Washington State Deparment of Health Officer Kathy Lofy issued a statewide standing order on Wednesday for naloxone, a drug that can prevent opioid overdose deaths.
The order, which functions like a statewide prescription, enables all Washingtonians and organizations to go to any pharmacy to get naloxone, without another physician’s approval.
Naloxone comes in two forms, a nasal spray and an injection, and both forms can reverse the effects of an opioid overdose, potentially saving a person’s life if administered quickly after the overdose.
Opioids are pain relievers that are responsible for a nationwide drug crisis due to their addictive qualities. Overdosing on opioids can cause a person’s breathing to slow or stop. Naloxone can reverse the effects of any prescription opioid, heroin or synthetic opioid overdose.
This year, lawmakers in Washington passed a state law to allow any person or entity to possess, store and administer naloxone. Naloxone itself is not addictive, Lofy said, and it is most effective when administered immediately after an opioid overdose.
“It kind of prevents the opioid from working on the brain, and it only works temporarily, so it does wear off,” Lofy said.
The state health department is encouraging people at risk for an overdose or a person likely to witness an overdose to carry naloxone. All pharmacies can carry and give out naloxone under the statewide standing order, but the cost to Washingtonians will depend on what insurance provider they have.
Medicaid will cover most of the cost, Lofy said, but other private insurers will have different rates or co-pays on the drug. Without insurance a two-dose NARCAN naloxone nasal spray prescription costs about $150, she said.
Many law enforcement agencies and syringe service programs in the state already have access to naloxone, but the new standing order will open up access for other service providers working in behavioral or substance use counseling, homeless services or even schools. Lofy said jails could make use of the new standing order, too.
“We’re trying to get into the jail setting, so that jail health (providers) can distribute naloxone to folks as they’re leaving because we know that that’s a time when people are at a high risk for overdosing,” she said. “And like opiate treatment programs and other substance use disorder programs, they can go and get naloxone if they have funding or can get it through our grants and distribute it to their clients.”
Organizations or people interested in getting naloxone should call their pharmacy first to ensure it is in stock, Lofy said. Pharmacists are supposed to provide written instructions for how to properly administer naloxone, including seeking medical attention first. Lofy said if someone has overdosed, a person should always call 911 or first responders first.
Opioid overdose deaths in the state have remained stable in recent years. While prescription opioid overdose deaths have declined with state regulations and in the midst of a statewide response to the crisis, heroin and synthetic opioid overdose deaths have edged up.
Preliminary data from 2018 show that 710 Washington residents died from an overdose involving any opioid. That number is down slightly from 739 opioid overdose deaths in 2017. Overdoses from heroin and synthetic opioids such as fentanyl accounted for more than half of deaths due to opioids in 2018, however, and synthetic opioid overdose deaths are rising in the state.
While naloxone can prevent overdose deaths, it is not a long-term treatment. Other opioid-use disorder treatments, like medication-assisted treatment, are offered by some medical providers to help treat opioid addiction.
Several states have issued standing orders for naloxone in the past decade. Lofy hopes it leads to the decline of opioid-related overdose deaths in the state.
“There is data showing that it is really important to saturate your communities with naloxone, so that people are there to help if somebody is overdosing,” she said.
A study of New Mexico’s strategy to combat opioid overdoses with naloxone found that the standing order appeared to help the state lower its overdose death rate.
“New Mexico observed a 25.7% decrease in synthetic and semisynthetic opioid overdose deaths during 2014-2015, a finding that suggests statewide and local community overdose prevention efforts are having a positive impact in a state that has historically led the nation in overdose death for decades,” the study said.
The standing order will be in effect in Washington until Sept. 1, 2021, or until Lofy revokes it.
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