Introduction
Perhaps the most convincing argument against abuse is its propensity of fatal overdose. Whereas there are many other negative implications of drug abuse, nothing jolts an intending drug abuser as the idea of dying due to the drug use (Walley, Xuan, Hackman, Quinn, & Doe-Simkins, 2013). Currently among the most lethal drugs being abused are opioids, which in can simply defined as morphine and other legal or illegal substances that produce a morphine-like effect (Wheeler, 2012). However, a potentially fatal overdose of opioids can always be reversed using Naloxone, a drug that is patented and sold inter alia under the brand name Narcan (Hawk, Vaca, & D’Onofrio, 2015) .
It therefore follows that the age-old anti-drug abuse threat of death by accidental overdose is now tempered by the availability of a drug that is almost guaranteed to reverse the fatal consequences of opioid overuse (Kim, Irwin, & Khoshnood, 2009) (Hawk, Vaca, & D’Onofrio, 2015) . This paper will explore the issues relating to the balancing act between availing Narcan to save the lives of those who overuse and/or abuse opioids while balancing it with the prospect that this availability will encourage the continued abuse opioids.
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Background
One of the most effective painkillers of our times is morphine, a prescription drug that is available under different brand names and relieves both acute and chronic pains by acting currently on the nervous system (Wheeler, 2012). This and many other drugs that operate on a similar basis are known as opioids and are either natural like extract of opium like Morphine and heroine or synthetic and semisynthetic like heroin, tramadol, oxycodone, methadone, hydrocodone, fentanyl, asnaloxone, endorphins (Walley, Xuan, Hackman, Quinn, & Doe-Simkins, 2013). Whereas most of these drugs are legal in the US as prescription drugs, they have been open to abuse and over use: indeed, fatal overdoses from legally acquired opioids have been causing twice as many fatalities as the use illegal narcotics in recent times (Hawk, Vaca, & D’Onofrio, 2015) .
Narcan, a brand name for the prescription drug Naloxone, which is the most effective remedy for an opioid overdose and may be chemically combined with opioids to make them ineffective, is someone tries to use them as an injectable instead of as an ingestible. Indeed, due to the propensity for opioid overdoses all over the world, the WHO has placed Naloxone on its list of essential medicine, a list of medications that the WHO considers a must keep in a basic health system (Kim, Irwin, & Khoshnood, 2009). It is also worthy of notice that the Naloxone is also available of the counter in at relatively low prices ranging from US$ 0.50 in developing countries and US$5.00 in the US (Baca, 2005) (Walley, Xuan, Hackman, Quinn, & Doe-Simkins, 2013).
The ease of availability is however convoluted by the difficulty to use; Naloxone triggers opioid withdrawal symptoms, which include aggressiveness, agitation, restlessness, nausea, vomiting, fast heart rate, and sweating which can also have adverse consequences considering that Naloxone is usually used when the situation is already dire (Clark, 2014). It therefore calls for careful use in small doses over a regulated amount of time (Clark, 2014). Further, opioids take longer to clear from the bloodstream that Naloxone therefore repeat doses need to be used at regular intervals as and when the symptoms demand until the peril posed by the overdose has passed. It is clear from the foregoing that a trained professional can only observe the proper and safe use of Narcan (Clark, 2014).
The upshot of the foregoing is that the very knowledge that Narcan can reverse the effects of an opioid overdose will create a form of false security and an element of carelessness for opioid abusers. However, when the decisive moment comes, it may not be able to serve them since it takes expertise to use it effectively (Kim, Irwin, & Khoshnood, 2009). Another effect of this is that the previously mentioned false hope and clearly ness is bound to increase the use and abuse of opioids. Moreover, when the abusers do not overdose, they will still suffer other adverse consequences including the short-term effects such as itching, nausea, dry mouth, constipation, and drowsiness. Long-term effects would include psychological imbalance, addiction, and/or dependence, dizziness, Loss of libido and/or impaired sexual function, decrease in levels of testosterone, acute depressive disorder, lack of or reduced immunity, acute sensitivity to pain and in extreme cases, one may go into a comma (Kim, Irwin, & Khoshnood, 2009).
