Need is desperate for a stable naloxone supply
“Can I get some Narcan?” asked a regular client at one of Connecticut’s largest syringe services programs last week.
“No, we’re out,” I said as I watched them walk out for what could be the last time.
This seems like a reasonable request, given that the United States is in the midst of one of the most volatile opioid epidemics globally, with over 100,000 deaths across the country in 2020. That is the equivalent of a Boeing 737-400 crashing every day for a year.
Naloxone, under the brand name Narcan, is a lifesaving antidote to reverse overdoses. The rise in overdose deaths is driven by an influx of powerful synthetic opioids like fentanyl into the drug supply.
Naloxone works by blocking receptors on the brain so opioids cannot attach and cause nervous-system depression, which leads to hypoxia (lack of oxygen) and death. Across Connecticut naloxone distribution is becoming increasingly important as the overdose crisis makes substantial shifts into urban communities.
Despite its effectiveness the availability of naloxone has not met the level of need. The Connecticut Department of Public Health and SSPS around the state have been out of naloxone for three weeks. Though some SSPS have made informal arrangements to get supplemental supplies of naloxone from pharmacies and private partnerships, these week-by-week agreements are not sustainable. In the absence of naloxone in SSPS and their surrounding communities, we run the risk of heightening the overdose crisis in Connecticut.
The scale-up of SSPS in the U.S. has been severely limited; only 39 states have laws explicitly authorizing their use. Even after decades of evidence that show SSPS are a cost-effective strategy for decreasing the risks of drug use, including infectious diseases and overdose, the locations that need them most have disregarded their benefits for primarily political reasons.
In this country we have disinvested in public health, as shown by the failures we’ve seen during the COVID-19 pandemic. This has led to an overall lack of funding for harm-reduction services, which includes SSPS and community-based naloxone distribution.
Though the Biden administration has made a small stride toward providing funding to address the overdose crisis, his platform still largely relies on the failed methods of the War on Drugs, while only a small fraction of the 2023 budget is dedicated to harm-reduction services.
As a result naloxone distribution within SSPS remains challenging. In many states
only individuals at risk of overdose can receive a prescription for naloxone; however, we know this does not work systematically. Getting naloxone into drug users’ social networks is one essential step toward ending the overdose crisis.
We need to flood the community with naloxone to ensure people at risk for overdose will be able to be revived if they begin to overdose. Integrating naloxone distribution into SSPS is necessary to decrease the number of deaths caused by overdose.
Connecticut is one of seven states that permits community organizations, such as SSPS, to distribute naloxone. Yet the funding necessary to sustain these lifesaving programs is insufficient.
In 2021 alone, one SSP in New Haven gave 374 naloxone kits (with two doses in each kit) and many more overdose education sessions to its hundreds of clients, but unsurprisingly its budget does not speak to its success. Despite being affiliated with Yale University, funding is scarce for the SSP in New Haven. Like many others throughout the state, the program operates almost exclusively with money from the DPH and one-off grants, which is simply not enough.
For example, of the total 2020 budget of the DPH, needle and syringe exchange programs received only $450,000, a fraction of a percent of the overall DPH budget. Though this number shows the gross underfunding of SSPS, the debate here is not whether another vital program should have money shifted from it. Like many other health departments, the Connecticut DPH is underfunded and overwhelmed.
We need a change in how these programs are prioritized and funded. Funding needs to meet demand.
Data from the Substance Abuse and Mental Health Services Administration in 2020 found that 40.3 million people aged 12 or older had a substance-use disorder in the past year. As it stands, SSPS throughout Connecticut regularly run low on clean syringes and naloxone.
Having sustainable funding that can meet the daily needs of our communities is essential for the future operation and success of SSPS. In Yale’s case, not only does the New Haven SSP provide lifesaving services to its community, but the program has had substantial benefits for the university. Since its inception in the early 1990s the New Haven SSP has been a pioneer in service delivery, leading to the renowned success of many faculty and the Yale Program in Addiction Medicine.
As the drug supply becomes further contaminated and deadly, people need these services to survive.
If your relative walked into the needle exchange last week, you would have wanted them to access a medication that could save their life. So why should anyone else walk away with anything less?