Harm reduction agencies look to more opioid overdose reversal drugs as additional tools. Is Narcan the only answer?

Narcan is just one brand of a drug called Naloxone, a drug used to help revive patients who are in mid-opioid overdose, essentially bringing them back from the brink of death. This tool is so useful the state of Colorado buys Narcan in bulk to distribute to harm-reduction-eligible entities such as law enforcement agencies or emergency medical facilities, or even groups focused on the elimination of deaths by overdose, as is the case for the High Rockies Harm Reduction group in Carbondale. 

Due to the current Colorado standing order for Naloxone, Narcan is the only reversal drug distributed free of charge to organizations, but it's not the only reversal drug that's FDA approved for the same purpose, and other brands or even other compounds could have different, possibly better success rates. 

Maggie Seldeen, founder of High Rockies Harm Reduction, said it's about having the opportunity to make that choice, instead of being constrained to one brand. 

"What we are hearing since fentanyl contamination -- people unknowingly consuming fentanyl, and it does kill quicker and faster," Seldeen said. "There is some data that suggests a larger quantity could be helpful in a lot of these cases."

In addition to 4mg Narcan nasal spray, the fund also provides 4mg Padagis nasal spray, 2ml prefilled naloxone syringes, and 0.4mg single-dose naloxone vials-also free of charge. Still invested parties are interested in adding additional options for organizations.

Additional overdose reversal drugs such as Nalmefene are not currently supplied by the state, but folks working on the front lines of the crisis see potential benefits to additional options. 

"Currently, as law enforcement officers here in Colorado, we see the impact of the opioid epidemic in our communities," Summit County Sheriff Jaime Fitzsimons said. "Nationwide, you see the epidemic shrinking; it's actually growing in Colorado. Part of the problem for us [with] the current standing order is that there is one approved reversal agent for opioids, and there are many other options available but not to first responders."

"What we need is the most available tools we can get to fight this epidemic," Fitzsimmons added.

Coreen Johnson with Young People in Recovery also sees the benefit the free market could bring to a statewide bid like an overdose reversal drug, so long as the quality remains the same or improves. 

"That would be great, keyword being as cheap as possible," Johnson said. She had a sobering reminder of the victims of the opioid crisis -- potentially anyone. 

"Who aren't the folks who could be suffering from substance abuse disorder?" Johnson said. "It could be my son who got injured playing football and had a knee surgery and was prescribed opiates to mask that pain, and then, that addiction forms because of what happens neurologically in the brain. It could be my mom who got a tooth pulled at the dentist."

To that same effect, Seldeen said she believes having different tools to address different issues with overdosing makes sense. While someone who is consistently using opioids might react one way to a reversal drug, someone who is a first-time user, but whose substance was spiked with fentanyl, could need something different for the best chance to save them. 

"My belief is we should have all of these tools and utilize higher doses where appropriate. Such as in high schools, for parents, things like that," Seldeen said. "When we are talking about specifically 8 milligrams of Naloxone, there is some evidence that shows it could work better to combat fentanyl overdoses, and I believe we should have all available tools in our tool kit."