“Narcan has to be everywhere,” New York City Health Commissioner Ashwin Vasan announced last week. “We have defibrillators behind every bar, in every business, in every public event. Increasingly, we have epinephrine pens, EpiPens, in public settings.”
Yes, commissioner, but if everyone was dropping of cardiac arrests or anaphylactic shock, defibrillators or EpiPens would not be nearly enough — instead it would be a tip-off to physicians to look for the cause of increased heart disease or allergies.
Medicine and public health are always about getting at the cause.
In this case, it’s a leaky border and a supply chain of pharmaceutical ingredients including the ubiquitous piperidone — used to make fentanyl — from China and India flowing to Mexico.
The drug cartels manufacture the synthetic opioid hundreds of thousands of doses at a time and smuggle it across the southern border.
They then advertise it on social media, at schools and elsewhere.
Americans are bringing the supply to teens, mixing them with speed and cocaine or disguising them in pills.
Don’t get me wrong: I have no problem with Narcan (an opioid-antagonist chemical called naloxone) because even if you give it to someone who has fallen to the pavement or stopped breathing from something other than an opioid overdose, there really is no downside — and you could conceivably save a life if opioids really are the reason for the respiratory arrest.
Just because I have never seen a passerby administer a Narcan nasal spray to someone stricken on a New York street doesn’t mean it has never happened.
If this trend continues, I know I will eventually see it or administer it myself.
Still, it is more of a symptom of the problem than a cure.
Plus, you have to use Narcan repeatedly over days — in the hospital — to counteract a long-acting, powerful synthetic opioids such as fentanyl.
And even if you then transition the patient successful to medically assisted therapy with a mild opioid agonist such as buprenorphine and get him or her into rehab, there is still a high recidivism rate.
Dr. Anna Rose Childress, director of the Brain-Behavioral Vulnerabilities Laboratory Center for Studies of Addiction at the University of Pennsylvania School of Medicine, confirmed to me that faster-acting, more-powerful versions of Narcan are on the way — but this is also not a solution, just a bigger Band-Aid.
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We must not only educate and warn our teens.
We need to cut down significantly on access through schools and social media while increasing direct parental involvement.
And we need to close and guard the border.
Childress told me that the risk of such a potent deadly drug can actually be alluring to teens.
Of course there are many teens who are exposed to it inadvertently or don’t realize that just 2 mg of fentanyl is enough to kill.
But social media, like TikTok and other platforms, are playing a huge role in providing youngsters access to fentanyl and other drugs.
And fentanyl is no longer the only problem.
A recent University of California, Los Angeles study published in Addiction revealed that up to one-third of overdose deaths involved more than one drug, most commonly fentanyl plus either cocaine or methamphetamine.
Childress said this combination of drugs may extend the high.
Then there are nitazenes, which are even stronger than fentanyl.
They are increasingly being used and are only partly responsive to a Narcan antidote.
And there’s xylazine, which is not an opioid and doesn’t respond to Narcan at all.
We are in trouble. And no amount of Narcan is going to fix it.
Marc Siegel, MD, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.
