In October 2006 the sale of over-the-counter pseudoephedrine, also known as Sudafed, was restricted to purchase from behind the pharmacy counter in Hawaii. This was done due to the risk of large quantities being used to make illegal drugs, like ice or crystal methamphetamine.

The program required a signature and proof of identity, in the hopes that this would restrict people from buying large quantities at once from different locations, and using it to make illegal ice.

The end result – pretty effective.

Manufacturers changed the ingredient in many of the over-the-counter cold remedies and for those who really needed to purchase the pseudoephedrine products, it was available with a small additional inconvenience of going to the pharmacy with an appropriate ID.

Given the way the system has worked so successfully, why can’t this be implemented with another lifesaving drug, naloxone?

Nalaxone is administered in the case of overdone. Hawaii needs to make access to it much easier.

Mark Oniffrey/Wikimedia

In 2016, Gov. David Ige signed Senate Bill 2392, which gave immunity to all first responders, family members, pharmacists, etc who gave or administered naloxone to someone who was suspected to be experiencing an overdose. This also provided for coverage for the medication under the Medicaid program.

According to studies done by the National Institutes of Health , there is not an increase in use of narcotics when naloxone is readily available.

Several countries around the world like Italy, the UK, Germany and Australia provide this medication to opiate users and their families routinely. So the question becomes, why restrict the access to this medication at all?

If a family is living with someone who is an addict, how can they get access to naloxone easily, without any hassle, without a prescription?

Narcotic pain medications, whether legal or not, are the cause of overdoses. Those who take the standard formulations of hydrocodone, oxycodone, and others prescribed by their doctor should be able to also get a prescription for naloxone, along with training for their family members to administer the medication if an overdose is suspected.

However, this rarely happens in clinical practice. It’s just not the current standard of care for most physicians.

It could be, and once a year, doctors could give an updated prescription for naloxone along with other opioid pain medication.  The medication is not expensive, and could be mandated to be prescribed for anyone taking high dose pain pills.

But what about the addicts?

Although this might help those who take prescribed medication to avoid overdose, it would not do much for those taking illegal drugs. It’s highly doubtful that someone on heroin is going to see their doctor and get a prescription for a reversal drug.

Needle exchange clinics could help. These were set up to provide clean needles for those using IV drugs in an attempt to reduce the spread of Hepatitis B, C and HIV, among other infections. In Hawaii the CHOW program has over 25 years of experience taking care of addicts, providing education, resources, and on site care for drug addicts.

In this situation, giving naloxone to those self-selected individuals or their loved ones might work.

But what about the drug user on the street who never goes to a clinic? How can they receive naloxone?

Only by having bystanders call 911 and seek emergency assistance. That works, but it might not be fast enough. For someone who overdoses, minutes count. In addition to the delay in receiving care, this also costs taxpayers a lot of money each year for the subsidies of unpaid care. This affects not just taxes, but also the cost of medical insurance for everyone else as well.

Selling naloxone over the counter from the pharmacies, like pseudoephedrine, would improve access, and provide another possible opportunity to educate addicts about their need for drug rehabilitation services, and other programs that can help.

It may seem like this would make people more likely to push their illegal drug use to the edge if they had naloxone available, but this shouldn’t be the reason to restrict this life-saving drug from being more readily available to save lives. The principle of harm reduction makes the need to have access to naloxone essential.

Since 2008 the number of overdose deaths has surpassed the numbers of motor vehicle accident deaths every single year. Rates have doubled in the past almost two decades. Not everyone could have been saved by naloxone, but as the opioid epidemic continues, there are few other ways to save lives immediately and provide people with a second chance.

The most cost-effective way to do this is to put the medication in the hands of those most likely to need it, without the barrier of requiring a prescription.  Families who know of an addict in their household could also purchase this and be trained on how to administer it if necessary.

It only takes the death of one close family member or loved one to beg the question of why this life-saving medication is not more readily available.

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