New hope for treating fentanyl overdoses

By now, fentanyl is not a new word in the vocabulary of anyone working to fight the scourge of substance use disorder. The statistics speak for themselves when it comes to the number of fentanyl-related deaths in Alaska. James Cockrell, Alaska’s Commissioner for the Department of Public Safety, spoke to Alaska Public Media recently about the fentanyl crisis in Alaska, citing how between 2021 and 2022, overdose deaths nearly doubled from the previous five-year average.

Addiction treatment experts Curednation.com recently analyzed data from the latest Substance Abuse and Mental Health Services Administration (SAMHSA) drug use survey to discover the rates of illicit drug use in each state, and the research revealed Alaska placed second in the list, with 22.91% of respondents saying they had used drugs in the previous 30 days. Marijuana use is also second highest in Alaska, with 22.52% of people saying they had used it in the past month – only Vermont had a higher rate.

Currently, the tool most-widely used to help prevent deaths from fentanyl is Naloxone, commonly called Narcan, a nasal spray medicine that works to prevent deaths from overdoses by blocking the effects of opiates on the brain and restoring breathing and is safe for just about everyone to use.

But the high rate of drug use and fentanyl-related deaths also emphasizes the fact that fentanyl is not going away any time soon, and to prevent more overdose deaths from happening, new tools are desperately needed.

Enter Opvee, an FDA-approved overdose reversal nasal spray specifically indicated for both natural and synthetic opioids, like fentanyl. Opvee, whose active ingredient nalmefene, was approved by the Food and Drug Administration for opioid overdose treatment in May, 2023. Jerome Adams, United States Surgeon General from 2017-21, explained the importance of this drug, which was specifically made to address overdoses caused by fentanyl.

“The opioid epidemic originally came on the scene, really, as a prescription opioid epidemic,” said Adams. “Doctors were over-prescribing pills and we clamped down, in terms of prescribing, in terms of tamper resistant forms ... and then people shifted to heroin.”

Adams explained that once heroin took over the opioid scene, people were injecting their opioids and more hepatitis outbreaks soon followed. In 2018, he put out a Surgeon General’s Advisory requesting more people carry naloxone.

“A person was dying every 10 to 11 minutes of an opioid overdose,” he said. “What we’ve seen now is that we shifted from this being a primarily heroin-based epidemic, to it being a fentanyl-based epidemic, and fentanyl is 50 to 100 times more potent than heroin.”

“We needed an overdose reversal agent that was designed to respond to a fentanyl overdose and that is what Opvee is,” Adams said. “It is nasal nalmefene, and it's administered in the same way as naloxone …But it's designed pharmacokinetically and pharmacodynamically to respond to a fentanyl overdose.”

Narcan has a plasma half-life of 2 hours when administered intra-nasally, while fentanyl has a plasma half-life of roughly 4 hours, which can necessitate the administration of a second dose when treating an overdose.

Nalmefene, on the other hand, has a plasma half-life of 11 hours, which holds the promise of reducing the need for repeated administrations while someone is overdosing.

“It's not something that is a competitor with, or is meant to replace naloxone,” Adams said. “It's a tool in the toolkit. And we want people to understand that as your enemy evolves, you have to evolve too. And so again, almost all drug overdose deaths now involve fentanyl. And if we want to turn it around this time, we need to respond in kind with an agent that has been developed to reverse fentanyl.”

Adams stressed that while Opvee shows potential, its adoption nationwide has been slow.

“It’s important to understand that any time a new drug is released, it takes a certain amount of time for the public to know that it's out there and understand how to utilize it, and then also just to make it more widely available,” Adams said. “That just takes time, and this medication has barely been out six months, in terms of being FDA approved.”

Adams gave another reason nalmefene is not that widely available in the United States-many of the states’ standing orders in place making opioid overdose reversal agents more widely available without a prescriptions specifically worded to say naloxone or Narcan, because that was the only tool at the time.

“Now we need to understand that there are more tools, and in many cases tools specifically designed to respond to the current fentanyl crisis.”

Adams said he is most focused on seeing this drug in the hands of firefighters, police and emergency medical personnel.

“I want them to have another tool in the toolkit that will hopefully allow them to be able to be more effective,” he said.