‘We need to stay open minded’: Embracing new and old treatments to combat the opioid epidemic
In a small apartment community in Robeson County earlier this year, volunteers from a variety of nonprofits handed out school supplies to residents. Site manager Trina Locklear showed off drawstring bags that parents could fill with markers, colored pencils, erasers, and all sorts of other school necessities.
"And we also have some toothbrushes," Locklear said.
But that's not all.
Representatives from the health department also had information on safe sex and drug abuse prevention. At one table, Gerren Maynor sat behind a stack of Narcan kits, the nasal spray that reverses the effects of an opioid overdose. Maynor volunteers with PAWSS, a Robeson County nonprofit with a special focus on substance use disorders.
She took one of the Narcan doses out of its box and explained how to administer it.
"You insert the tube into the nose of the individual who is not responsive," Maynor said.
According to Maynor, information about how to help someone during an overdose doesn't always make its way to the people who need it, especially in rural areas where opioid use disorder is still highly stigmatized. She said being at a back-to-school event helps her reach more people and explain how to administer Narcan to someone who might not know.
"Watch their respirations for two minutes," she continued. "If they're not at least 12 respirations per minute, administer another dose of Narcan."
Narcan — or its generic version called naloxone — has become a crucial tool in the fight against the opioid epidemic, especially as highly potent fentanyl now floods the drug supply. In some cases, people given Narcan describe an almost back-from-the-dead experience in which they sit straight up and gasp for air.
Maynor described how the spray medication works once it's in the human body.
"When the opioids are broken down, they attach to certain receptors in the brain," she said. "When Narcan is administered, it's stronger; it has a stronger affinity for that receptor than the opioid does. So, it knocks the opioid out and covers that receptor to reverse the opioid effect."
In September, drug stores nationwide began selling Narcan over the counter. Some hope this will increase availability, but with a price point of $45 dollars or more, community health workers say the impact will be minimal.
Meanwhile, another kind of treatment in development could stop a fentanyl overdose before it even happens.
Chapel Hill-based Cessation Therapeutics is working on a monoclonal antibody designed specifically to prevent a fentanyl overdose. Company chief scientific officer Andy Barrett said that unlike naloxone, this treatment aims to attack fentanyl in the blood stream before it even gets to the brain.
"The brain is where it produces its toxic effects, meaning it produces its profound respiratory depression that can lead to death," Barrett said. "That's also where it produces its pleasurable or euphoric effects in the brain. So we stop it before it ever gets to the brain and sequester it in the bloodstream to prevent its harmful effects."
This summer, Cessation received FDA approval to test the new medicine in healthy humans — called a Stage 1 clinical trial. This is a massive step for a drug developer, though it still has a long way to go before full approval.
Many doctors say this kind of treatment would help but see it less as a silver bullet and more as another good tool in the fight. Big picture, they say society still needs to shift from seeing substance use disorder as a character flaw and more for the disease it is.
Dr. Marla Hardenbergh treats patients in Lumberton and compares opioid use disorder to breast cancer.
"When we have the bridge of chemotherapy for breast cancer, between breast cancer and disease remission, we see disease remission," Hardenbergh said. "And substance use disorder is really no different in terms of the disease model."
Some of those treatments still come with social stigma. Medication Assisted Treatment allows for the use of some opioids during a detox. Harm Reduction treatment actually provides clean syringes to people who use drugs. Hardenbergh said evidence shows these methods reduce overdose death.
"But we as a society and with our frailties often become resistant to things where behavioral health is involved," she said.
Still, Hardenbergh also has some criticisms for harm reduction advocates who don't leave any room for a 12-step program or treatments that incorporate faith or spiritual therapy. She said not many people mention medication assisted treatment and a spiritual-based program in the same breath.
"If we're going to really see long-term disease remission, we need to stay open minded to all the things that work," Hardenbergh said.
Finding solutions that work continues to be necessary as North Carolina is on pace to set another record high of opioid overdose emergency department visits in 2023.