On March 29, 2023, the U.S. Food and Drug Administration approved Narcan for over-the-counter sale. Narcan is the 4-milligram nasal spray version of naloxone, a medication that can quickly counteract an opioid overdose.

The FDA’s greenlighting of over-the-counter naloxone means that it will be available for purchase without a prescription at more than 60,000 pharmacies nationwide. That means that, for 90% of Americans, naloxone nasal spray will be accessible at a pharmacy within 5 miles from home. It will also likely be available at gas stations, supermarkets and convenience stores. The transition from prescription to over-the-counter status is expected to take a few months.

We are pharmacists and public health experts who seek to increase public acceptance of and access to naloxone.

We think that making naloxone available over the counter is an essential step in reducing deaths due to overdose and destigmatizing opioid use disorder. Over-the-counter access to naloxone will permit more people to carry and administer it to help others who are overdosing. Moreover, increasing naloxone’s over-the-counter availability will convey the message that risks associated with substance use disorder warrant a pervasive intervention much as with other illnesses.

Deaths from opioid overdoses across the U.S. have increased nearly threefold since 2015. Between October 2021 and October 2022, approximately 77,000 people died from opioid overdoses in the U.S. Since 2016, the synthetic opioid fentanyl has been responsible for most of the drug-involved overdose deaths in America.

What is naloxone?

Naloxone reverses overdose from prescription opioids like fentanyl, oxycodone and hydrocodone and recreational opioids like heroin. Naloxone works by competitively binding to the same receptors in the central nervous system that opioids bind to for euphoric effects. When naloxone is administered and reaches these receptors, it can block the euphoric effects of opioids and reverse respiratory depression when opioid overdose occurs.

There are two common ways to administer naloxone. One is through the prepackaged nasal sprays, such as Narcan and Kloxxado or generic versions of the drug. The other method is via auto-injectors, like ZIMHI, which deliver naloxone through injection, similar to the way epinephrine is delivered by an EpiPen as an emergency treatment for life-threatening allergic reactions.

The FDA will review a second over-the-counter application for naloxone auto-injectors at a later date. Although no interaction with a health care provider will be needed to purchase over-the-counter naloxone, when naloxone is purchased at a pharmacy, a knowledgeable pharmacist will be able to help people choose a product and explain instructions for use.

Research shows that when people who are likely to witness or respond to opioid overdoses have naloxone, they can save patients’ lives. This also includes bystanders as well as first responders like police officers and paramedics.

But until now, people in those situations could intervene only if they were carrying prescription naloxone or knew where to retrieve it quickly. Friends and family of people who use opioids are often given prescriptions for naloxone for emergency use. Over-the-counter naloxone will help make the drug more accessible to members of the general public.

Reducing stigma and saving lives

Naloxone is a safe medication with minimal side effects. It works only for those with opioids in their system, and it’s unlikely to cause harm if given by mistake to someone who’s not actively overdosing on opioids.

Since approximately 40% of overdoses occur in the presence of someone else, we believe public access to naloxone is extremely important. People may wish to have naloxone on hand if someone they know is at an increased risk for opioid overdose, including people who have opioid use disorder or people who take high amounts of prescribed opioid medications.

Community centers and recreational facilities may also keep naloxone on hand, similar to the placement of automated external defibrillators in public spaces for emergency use when someone has a heart attack.

There’s a long-held public stigma that suggests addiction is a moral failing rather than a chronic yet treatable health condition. Those who request naloxone or who have an opioid use disorder experience stigma and often aren’t comfortable disclosing their drug use to others, or seeking medical treatment. Removing naloxone’s prescription requirements by making it over the counter could decrease the stigma experienced by individuals since they no longer must request it from a health care provider or behind the pharmacy counter.

In addition, we encourage health care providers and members of the general public to use less stigmatizing language when discussing addiction.

Questionable accessibility

Often, medications switched from prescription to over the counter are not covered by insurance. It remains unclear if this will be the case with Narcan. If so, the costs will shift to the patient, highlighting the reason continued support of programs that offer naloxone free of charge remains important.

What’s more, over-the-counter access could paradoxically cause a decrease in the drug’s availability. A rise in purchases could make it harder to buy naloxone if manufacturer supply does not keep up with increased consumer demand. The U.S. experienced such shortages of over-the-counter drugs in late 2022 during the nationwide surges in flu, respiratory syncytial virus and COVID-19.

Federal and state governments could lessen these potential barriers by subsidizing the cost of over-the-counter naloxone and working with drug manufacturers to provide production incentives to meet public demand.

The effects of nationwide access to over-the-counter naloxone on opioid-related deaths remain to be seen, but making this medication more widely available is an important next step in our nation’s response to the opioid crisis.

Lucas Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of Pittsburgh; Janice L. Pringle, Professor of Pharmacy and Therapeutics, University of Pittsburgh, and Joni Carroll, Assistant Professor of Pharmacy and Therapeutics, University of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The National Commission on Excellence in Education’s release of a report titled “A Nation at Risk” in 1983 was a pivotal point in the history of American education. The report used dire language, lamenting that “the educational foundations of our society are presently being eroded by a rising tide of mediocrity that threatens our very future as a Nation and a people.”

Using Cold War language, the report also famously stated: “If an unfriendly foreign power had attempted to impose on America the mediocre educational performance that exists today, we might well have viewed it as an act of war.”

