The Daily Tar Heel

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Friday August 19th

Op-ed: Astroworld Festival’s hidden lesson about naloxone access in North Carolina

Amid the chaos surrounding Travis Scott’s Astroworld Festival on November 6, an unexpected hero surfaced as a lifesaver: naloxone.

Multiple potential drug overdoses were investigated, including a security guard managing the event, according to the Houston Police Department. Fortunately for the security guard, nearby medics administered naloxone, a life-saving medication that reverses the effects of opioid overdose.

Astroworld Festival’s potential drug-related casualties highlight important talking points in the conversation of naloxone access in North Carolina. The argument calling for all emergency personnel to carry naloxone is prominent and well-received, but in the case of a situation like Astroworld Festival, medical professionals were gravely understaffed and unprepared resulting in a lack of product and an inability to reach everyone in need. 

While the event took place in Texas, North Carolina representatives should pay attention as opioids continue to present a public health crisis. Last year, eight people died each day from drug overdose. Two years prior, 79 percent of drug overdoses involved opioids. While alarming, this high rate follows prescription trends as that same year, North Carolina providers reportedly wrote 61.5 opioid prescriptions for every 100 persons compared to the national average of 51.4. 

With the rising severity of the opioid epidemic in the state, there are an increasing number of scenarios, like Astroworld Festival, where relying on medical professionals and first responders to assist is neither efficient nor feasible. Naloxone must be accessible and commonplace for the public.

So, how do we do this?

North Carolina is already a step in the right direction. Since June 2016, naloxone is available without a prescription via statewide standing order. This standing order authorizes pharmacists to dispense to any person or any person proximate to someone at risk or of opiate-related overdose. 

This policy proved effective as deaths involving prescription opioids declined from 659 to 489 per 10,000 people between 2017 and 2018. There are, however, still barriers that perpetuate naloxone inaccessibility. 

A 2018 study that surveyed community pharmacists in North Carolina under the standing order found that 50 percent of respondents were not comfortable distributing naloxone. Additionally, a 2021 study found that inconsistent stocking, inequities in availability and unclear naloxone dispensing protocols served as common issues in multiple states with standing orders. 

What will adequately expand access to naloxone? Transitioning to over-the-counter distribution. 

Naloxone meets the four criteria for FDA over-the-counter status. Additionally, the FDA explicitly showed support for this switch and developed/tested a model drug facts label for over-the-counter naloxone. The feasibility and initial groundwork are established, North Carolina state representatives now need to back their support and collaborate on a federal level.

With any policy change, we must address concerns. One hurdle is if naloxone becomes over-the-counter, there’s no guarantee all insurance companies will cover it making cost a newfound barrier for some. State officials can combat this by taking after other states and mandating insurance coverage of naloxone, making sure to extend it to over-the-counter formulations. 

The other major hurdle is the lack of pharmacist-patient communication. This, however, presents the opportunity to implement educational components more broadly. Rather than limiting education to pharmacies, state officials can require larger entities such as doctor’s offices and schools to adopt general substance-use education that involves naloxone training. This not only increases awareness and self-efficacy but works against substance abuse-related stigma to normalize naloxone and increase uptake.

North Carolina representatives: here’s your call to fight for greater accessibility and equity. Previous prescription-only medications successfully made the transition to being available over-the-counter and it’s time to make the final push for naloxone to be next.

Kylin Adams

MPH Candidate | Gillings Schools of Global Public Health 2023


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