A medical examiner has confirmed that musician Prince died of an overdose on fentanyl, a powerful opioid. This high-profile case illustrates why governments must embrace naloxone: a safe and affordable medicine that prevents deadly opioid overdoses.
Naloxone is included on the World Health Organisation’s (WHO) List of Essential Medicines; an assortment of medications described as "the most efficacious, safe and cost-effective" for all healthcare systems. It is a colourless liquid, primarily administered intravenously or by injecting into a muscle. Within two to five minutes, it blocks opioid receptors in the brain, reversing the effects of opioids – including fentanyl and heroin – and thereby preventing potential overdoses. There is no opportunity for naloxone to be abused – as it has little to no effect on people who don’t use opioids – and its potential side-effects for opioid users, though hazardous, are certainly preferable to untimely death.
Prince’s life could have been saved if he had been with someone who was in possession of naloxone. As could many of the estimated 69,000 people worldwide who – according to the WHO – die from opioid overdoses each year. Management Science for Health estimates a low cost for a single dose – between $0.50 and $5.30 (£0.34 – £3.65) – yet access to naloxone varies considerably around the world.
Success in reducing opioid-related deaths is consistently documented when naloxone availability is increased. The BBC reports that, in Wales, drug-related deaths reduced by 30 per cent in the five years following the introduction of a naloxone programme. In 2010, the city of Quincy, Massachusetts, began a programme in which police officers were trained to administer naloxone; within three years, police recorded a 95 per cent success rate in preventing overdoses – according to CBS News.
A 2015 report by the European Monitoring Centre for Drugs and Drug Addiction asserts that, in the EU, "in most jurisdictions, naloxone is a prescription-only medicine and its use is restricted to medical personnel or to patients to whom it is prescribed". It is key for these restrictions to be reduced, and for more people to be trained in administering naloxone, so that friends or family members of people who use opioids can be ready to respond to an overdose.
In some regions, however, even prescription-based naloxone is opposed by legislators. In the US state of Maine, Governor Paul LePage vetoed a bill to allow pharmacists to provide naloxone. LePage claimed that “naloxone does not truly save lives; it merely extends them until the next overdose”, and was seemingly oblivious to the fact that ‘merely extending life’ is the purpose of medicine and healthcare.
It is essential to recognise that the failings that led to Prince’s death were avoidable, just as they are for all those around the world who die from opioid overdoses. It is hopeful to see a range of governments making progressive steps to improve access, but it is essential for the process to move faster, and for the power that naloxone holds to be publicised as much as possible.