Landscape
Drug abuse has always been a contentious issue on the US due to its common use and negative implications. The situation is relatively easier when dealing with commonly accepted hard drugs such as crack cocaine since almost all reasonable people are on the same side: against it. However, when it comes to drugs like opioids that have both legal and illegal versions, some are crucial as morphine yet others are as dangerous and illegal as heroine. Consequently, both are extracts of the same plant thus creating the level of ambiguities and controversies congruent to those revolving around marijuana. The concept is made worse by the fact that this is a life and death situation involving remedy to a dying person. There is also the underlying issue relating to the complex pharmaceutical industry, as nay policy made regarding Narcan will affect the industry whose management always involves a careful high stakes balancing game.
Political factors
The politics of Narcan is complicated with many parties pulling and pushing from different directions for various varying reasons. The giant pharmaceutical industry usually christened ‘Big Pharma’, a real behemoth in the political arena would look at this from a commercial perspective meaning sales. They would therefore back the side that would support the increased purchase and use of Narcan with increased marketing campaign: they would also seek to diminish mention of the negative aspects and augment the positive ones. Medical bodies would take the middle safety first dimension of using it right. Anti-drug crusaders another political behemoth might even go as far as pushing for its removal as its safety-net effect increases the propensity for drug use, this is where most members of the GOP would fall. Parental groups may side with the doctors, but when used right especially to save lives, such an argument would resonate with democrats.
Social factors
On the 21st day of April 2016 one of the greatest musical legends of our time, Price died from a fentanyl (am opioid) overdose because Narcan was not available at that moment in time. This brings to fore the social aspects of opioid use and by extension its overdose and the Narcan element. America is a nation full of a depressed populace which makes is easy for the normal population to sympathize with anyone that find themselves having to abuse drugs more so opioids which seemingly numbs pains and other adverse feelings thus creating a high in the midst of a chaotic world. In the same measure, as many people are against drug abuse and its negative impacts and will not shy away from vociferously letting their opinions be known even when they have nothing to do with the issue. It therefore follows that any opioid related issues more so one that regards a user’s life and death situation is automatically a sensitive social issue.
Economic Factors
Hard drug abuse is a serious economic problem for the US, which directly costs the US government approximately US$193 billion annually, which is scary when compared with cancer that costs the government US$171 Billion (US Department of Health & Human Services, 2016)! Over and above this are the secondary economic implications of drug abuse including its effects on the job market and the worrying economic future occasioned by poorly trained future workforce due to increased hard drug use, including opioids (Kim, Irwin, & Khoshnood, 2009). The economic argument favors the side of the Narcan use impasse that ensures a reduction in drug use. There is however, the other side of ‘Big Pharma’ a mighty economic force that rakes in fortunes from Narcan and other Naloxone drugs that must also be put into consideration.
Practical factors
All policy is as good as its capacity for implementation: the US spends Billions US dollars and a lot of man-hours trying to regulate drug abuse and from recent statistics, the war is being lost. Indeed, many of the proponents of Marijuana legalization apply the argument that its legalization will give government time to fight the more serious and harder drugs like heroine and opioid. Throwing in Narcan regulation of any form into this matrix will only further stretch an already overstretched system therefore any suggestions made must come with sound and novel implementation stratagems for practicability purposes (Kim, Irwin, & Khoshnood, 2009).
Legal factors
This is another complicated area that has good and bad elements. Accident in the rare accidental circumstances, whenever the Narcan argument arises, someone has broken the law and is liable for misdemeanor in case of abuse of legally acquired opioids or serious felony charges in the case of a heroin overdose. This is the first legal hurdle since the family or friend of a sufferer face a quagmire every time Narcan becomes necessary since calling for help also means reporting a crime (Kim, Irwin, & Khoshnood, 2009). The good legal side is that Narcan albeit being prescription drugs are not regulated drugs since they do not have addictive tendencies. There are however legal restrictions that vary from state to state and make it increasingly difficult for anyone who has not be legally prescribed an opioid to access it. The good news that it is legally readily available cancels out with the fact that as a prescription drug, you need some form of probable cause for use to access it and when the moment of needs comes, sufferers and their family or friends will be very reluctant to call for help.
