Rédaction Africa Links 24 with Lev Facher
Published on 2024-02-08 18:00:43
A recent study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report has found that individuals receiving a double dose of naloxone are not more likely to survive an opioid overdose than those receiving a standard 4-milligram nasal spray. The research showed no significant difference in survival rates between people who were revived using either 4- or 8-milligram sprays of naloxone, commonly known by the brand name Narcan. Additionally, those who received the smaller dose did not require a higher total number of sprays, despite having received just half the initial amount. The only significant contrast found was that those who received the double dose were over 2.5 times more likely to experience severe withdrawal symptoms, such as vomiting.
This new insight comes as pharmaceutical companies continue to market expensive high-dose formulations of naloxone, claiming it is crucial to deliver as much of the overdose-reversal medication as possible, given the increasing levels of drug deaths caused by potent synthetic opioids like fentanyl.
Harm Reduction Therapeutics CEO Michael Hufford stated, “For-profit pharma has been trying to wring profits from this public health emergency for years. Most recently, sales reps have been pushing buyers to purchase high-dose naloxone products, despite knowing that more naloxone is not only often not required for successful reversals, but dramatically increases the risk of serious withdrawal.”
Although naloxone is widely used by first responders, harm-reduction groups, and people who use drugs to reverse opioid overdoses, more does not always equate to better. A growing body of evidence suggests that too much naloxone can have significant consequences. Experiencing painful withdrawal can be not only uncomfortable but also dangerous, as severe symptoms may lead people to use opioids again, potentially resulting in a second overdose almost immediately following the first.
Despite these findings, numerous drug companies have continued to develop and market higher-dose naloxone products, arguing they are a necessary component of the U.S. overdose-prevention effort. However, these higher-dose products are far more expensive than lower-dose options such as generic injectable naloxone, which typically sell for just a few dollars per dose.
For example, the generic, injectable naloxone typically retails for just a few dollars per dose, while the two nasal sprays approved for over-the-counter sales, Narcan and RiVive, each run about $50 and $36, respectively. In contrast, higher-dose naloxone products like Kloxxado and Zimhi retail for roughly $140 for a two-pack. Moreover, Káleo faced significant blowback after marketing a 5-milligram mechanized auto-injector with a speaker that played instructions to users, which retailed for $4,100. This device, however, was repurposed for use by the Pentagon in a 10-milligram version designed for military personnel or first responders, thereby allowing the company to sell nearly 788,000 of these injector kits to the U.S. Department of Defense.
Amidst this trend, a study conducted by the New York State Department of Health concluded that there were no benefits to administration of an 8-mg intranasal naloxone compared with a 4-mg product. However, Hikma, the manufacturer of Kloxxado, cited past studies that voiced concerns about insufficient naloxone doses in the fentanyl era, and emphasized the need for all FDA-approved treatment options to be available for those on the frontline of the public health epidemic.
The research overwhelmingly shows that more naloxone does not necessarily translate to higher survival rates and that it can have significant consequences. This study emphasizes the importance of making informed decisions regarding the use of naloxone, particularly as communities strive to address and prevent opioid overdoses.
