Naloxone reverses overdoses without hefty price tag

Distributing a drug that reverses drug overdoses in heroin users would save lives and be cost-effective, according to a new analysis.

U.S. researchers, who published their findings in the Annals of Internal Medicine on Monday, calculated that one death may be prevented for every 164 naloxone injection kits they distribute to heroin users.

That, the researchers say, works out to be a few hundred dollars for every year of healthy life gained.

“The great news here is these overdose deaths can be prevented, it’s cost effective to do so, and may even be cost saving,” said Dr. Phillip Coffin, the study’s lead author from the San Francisco Department of Public Health.

Naloxone is a drug that stops opioids such as heroin from reaching receptors in the brain, which may reverse an overdose. The drug is currently only approved by the U.S. Food and Drug Administration (FDA) to be injected into a person, but there are promising trials for an inhaled version of it.

The general idea, according to Coffin, is that giving heroin or opioid users naloxone injection kits gives them the chance to reverse another person’s overdose.

“Typically when someone has an overdose, they’re unconscious and they fall asleep quite quickly… So the idea that you would reverse your own overdose is not practical,” said Dr. Wilson Compton from the National Institute on Drug Abuse (NIDA) in Bethesda, Maryland.

Naloxone (also called Narcan) is the antidote that reverses an opioid overdose. It has been used in abulances and hospitals for decades to reverse overdose. It’s legal and has been approved by the Food and Drug Administration (FDA). It works by neutralizing the opioids in your system and helping you breathe again. Naloxone only works if a person has opioids in their system; the medication doesn’t work on other drugs. You can’t get high from it and it is safe for nearly everyone. It has been used in programs all over the world to effectively reverse opioid overdoses. It’s a lifesaver, there’s no doubt about it. There are two kinds of naloxone, one that you can squirt up someone’s nose and another that can be injected through clothing into a muscle.

Indications and Usage for Naloxone

Naloxone hydrochloride injection is indicated for the complete or partial reversal of narcotic depression, including respiratory depression, induced by opioids including natural and synthetic narcotics, propoxyphene, methadone and certain narcotic-antagonist analgesics: nalbuphine, pentazocine and butorphanol. Naloxone hydrochloride is also indicated for the diagnosis of suspected acute opioid overdosage.

Naloxone hydrochloride injection may be useful as an adjunctive agent to increase blood pressure in the management of septic shock.

Currently, an estimated 213,000 people in the U.S. use heroin each year. Over that population’s lifetime, more than one in 10 users may die of an overdose.

Compton, who co-authored an editorial accompanying the study, said naloxone has few side effects, except that high doses may send someone into withdrawal.

For the new study, Coffin and a colleague created a computer simulation that predicted what would happen if they distributed naloxone injection kits to 20 percent of U.S. heroin users, and compared the resulting deaths and costs to a simulation of users without kits.

In that scenario, the model found that in a population of 200,000 heroin users 6.5 percent of deaths that would have occurred could be prevented with distribution of the kits.

The simulation also found that almost 2 percent of heroin users eventually quit when the kits were distributed. That, however, also led to about a 1 percent increase in overdoses, because high-risk users were living longer.

NALOXONE (NARCAN) Adverse Reactions

Nausea and vomiting

Drug Interactions

Is incompatible with bisulfite and with alkaline solutions.

The researchers calculated that the kits would cost about $400 for every year of healthy life gained.

That’s well below the $50,000 per healthy year of life gained threshold that policymakers typically think is worth paying for, the authors note.

Coffin told Reuters Health that distributing the kits may end up saving money because it might prevent aggressive attempts to revive a person who overdoses, which can be costly.

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