The report ushered in four decades of ambitious education reforms at the state and federal levels. Those reforms included landmark policy shifts like George W. Bush’s No Child Left Behind Act, Barack Obama’s Race to the Top program and major state reforms in areas including teacher quality, school choice and test-based accountability for schools and teachers. But what is the legacy of “A Nation at Risk” 40 years after its publication? And what are the implications for school reform in the coming years?

As a scholar of education who specializes in standards-based reform and accountability, I believe important lessons can be learned about American education by examining what has taken place since the release of the report. Here are three:

1. Education reform has improved outcomes, but progress has slowed or reversed in the past decade

The U.S. has had major challenges with educational performance that long predate “A Nation at Risk.” One is that too many students are not mastering grade-level material. Another is that not enough are enrolling in and completing college given the benefits of college to individuals and society. Additionally, large gaps exist in both of those areas based on race and ethnicity and income.

Since the report, students from all racial, ethnic and socioeconomic groups have continuously made achievement gains, and gaps have narrowed considerably since the 1970s – especially in the early grades. Yet low levels of achievement and gaps in achievement remain. For instance, even before the COVID-19 pandemic, 34% of fourth graders scored below the “basic” level on the National Assessment of Educational Progress, meaning they weren’t reading at grade level. Since COVID-19, national assessment results in reading and math indicate the pandemic erased two decades of achievement gains; for instance, in eighth grade math the number of students scoring below basic increased from 31% in 2019 to 38% in 2022.

The nation has also made tremendous progress in outcomes beyond academic tests. For instance, the high school dropout rate has plummeted, dropping from about about 14% around the time of the report to about 6% now. Meanwhile, the proportion of 25-to-29-year-olds with a four-year college degree has doubled to about 38%.

2. The reforms did not address the root causes of the problems

The report spurred four decades of intense reform led by states and the federal government. But these reforms have largely not addressed the major causes of poor educational performance – poverty and other factors outside of school, as well as highly decentralized educational systems that thwart meaningful school improvement.

For example, child poverty is still widespread; many students lack access to quality early childhood education; and many children live in polluted environments that affect their learning.

The result of these factors in the early years is that only about half of children enter kindergarten healthy and ready to learn, and even fewer among children from low-income families.

While schools can help lessen these disparities in school readiness between more and less advantaged children, the report failed to look beyond schools for solutions to problems that stem from social inequality.

The narrow view of “A Nation at Risk” is notable because the widely accepted wisdom of the time, especially among Republicans, and going back to the 1966 Coleman Report, was that schools aren’t a primary driver of inequality. After all, the Coleman Report found that differences in school resources, like money and books, didn’t account for differences in student achievement between more and less advantaged children.

Even the education efforts since the report have not been able to address the structural barriers in U.S. education to large-scale improvement. For instance, in a recent book I show that state and federal policies over the past 30 years that focus on improving schools through better and clearer standards have only modestly improved teaching.

A big part of why standards and other education reforms have failed has to do with the fact that school systems in the U.S. are remarkably decentralized. About 13,000 school districts and their individual teachers exercise substantial control over what actually happens in classrooms. The inability of policymakers at higher levels – such as states or the federal government – to meaningfully change school practice partially explains why other major reforms have failed to achieve real results. Examples include the Obama administration’s US$7 billion school turnaround plan and teacher evaluation reforms. In a more centralized system, policies enacted at the state and federal levels could be implemented as intended; that is rarely the case in U.S. education.

3. The political coalitions that brought reform have fallen apart

As on other topics, Americans are highly polarized on education policy. From “A Nation at Risk” through even much of the Obama administration, many aspects of the education reform agenda had bipartisan agreement. Governors of both parties came together to enact standards and testing reforms that set expectations for student learning and measured student progress against those expectations in the 1980s and 1990s. Congress voted overwhelmingly for the No Child Left Behind Act in 2001, calling for more rigorous standards and more frequent testing to drive educational improvement.

And some versions of school choice – especially charter schools – were supported by Republican and Democratic administrations in Washington and nationwide. Even the now-controversial Common Core standards, which aimed to create consistent expectations for student learning in math and English nationwide, were originally bipartisan. That is, they were created and endorsed by leaders from both parties.

This broad reform coalition is no more.

Debates over what to teach children in schools are driving a partisan wedge between schools and parents. Republican states are removing racial and LGBT-related topics from the curriculum. Meanwhile, Democratic states mandate their inclusion.

And expanding choice programs continue to drive down public school enrollment in states across the nation. Over a million students have been lost from public schools, and private school enrollment has increased 4% since the onset of COVID-19.

The result of these trends is that the reform consensus that brought about a broadly national approach to education reform is splintering into red state and blue state versions. I expect red state reform will likely emphasize school choice and a back-to-basics curriculum focused on reading, math and the avoidance of controversial topics. I expect blue state reform will likely emphasize whole-child supports like mental health, social-emotional learning and curriculum that is intended to reflect the culture of the nation’s increasingly diverse student body.

The problems raised in “A Nation at Risk” remain as important as they were in 1983. In my view, national leaders need to continue to improve educational opportunity and performance for America’s schoolchildren. Improved education benefits individuals – those with college degrees have longer life expectancies, higher earnings and wealth and even more happiness than those with a high school degree or lower. Education also benefits societies, leading to greater economic growth. But 40 years after the report, policymakers don’t seem to have learned the lesson that schools alone won’t solve the nation’s educational problems. And if that’s true, the nation remains at risk.

Morgan Polikoff, Associate Professor of Education, University of Southern California

This article is republished from The Conversation under a Creative Commons license. Read the original article.