by Jared Scott |
In the wake of the COVID-19 pandemic, the Opioid Epidemic has brought many American families to their knees while waging the loss of thousands of young lives. A climbing number of teens are dying as victims of overdose on opioids, such as prescribed pain medications and similar unprescribed substances. These drugs include heroin, oxycodone, hydrocodone, and fentanyl, among others. However, there’s a medicine called Naloxone that can and has been saving lives by immediately reversing the effects of opioid overdoses. It is referred to as an opioid antagonist and its availability is widely hailed as the foundation of the country’s response to the crisis. Unfortunately, stemming from a set of unsupported presumptions, some people are worried that using Naloxone might make the opioid crisis worse by “enabling” those who use opioids in a risky way to use it in an even more dangerous way. Honestly, this couldn’t be further from the truth. This concern is part of a larger concept called “Naloxone stigma”.
Role of Naloxone in the Opioid Epidemic
As previously mentioned, Naloxone is a powerful medicine that can quickly reverse the effects of opioid overdose; it is a life-saving intervention. Its importance in combating the opioid crisis cannot be overstated, mainly because it has the ability to rapidly restore normal breathing in such overdose cases. Since 2016, experts from the Centers for Disease Control and Prevention (CDC) have insisted that doctors should give Naloxone to people who take opioids regularly to help keep them safe from overdoses, emphasizing its significance in the fight against opioid-related deaths.
Concerns and Criticisms Surrounding Naloxone
Even though Naloxone can save lives, some people aren’t sure about it. Generally, they are concerned that making Naloxone more available might make drug use more dangerous for people at risk of overdosing. As previously stated, this worry is rooted in what has been called “Naloxone stigma”, which, in a nutshell, describes negative thoughts or beliefs about Naloxone. Again, this perspective is rooted in assumptions that are FAR FROM THE TRUTH and might stop Naloxone from helping as many people as it could.
Studies on Naloxone Use and Opioid Behaviors
Scientists have conducted many studies to figure out if the availability of Naloxone could make those who use opioids use them in a more risky way. These studies have given insights that challenge such beliefs concerning Naloxone and the broader concept of
“harm reduction“. Harm reduction focuses on working directly with individuals who use drugs to prevent harmful outcomes including overdose and the spread of infectious diseases. Work in harm reduction also aims to enhance their physical, mental, and social well-being while providing low-barrier access to healthcare services, such as substance use treatment and mental health care. A study published in 2023 focused on teenagers’ access to Naloxone, and they concluded that Naloxone laws and pharmacy distribution may lead to reduction in lifetime heroin use, not an increase as many may assume. In other words, having more Naloxone around was associated with teenaged heroin users using heroin LESS, not more! Another study evaluated the outcomes of giving Naloxone as a protective measure for those at risk of overdosing. The study showed that giving Naloxone to people who might overdose does not appear to lead to more “careless use”. Overall, these studies suggest that Naloxone distribution does NOT make people use drugs more dangerously. This flies in the face of a widely held concern that “parachutes may make them jump”.
Effects on Youth
When opioid use or misuse is addressed, mature adults typically come to mind as the primary group affected by the crisis. However, this perspective overlooks the significant impact of the epidemic on younger populations like adolescents and young adults. Although most opioid overdose deaths occur among middle-aged and older adults, 10% involve individuals under the age of 26. This age group is crucial, as early opioid use can lead to higher risk of opioid-related deaths later on, making harm reduction strategies essential once use begins. Several barriers prevent effective harm reduction in adolescents. One major issue is the shortage of pediatric-focused addiction medicine doctors, which contributes to the low adoption of Naloxone. Despite many addictions arising during adolescence, only a tiny fraction of addiction medicine providers are pediatricians, and even fewer offer or prescribe Naloxone. This limited access to harm reduction tools ultimately fuels the problem. Existing harm reduction efforts often rely on abstinence or a “Just Say No” approach, which has proven ineffective for younger audiences. To address the opioid crisis among youth, a more flexible and youth-focused strategy is required to ultimately improve efficacy. A critical first step is ensuring adolescents have unrestricted access to Naloxone. This shift in approach is essential for effectively tackling the opioid crisis among young people.
Naloxone Stigma as Multi-Dimensional
Naloxone stigma isn’t just one problem. It is comprised of a broad collection of detrimental beliefs and related actions. First, societal expression of stigma against the use of substances (as you may recognize in news media, film, policy, education, etc) can influence people with substance use disorder (SUD) to be less willing to seek treatment due to shame, guilt, and various other emotions that stifle their journey in seeking help. Moreover, it is a common misconception that Naloxone is only for people with an unhealthy relationship with a medication or a substance which, compounded with the associated stigma, makes others less likely to learn about it, carry it, or use it to help someone else. Beyond that, negative stereotypes about people with SUD are unfortunately common amongst healthcare professionals as well, preventing more therapeutic conversations about substance use and harm reduction (like Naloxone distribution). Therefore, stigma, especially as it pertains to Naloxone, limits the effectiveness of its distribution. From here, we see a clear “domino effect”:
More stigma → less Naloxone distribution → more overdoses → more loved ones lost.
People have to be alive to seek recovery, and Naloxone gives them that opportunity.
It is essential to understand that the main barriers to the spread of Naloxone is a complicated relationship of societal norms, systemic challenges and individual beliefs. There isn’t a “one-size-fits-all” approach, so we have to consider the many factors contributing to this stigma, as all these beliefs together make it harder for Naloxone to be accepted as a life-saving medicine.
Despite the overwhelming evidence, if questions remain about the perceived harms of Naloxone availability, consider this: do more fires occur where more fire extinguishers are available? do more hearts stop because there are more defibrillators? do more people fall overboard because there are more life vests?
Regardless, it is clear that Naloxone is important for saving lives during this opioid crisis. Even though Naloxone stigma is still a problem, we can’t ignore how helpful Naloxone is to people who are at risk for overdose. Given the steep rise in opioid-related overdose deaths, it’s crucial to utilize all available resources and create multidisciplinary partnerships with the ultimate goal of saving lives. As communities who care about young people, it is our responsibility to address Naloxone stigma, promote harm reduction as a whole and find ways to make sure Naloxone gets to the people who need it most. It is a team effort involving scientists, doctors, and communities to fight the Opioid Epidemic and make sure Naloxone is in a position to save as many lives as possible.
Jared Scott is a dedicated third-year medical student at Loma Linda University School of Medicine with a strong commitment to patient care and community service. In addition to his studies, Jared balances his life by pursuing passions outside of medicine, including weightlifting, playing soccer, and honing his musical skills on the piano. He believes in the importance of maintaining a well-rounded lifestyle, regularly volunteering with local community outreach programs, such as aiding at a local children’s Bible school. Jared values the time spent with family and friends, and he strives to carry this sense of balance into his future career as a physician. His ultimate goal is to provide the highest quality of care for his patients while nurturing a fulfilling personal life. Jared’s dedication to his community, both inside and outside the hospital, reflects his deep-seated belief in compassionate and holistic healthcare.