Q&A: Stigma remains a substantial barrier to naloxone availability in US

Key takeaways:

• Stigma prevents may patients from asking providers about naloxone.
• Naloxone should be made available in a variety of public settings at no cost, an expert said.

Although key steps have been taken to improve access to naloxone for the acute treatment of opioid overdose, more work is needed to overcome the stigma associated with the root cause — substance use disorder.

Healio spoke with Jenna Butner, MD, MPH, FASAM, AAHIVS, assistant clinical professor at Yale School of Nursing, who advocates for wider distribution of this life-saving treatment.

Healio: The FDA has taken steps to improve access to naloxone, including approving an over-the-counter spray . How much of an impact has this had on availability?

Butner: With the elimination of a need for individual prescriptions for naloxone, more people can obtain it through a tanding rder at most pharmacies in a majority of the US. This has made it much easier for those who may have an increased risk of overdose to obtain it, in addition to the general public. Over the last several years, there has been greater public awareness of naloxone and its ability to save lives.

The approval of over-the-counter sales will lead to decreased costs with more availability of it, thus improving affordability. Overall, there has been and will be greater public awareness of naloxone and its ability to save lives.

Healio: What needs to be done to make naloxone more affordable?

Butner: The provision of naloxone should be fully covered by the government. It should be made available in a variety of settings at no cost, ie public libraries, restrooms, etc.

Healio: What other barriers do we face in terms of naloxone access?

Butner: Stigma of substance use disorders, specifically opioid use disorders in the United States and worldwide, is a major barrier to naloxone accessibility. People may feel judged or questioned if they are simply asking for a prescription from a provider or pharmacist. Overdose education and provision of naloxone should be incorporated into regular medical touchpoints, whether primary care, emergency department, dental or other settings.

Healio: Recent data suggest that most people are unprepared to handle an overdose if one happens in front of them. What role do providers have in educating patients? When and under what circumstances should they be talking to their patients about how to use naloxone?

Butner: Unintentional injury is the third leading cause of death in the US, with substance use (and gun violence) as the main drivers. It is imperative that all practitioners discuss overdose prevention with patients. It should be incorporated into any routine visit, just as if one were screening for diabetes.

Healio: Other research shows that many providers are not prepared to treat opioid use disorder, which may increase the chances that naloxone has to be used. Why do you think this gap in knowledge exists, and what needs to be done to address it?

Butner: Stigma and education. Many providers are not trained or educated on evidence-based prevention and treatment for opioid use disorders. Practitioners may be unwilling to treat substance use disorders for a myriad of reasons, which is largely driven by stigma.

Healio: What else should our readers know about this?

Butner: Naloxone is NOT a treatment for opioid use disorder.

It is an opioid blocker which can reverse an opioid overdose. It’s important to remember that in the drug supply, adulterants are added to enhance effect, like xylazine or benzodiazepines. When these are used with opioids, naloxone will not reverse the effect of these substances. Additionally, with the advent of fentanyl and other high potency synthetic opioids, a greater amount of naloxone is often needed to reverse an overdose.

For More Information:

Jenna Butner, MD, MPH, FASAM, AAHIVS, can be found at: https://medicine.yale.edu/profile/jenna-butner/.