Options
This scenario creates the scenario described by Frederick Forsyth in his a1979 book, the Devil’s Alternative where describes a choice which will have fatal consequences either way. The instant scenario creates a situation where whichever decision is finally made, people will die.
Option 1
The first option will prioritize the saving of the lives in immediate danger at the expense of the overall war against opioid abuse. It involves loosening the level of Narcan prescription regulations to allow those who fear a friend or loved one is prone to an opioid overdose are able to access the medication (Bazazi, Zaller, Fu, & Rich, 2010) . They should also be a moratorium preventing prosecution from anyone whose drug use is discovered through an emergency call for assistance after an opioid overdose (Baca, 2005). Unfortunately, this will also open a door for perennial opioid abusers to stock up on Narcan with the resultant bravado for use and effects as outlined above (Bazazi, Zaller, Fu, & Rich, 2010) . It will save lives in the interim but destroy many more in the long-run. In the very least, it may have saved the music icon Prince. The Parental groups, Democrats and Big Pharma would support this but the Republicans, anti-drug abuse crusaders and the Church would be outrageous.
Option 2
This is the very opposite of opposite of option one. Tighten the regulation for prescription of Narcan by increasing the threshold for prescription of Narcan or any of its generic derivatives and create follow up rules where a patient has to account for any of the prescribed Narcan used. Further, anyone who call for assistance after an overdose as well as the one who has overdosed in case of a third party caller will be subject to thorough investigation an indicted if any illegal conduct was involved (Bazazi, Zaller, Fu, & Rich, 2010) . This would ensure that any abuse of opioid becomes potentially fatal and will thus be discouraged which will save lives in the long run. It will however guarantee several deaths for those who are fool hardy enough to use the drug as they will neither nave Narcan at hand not have the temerity to call rescue services (Bazazi, Zaller, Fu, & Rich, 2010) . The Anti-drug abuse crusaders, Church lobbies and the conservative wing of the Republicans would love this option but the Democrats would rally human rights watchdogs and get funding from Big Pharma to fight against it.
Recommendations
All lives are precious and worth saving, a live that is in immediate danger should be prioritized for saving that the bigger picture lives tomorrow: a plan that makes allows people to die today to save a few more tomorrow will definitely mean political suicide today and therefore no tomorrow. Option one is therefore the recommendable way to resolve this impasse. However, there should be found a way of keeping a database for all those who seek Narcan prescriptions for possible follow up and or investigation with programs for rehabilitation and assistance in the offing designed in a manner to look like they are optional, yet they really are not since albeit saving lives today is paramount, fighting opioid abuse is equally important.
References
Bazazi, A. R., Zaller, N. D., Fu, J. J., & Rich, J. D. (2010). Preventing Opiate overdose deaths: Examining objections to take-home Naloxone. , 21(4), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008773/
US Department of Health & HUman Services. (2016, March 24). Opioids: The prescription drug & heroin overdose epidemic. Retrieved July 2, 2016, from http://www.hhs.gov/opioids/
Wheeler, E., Davidson, P. J., Jones, T. S., & Irwin, K. S. (2012). Community-based opioid overdose prevention programs providing naloxone—United States, 2010. MMWR. Morbidity and mortality weekly report, 61(6), 101.
Baca, C. T., & Grant, K. J. (2005). Take‐home naloxone to reduce heroin death. Addiction, 100(12), 1823-1831.
Kim, D., Irwin, K. S., & Khoshnood, K. (2009). Expanded access to Naloxone: Options for critical response to the epidemic of Opioid overdose mortality. , 99(3). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661437/
Hawk, K. F., Vaca, F. E., & D’Onofrio, G. (2015). Reducing fatal Opioid overdose: Prevention, treatment, and harm reduction strategies. , 88 (3). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553643/
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., & Doe-Simkins, M. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. Research, 346, 174. doi:10.1136/bmj.f174
Clark, A. (2014). Legislative: Responding to the fatal Opioid overdose epidemic: A call to nurses . Retrieved July 2, 2016, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Legislative/Responding-to-Fatal-Opioid-Overdose-Epidemic.html
