Health agencies are calling for doctors who prescribe opioid painkillers such as Vicodin and Percocet to make sure many patients also receive a separate drug that could save their life if they accidentally overdose.

The recommendation from the Centers for Disease Control and Prevention and the Food and Drug Administration comes in response to an alarming rise in fatal opioid overdoses, which reached a record 33,000 in 2015, according to the most recent data from the CDC. One-third of those deaths involved prescription opioids.

Yet many overdose deaths could be prevented with a single drug: naloxone.

The rescue medication comes in the form of an auto-injector or nasal spray, either of which is easy for anyone to use in an emergency. It doesn’t even require a prescription in many states.

But most doctors aren’t prescribing naloxone often enough—and many patients don’t even know it exists. That has public health and medical organizations concerned.

"These new recommendations are helpful, but haven't yet reached most healthcare providers who—along with patients—may underestimate the risks of prescribed opioids for some people," says Phillip Coffin, M.D., director of substance use at the San Francisco Department of Public Health.

Why Don't More People Get Naloxone?

According to an analysis published in the New England Journal of Medicine last December, only 3.2 million naloxone prescriptions were dispensed in 2015. That compares with 220 million prescriptions for opioids that same year, according to IMS Health, a firm that tracks the pharmaceutical industry­.

One reason is simply lack of awareness, says lead author Ravi Gupta, a medical student at the Yale University School of Medicine. The risks of opioid overdoses, especially for people who take them at high doses for long periods of time, have only recently started to come to light.

“Many doctors just weren’t trained to consider it as a precautionary measure when prescribing opioids to people for pain relief,” Gupta says.

It’s relatively easy to get naloxone for $40 or less. But be aware that some versions of the drug have shot up in price recently. (Read our earlier report here.)

Naloxone comes in two forms: Narcan Nasal Spray and Evzio Auto-Injector.
Naloxone comes in two forms that are easy for anyone to administer in an emergency: A nasal spray (Narcan) or an auto-injector with voice commands (Evzio),...

Who Needs to Keep Naloxone?

People who take opioids regularly for pain should talk to their doctor about naloxone, advises Roger Chou, M.D., associate professor of medicine at Oregon Health & Science University in Portland and co-author of recent CDC guidelines for using opioids to treat chronic pain.

“Getting naloxone makes sense for anyone prescribed opioids, especially if people who have any factors that could put them at risk for overdose,” he says. “That includes things like taking high doses or taking certain other medications such as a muscle relaxant, sedative, or sleep drug that can intensify the dangerous side effects of the opioid.”

But Chou also cautions that naloxone should be only one part of your safety strategy. “Ideally, you should use that conversation with your doctor to talk about ways to reduce your risk, such as slowly tapering down to a safer dose of your pain medication.”

Anyone who uses opioids recreationally or has a history of opioid addiction should also have naloxone on hand.

These new recommendations haven’t trickled down everyday practice for many physicians, who may still underestimate the dangers of prescribed opioids," says Roger Chou, M.D., associate professor of medicine at the Oregon Health & Science University in Portland and co-author on recent CDC guidelines for using opioids to treat chronic pain.
These new recommendations haven’t trickled down everyday practice for many physicians, who may still underestimate the dangers of prescribed opioids," says Roger Chou, M.D., associate professor of medicine at the Oregon Health & Science University in Portland and co-author on recent CDC guidelines for using opioids to treat chronic pain.


For a more in-depth look at this topic, read our full report here (PDF).
 

How to Get Naloxone, Even Without a Prescription

Healthcare providers can prescribe naloxone, but in most cases you can get it even without a prescription. Most states have passed laws allowing pharmacists to dispense the drug.

Your pharmacist can submit the cost to your insurance, regardless of whether you have a prescription.

But because recommendations calling for wider use of naloxone are still relatively new, not all pharmacies are stocking the the drug at this point, according to John Beckner, B.S.Pharm., senior director of Strategic Initiatives at the National Community Pharmacists Association (NCPA).

“It’s a good idea to call ahead to ask the pharmacy to order the drug if necessary and to set up a time for your pharmacist to go through what you and the people around you need to know about when and how to use the drug in case of an emergency,” Beckner says.

If you want to have naloxone on hand for a friend or family member, you can still get the drug from the pharmacy, but your personal insurance probably won’t cover it, says the NACP’s Beckner.

Although you can get generic naloxone in vials to be used with injections or in nasal spray kits, the newer brand-name products, Narcan Nasal Spray and Evzio Auto-Injectors, are much easier for people without medical training to use. Read more about how to get those products for as little as $30—or free—with your insurance.

For those who don't have health insurance or are buying naloxone for someone else, the cheapest price we found was Narcan Nasal Spray for about $140 for a two-pack using a coupon from GoodRx.

Another option is to contact your local public health department. It may be able to connect you with a community outreach program that distributes naloxone free.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).