Naloxone, also known as one of it’s brand names, Narcan, is a medicine that has greatly helped during the opioid crisis. Some people have been calling it a miracle medicine. Considering it can bring people back from the depths of overdose, how could you blame them? However, can too much of a good thing turn bad? As Naloxone has been getting more media attention, doctors and drug companies have been administering and recommending stronger doses. In an article written in the Atlantic titled “An Anti-Overdose Drug is Getting Strong. Maybe That’s a Bad thing?” researcher at Brown University Abdullah Shihipar warns of the possible negative effects of naloxone.
First, for those who might not know what naloxone does, Shihipar explains that “[w]hen taken as a shot or a nasal spray, it blocks opioid receptors in the brain, preventing opioids such as oxycodone and heroin from binding to them.” In layman’s terms this means that “when someone is unconscious or about to die from an overdose, naloxone can fully revive them in minutes.” The need for naloxone is higher than before as the opioid epidemic has been getting worse. Stronger forms of opioids including fentanyl have been circulating in the country. Shihipar reports that “Fentanyl and other synthetic opioids accounted for 60 percent of overdose deaths in 2020, up from 18 percent in 2015.”
The pharmaceutical industry has been trying to make sure naloxone can keep up with fentanyl. Recently there have been moves to bring stronger forms of naloxone into the market. Two have already been approved by the FDA in the past year. A nasal spray called Kloxxado and an injection called Zimhi. Shihipar reports that the dosages of these new drugs are significantly stronger, “Kloxxado is twice as strong as Narcan and Zimhi is 12 times as strong as the standard injection.”
The rationale is there: a drug that can save people from overdose can only get better in higher doses. Right? Unfortunately Shihipar points out that “more isn’t always better” when it comes to naloxone. Some experts suggested that stronger forms of the drug could end up backfiring, compounding naloxone’s harmful side effects with no significant benefit over the lower dosages.”
In the race to create a stronger drug, it’s also important to consider how the naloxone is given. Nasal sprays may be less effective than injections in certain situations. One could easily fall into a pit trap of thinking they need a stronger nasal spray, when in reality they would just need a low dose of an injection. Ryan Marino, a medical toxicologist and emergency-room physician in Cleveland, points out that “higher doses are rarely needed and usually indicate some other issues besides pure opioid overdose.” This could create a negative feedback loop where someone could be trying to increase a dose, but ignoring or not realizing there’s another problem.
Sheila Vakharia, the deputy director of research and academic engagement at the Drug Policy Alliance (DPA) explains that higher doses of naloxone may have unintended consequences, “when someone takes naloxone and is brought out of overdose, the experience is not always pleasant. The drug induces the same type of withdrawal that occurs when taking an opioid.” These withdrawal symptoms can lead to “headaches, nausea, vomiting, and sweating.” Higher doses are reported to make these symptoms worse, though they are quicker at getting people out of an overdose. The argument could then be made that the reward is far greater than the risk, but that still doesn’t mean naloxone should be glibly given out with no consideration.
It’s still too soon to really know or determine possible side effects or potential harms with higher doses. However, there is an unsettling irony surrounding the whole situation. The pharmaceutical industry has the responsibility to aid in fixing the damage it’s created in this crisis. This industry used deceptive techniques to market opioids in the first place, brushing aside the harms that we now see. Shihipar writes that “things are different this time around…naloxone is a life saving drug, and a new set of companies is pushing to make it more powerful. But the premise is similarly flawed: Stronger chemicals weren’t the cure-all then, and they aren’t the cure all now.” A prescient observation that hopefully doesn’t become an ominous prophecy.