut down "pill mills" but had the unintended consequence of moving users toward heroin as their supply of prescription painkillers was cut off, according to experts.

As for making naloxone readily available, Rigg said the move is just one tool in an all-of-the-above strategy to get a handle on opioid addiction.

"There's never been a society that's been totally drug-free," he said. "You can't eradicate it. You can control and mitigate it."

Contact Jack Suntrup at jsuntrup@tampabay.com or (727) 893-8092. Follow @JackSuntrup.

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