Narcan, a life-saving intervention for those experiencing an opioid overdose, has never been more accessible.

On February 1, Rhode Island’s first sanctioned safe injection site opened in Providence, offering access to Narcan, case management, and more. In September, over-the-counter Narcan hit pharmacy shelves at $50 for two doses, just six months after receiving the U.S. Food and Drug Administration’s approval. School districts across the country are purchasing large quantities of the overdose reversal drug and many communities are placing naloxone vending machines in libraries, churches, and fire stations.

This investment couldn’t have come at a more critical time, says Kristin Scaplen, Ph.D., assistant professor of neuroscience in Bryant’s Psychology department.

“We have an alarming rate of overdoses in the United States,” says Scaplen, noting that a national survey on drug use and health found that 9.5 million Americans misused opioids in 2020.

With more than 80,000 overdose deaths occurring each year, data from the Centers for Disease Control and Prevention reveal that adults ages 35 to 44 have the highest rate of drug overdose deaths. On the local level, the Rhode Island Department of Health documented 309 opioid overdose deaths in 2022.

“Those overdosing are not intending to do so,” says Scaplen, a researcher who studies addiction using fruit flies. “Opioids, just like alcohol, are one of the most addictive substances and pose significant health problems. Narcan is an opportunity to save lives.”

A quick-to-act drug

Time is of the essence when an overdose occurs. Since opioids affect the regions of the brainstem that regulate respiration, individuals often have slow, depressed breathing and ultimately stop breathing.

“Narcan is what we call an opioid receptor antagonist; it blocks receptors that opioids would typically bind to in order to prevent the effects of the drug,” Scaplen says, noting that our brain is full of chemical messengers that allow neurons to communicate. “When somebody has overdosed on an opioid, Narcan competes with that opioid. For instance, with heroin, Narcan competes for the binding site of the illegal drug. It kicks heroin off the receptor and blocks it from binding again, which helps get that person back to breathing.”

She adds that Narcan, which comes in the form of a nasal spray, starts working in two to three minutes but stops working between 30 minutes and an hour and a half. Since it’s possible that the opioids can remain in a user’s system for significantly longer, it’s important to get that person breathing again and to the hospital.

She notes that opioids have exceptionally high relapse rates and, if someone were to relapse, they are more likely to overdose.

“This happens because someone who has abstained from drug taking for long periods of time now has a lower tolerance for that drug. So, if they were to return to their original drug taking habits, their body would not be prepared and the drug’s effects would be stronger,” Scaplen says.

An ongoing fight

Recent data suggest that people are most at risk of overdosing in the weeks after leaving treatment. In these cases, individuals want to stop using but struggle with the insatiable desire to use. Scaplen adds that cravings are central to nearly all substance use disorders and play a huge role in risk of relapse, particularly when individuals are faced with cues that remind them of their drug of choice.

Many of those struggling with an opioid use disorder developed an addiction after being prescribed opioids for pain regulation. Scaplen notes that preclinical studies are in the works to develop therapeutics for pain that don’t have a high risk of dependence. For instance, the National Institutes of Health’s End Addiction Long-term® Initiative has more than 1,800 research projects and more than 40 research programs underway in all 50 states to focus on ending the opioid crisis.

Scaplen emphasizes that while the availability of Narcan is targeting the increased risk of death by overdose, it isn’t necessarily focused on the prevention or recovery from an opioid use disorder.

“Tackling the opioid crisis requires a multi-pronged approach: We need to prevent overdoses so we can save the lives of those suffering, we need better treatments for pain that are not addictive, and we need better treatments for addiction so individuals can remain abstinent,” Scaplen says.

She adds that overdose prevention centers have been helpful in reducing overdose rates outside of the United States and draws attention to Rhode Island’s safe injection site, which is the third state-sanctioned site in the nation following two in New York that opened in 2021.

“The new overdose prevention center in Providence is a huge step in reducing overdoses in our state,” Scaplen says. “The fact that the center offers other resources, like healthcare and counseling, will also be key in better supporting individuals and connecting them with appropriate recovery support services.”