A signature issue of the 2017 Virginia General Assembly session was the opioid epidemic and methods to reduce fatal drug overdoses. While a staggering average of 3 Virginians die each day from a drug overdose, the Western Region of the State including Pulaski County, whose drug overdose rate often exceeds surrounding counties, contribute disproportionately to this number. A large number of these overdoses are from Opiods, which include prescription medications (such as fentanyl, oxycodone (Oxycontin®, Percocet®) and hydrocodone (Lortab®)) and illicit drugs such as heroin.
Much of the legislation centers around the medication, Naloxone. Developed in the 1970s, naloxone is an opioid receptor antagonist that quickly reverses effects of opiates such as respiratory depression. Nationally, there has been a movement to expand naloxone’s use from healthcare settings, including emergency personnel, to lay persons. Effective November 2016, Virginia followed previous states in allowing pharmacists in Virginia to dispense naloxone without a prescription. Many Virginia law enforcement agencies are now equipped with naloxone.
In February, Governor McAuliffe signed additional legislation that allows community organizations, such as REVIVE!, to dispense naloxone and train lay individuals to give the medication. Those bills received unanimous support in both the state House and Senate, including Delegate Nick Rush and Senator Benton Chafin, Jr.
REVIVE! is the Opioid Overdose and Naloxone Education program for the Commonwealth of Virginia. REVIVE! offers 1-1.5 hour lay training covering “understanding opioids, how opioid overdoses happen, risk factors for opioid overdoses, and how to respond to an opioid overdose emergency with the administration of Naloxone.” A free training is offered in Roanoke the 2nd Wednesday evening of each month.
Naloxone is available at a pharmacy without a prescription in 3 formulations –an auto-injector, Evizo®, an intranasal spray or a naloxone kit containing a syringe and accompanying mucosal atomizer device (MAD).
Unfortunately, the costs of naloxone have increased significantly, “part of an overall trend of increasing prescription-drug prices for both new brand-name drugs and old, off-patent generics.” Legislation has dealt with access, but has not dealt with the cost impeding accessibility.
While increasing naloxone availability will likely save many lives, it is not a panacea for addressing drug abuse. Critics feel that naloxone constitutes a moral hazard by providing a false sense of security to opiate abusers, who may increase opioid use to seek a better high. Additionally, the availability of naloxone could be a disincentive to seek treatment.
However, proponents feel naloxone can offer time for those addicted to seek treatment and empower non-medical professionals to give life-saving care in the event of an overdose. Far from a way to get a ‘safe’ high, the use of naloxone can make the user feel violently ill and ruin their euphoria.
As the public conscience now widely accepts that addiction is a disease and not a personal failing, there is a moral imperative, particularly in an area with high drug abuse such as Pulaski County, that steps are taken to help prevent deaths and treat the disease of addiction.