Dr. IV on Narcan
Alex: We’re here to talk about Narcan. It is a nasal spray that can stop and reverse an overdose of opioids. The FDA may grant approval for it to be available over-the-counter. Can you tell us more about Narcan and how it works?
Dr. Mirus: This is what it looks like. There are two sprays. It is really easy to use. The medicine is in the red part. So when you put it up your nose, you squeeze it. That’s it. It works in a few minutes. I’ve been using this medicine in the emergency department for many years. It is really the easiest way to save someone’s life. It is a wonderful medicine. How does it work? In your brain, you have receptors. When someone uses opioids via needles or some other way, the opioids will move toward the receptors. If there are too many, it will make you feel high. The pain will go away. The opioids turn on the receptors in your brain. If there are too many receptors getting opioids, it causes you to become sleepy. Your brain starts to shut down. We use the same thing for anesthesia during surgery. It’s the same idea. You go to sleep. But the problem is that people typically stop breathing. Your brain is in a deep state of slumber that your breathing may cease. And when you stop breathing, a few minutes later, your heart stops because it must have oxygen. Or there is brain damage. So when we use Narcan, what happens is that the medicine replaces the opioids. It’s like the Narcan is moving and it sees the opioids in the receptors. The medicine will push away the opioids and insert itself in the receptors to turn off the effects. The patient will then start waking up and breathing again. It happens immediately. They are shocked, looking around, and asking “What happened?” They are confused but they are back to normal and breathing. It’s a really cool medicine.
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Alex: So if we have more OTC doses of Narcan available, do you think that’s a good thing?
Dr. Mirus: It is my opinion that it is a great idea. Last year, actually two years ago, in 2021, over 100,000 people died from opioid overdoses. Narcan, in theory, could have saved their lives if someone had the medicine with them. There are really no side effects. For example, if I used Narcan on myself right now, nothing would happen. So why are there limitations to it? The FDA has criteria, a series of requirements before medicine is allowed over-the-counter. It means anyone can go to the store and buy the medicine, they don’t need a prescription. There are some requirements — one example is that the medicine doesn’t require medical personnel to administer it. In the past, Narcan was given through a needle shot or an intravenous line. But now it’s a nasal spray and works effectively. So you don’t need medical personnel. Great. The second requirement is whether the medicine’s benefits outweigh the risks. Like I just mentioned, the risks are extremely low. The benefits are great as it saves lives. So the FDA requirements are being met and it is my opinion that the FDA should go ahead and approve Narcan for OTC use. Right now the laws in place are very confusing. States have various rules. Technically all 50 states allow you to buy Narcan without a prescription but you have to walk up to the pharmacist and ask for the medicine. Then they will decide. Some pharmacies have it, but some do not. It’s very inconsistent and very hard to access and obtain. So if it’s available OTC, anyone can go in a store, a grocery store or a pharmacy, and buy Narcan just like you would a cough medicine. So you have it ready with you, in the car, or in the home. You never know when you need to use it.
Alex: I really appreciate it and it’s interesting to learn. It is positive to see your robust endorsement because it saves lives without side effects. It seems like a commonsense decision to get Narcan.
Dr. Mirus: Yeah. Completely, 100% right, yes.