September 08, 2023

Credit: Rollcall

During the same week that naloxone — a nasal spray that reverses opioid overdoses — became available for purchase without a prescription, the nation’s top substance use officials called for greater availability and training for the drug, with five federal officials receiving training to administer it during a public demonstration at Health and Human Services headquarters Friday. 

The five were HHS Secretary Xavier Becerra; Deputy Secretary Andrea Palm; Rahul Gupta, director of the White House Office of National Drug Control Policy; Miriam Delphin-Rittmon, HHS assistant secretary for mental health and substance use; and Rachel Levine, the assistant secretary for health. They received their training — which may have been at least partly ceremonial, given the medical background of some in attendance — ahead of the Sept. 30 expiration of several critical public health programs, including a sweeping 2018 opioid prevention law. The Centers for Disease Control and Prevention estimates more than 110,000 individuals died from drug overdoses in the 12-month period ending March 2023, according to preliminary data.

While the Food and Drug Administration initially approved naloxone in 1971 as an injectable drug used in medical settings, it wasn’t until 2015 that the FDA approved a nasal spray version for prescription use. But the agency only approved the first over-the-counter versions of the drug this year. It became available without prescription this week, with Emergent BioSolutions’ 4 mg nasal spray selling for $44.99 for a two-dose product. Harm Reduction Therapeutics’s RiVive, is expected to become available in early 2024.

The price point has been a concern for some advocates who worry it could limit accessibility and use. In an interview, Gupta said the administration is working to bring the price point down as part of a larger effort to reduce health care costs.

“We’re constantly working with manufacturers because we’ve got to make this accessible and affordable. So we’re on this and we’re exploring every pathway working with HHS and our other government partners as well,” he said. 

“One of the top priorities for us as an administration is to make sure it’s affordable to people while providing all of the doses from the federal dollars as well,” said Gupta.

Becerra said the HHS headquarters has been outfitted with nasal sprays if they should be needed, along with written and audio instructions. “Naloxone is not the only way, but it is a proven way to save a life,” he said, calling on other workplaces to follow with a similar setup.

Capitol Hill will be hosting its second naloxone training next Wednesday for lawmakers and staff. Gupta and Reps. David Trone, D-Md., and Ann McLane Kuster, D-N.H., will speak at a training scheduled to be held at the Library of Congress next Wednesday. Trone has called for naloxone training for the Hill since 2019.

The administration’s substance use policy goals rely on three major must-pass legislative items tied to the end of the month: the reauthorization of ONDCP, the renewal of programs under the 2018 opioid law, and government funding for fiscal 2024.

Delphin-Rittmon touted the State Opioid Response Grant program, which she said has paid for naloxone used in 114,000 overdose reversals. The administration has called for an additional $350 million for the program to allow states to make naloxone free. 

Neither chamber has voted yet on its Labor-HHS-Education spending bill.

Gupta said reauthorizing ONDCP before it is set to expire Sept. 30 is also critical to continuing their efforts. 

“We’re having conversations on the Hill with the appropriate committees and leadership to ensure that that does not lapse this year,” said Gupta.