“Can I have a prescription for Narcan?” asked Judith Jordan, one of my long-time patients.

She’s in her late 70s and wanted to comply with Surgeon General Jerome Adam’s recommendation last month that community members —not just first responders — help combat the opioid crisis by keeping naloxone (Narcan) on hand.

But you aren’t taking any pain medicine,” I said. “Is anyone in your household on pain pills?”

“No,” she replied. “I just figured if I came across someone who was unconscious who had overdosed, I would be able to revive them and save their life.”

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I had to give her credit. Not one to shy away from danger, she wanted to be ready for anything should the need arise in her Kaneohe neighborhood, even when she’d never come across anyone who had overdosed in the past.

Hawaii has been lucky thus far. We are not seeing the same numbers of overdose victims as in other parts of the country. But that luck could run out someday, and the surgeon general wants everyone to be prepared.

I offered her the prescription, but she had second thoughts. Was it going to show up on her insurance? She didn’t want anyone thinking she was addicted to pain pills and needed the reversal agent for herself.

“Why can’t you just buy it over the counter?” she asked.

Good question.

Forty-three states allow for the sale of naloxone without a prescription. Hawaii is on the short list of those that don’t, along with Delaware, Maine, Michigan, Oklahoma, Nebraska, and Wyoming.

At any pharmacy in the islands, a prescription is needed to purchase naloxone, and insurance coverage is variable. Copays may apply, and there may be other restrictions or quantity limits according to someone’s insurance coverage.

“These addicts have parents, and maybe even their own kids, and I just want to do my part to help.” — Judith Jordan

Just a few years back, Gov. David Ige signed Senate Bill 2392 providing immunity for health care professionals and pharmacists who prescribe or administer overdose reversal agents, such as naloxone. This bill also authorized first responders, relatives and friends to administer medication to anyone experiencing an opioid-related drug overdose, with immunity from liability.

Naloxone is a relatively safe antidote to an overdose, and if given to someone who is not experiencing a opioid-related effect, it doesn’t do anything. But for those who have stopped breathing, the usual concern with narcotic overdoses, it can revive someone within seconds. Emergency personnel should still be called, as the person can relapse or require multiple doses of the medication before it truly works.

Chronic opioid users may have less of a reaction to the reversal agent, but short-term opioid or drug users may experience a sudden crash coming down from their high, especially with the rapid onset of the medication. This is a big concern, as the safety of the person who administered the naloxone can be at risk.

I asked Judith what she thought about that.

“I would be concerned, but if I could save a life, I would still want to do it,” she said.

She seemed undaunted by the potential that the person she might be treating could be violent, or put her in harm’s way.

“I don’t see why I just can’t go to the drugstore and buy it,” she said. “If more people had this with them, it would save thousands of people all over the country, and I don’t think it should be restricted by having a prescription.”

She had a solid point. Rather than limiting access to only those with medical insurance, and targeting those who are on prescription medication, if the reversal agent were easily available, then those who are not taking legal opioids could also benefit.

Some people have expressed concerns that having this overdose reversal agent more easily accessible could actually encourage people to experiment with illegal drugs or be more careless with their use, counting on being rescued by naloxone if they took too much.

This didn’t deter Judith at all. She felt that saving even one life would make it worth the use of naloxone, and the main issue at hand was our lack of resources available for drug treatment. Repeated use of naloxone is not the answer, but providing the opportunity to get clean and go to rehab was essential.

We both agreed that Hawaii needs more rehabilitation facilities in order to address the current drug problem, not just for opioids, but for crystal meth, cocaine, alcohol and more. Lack of available beds in these types of facilities combined with our current jail system for drug offenders amounts to not addressing the needs of the community.

In the end, she said she’d think about whether to proceed with a prescription while hoping that Hawaii would join most of the rest of the nation in making this available without needing any permission from a doctor.

After all, she said, “I’m a mother, and if someone saved my child’s life, I would be forever grateful for their help. These addicts have parents, and maybe even their own kids, and I just want to do my part to help.”

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