Quick Take
A new opioid overdose-reversing drug called Opvee is expected to be available over the counter later this year. Santa Cruz County health officer Dr. David Ghilarducci sees the addition of a new drug to the arsenal of tools to combat the opioid crisis as a positive development. But some are concerned about how much the treatment will cost and whether insurance will cover it.
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Santa Cruz County health care professionals say they are excited that another option for reversing opioid overdoses is on the horizon and will be available over the counter, but remain concerned about cost and insurance coverage.
Early last week, the U.S. Food and Drug Administration (FDA) approved a medication called Opvee — a novel opioid overdose-reversal nasal spray — for patients 12 and older. The medication can reverse the effects of an opioid overdose within 2½ to 5 minutes, and is expected to hit the shelves between October and December.
The approval comes a few months after the FDA approved Narcan — a brand of naloxone, another overdose-reversing medication — for over-the-counter sale.
County health officer Dr. David Ghilarducci said he sees the addition of a new drug to the arsenal of tools to combat the opioid crisis as a positive development, largely due to fewer administrative barriers because of its over-the-counter status. That could help both the general public and organizations like Janus of Santa Cruz and county health obtain the medications faster and easier. “You don’t have to get a physician involved to buy the medication or write a prescription for it,” Ghilarducci said.
The opioid crisis continues to stalk Santa Cruz County and the country as a whole. From 2020 to 2022, the county saw overall overdoses rise almost monthly. In California, Narcan prescriptions rose over 2,000% between 2012 and 2021.
Jen Hastings, lead physician for SafeRx Santa Cruz County — the wing of the Santa Cruz County Health Improvement Partnership most involved with harm reduction, drug awareness and combating the opioid crisis — says that having another potentially life-saving overdose reversing tool is exciting, but comes with some big questions.
“It’s great to have more options, but we still don’t know how much it’s going to cost,” said Hastings. “And the same goes for Narcan.” Currently, a box of two Narcan doses can cost up to $140 via prescription. In April, Emergent BioSolutions, the company that produces Narcan, said it plans to charge less than $50 for over-the-counter Narcan.
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Hastings also said that it’s hard to tell how over-the-counter availability might affect SafeRx’s ability to obtain and distribute the medication.
“We rely heavily on the California Department of Health Care Services distribution program,” Hastings said, adding that it’s unclear if the program will continue to support organizations like SafeRx with the products once they are more accessible.
Hastings said that another concern is how insurance companies will approach the medications — particularly MediCal, which is the coverage provider for many of SafeRx’s patients. Hastings said that sometimes when medications are approved for over-the-counter sale, they are no longer covered by insurance.
“But sometimes MediCal can continue coverage, like with acetaminophen and ibuprofen, but private insurance typically doesn’t,” said Hastings. “Access will remain an issue, and we have to do a lot of advocacy to make sure that it is still covered.”
Though many of the issues surrounding both Narcan and Opvee remain the same, the drugs work a bit differently, said Ghilarducci. Opvee’s active ingredient is nalmefene, which takes longer to take effect, but lasts longer than naloxone, Narcan’s active ingredient. That has positives and negatives.
“When you’re experiencing an opioid overdose and not breathing well, then you want that to act as quickly as possible,” he said. “On the other hand, some of the newer synthetic fentanyl is harder to reverse with just naloxone. So [Opvee] is about four times stronger than naloxone and actually lasts longer.”
However, a potential downside, Ghilarducci said, is that since the effects of Opvee last longer than Narcan’s, withdrawal symptoms may last longer, too. He said that even with the new tools to combat opioid overdoses, preventing drug addiction in the first place must remain a key focus in the crisis.
“Narcan and Opvee are like fire extinguishers — you have a fire and something to put it out. That’s great, but if you don’t address the underlying cause, it’s not as helpful,” he said. “If you can’t address the reasons why people are using unsafe drugs, and identify the issues behind it, there’ll be a time where someone needs the medication and there’s no one there to give it to them.”
Nevertheless, both Ghilarducci and Hastings said that the drugs’ eventual over-the-counter access could help break down one of the largest barriers in fighting the opioid epidemic: stigma. Making the medications more accessible can help dispel stereotypes that can lead to discrimination and halt progress in finding solutions.
“Addiction is a disease like any other disease, and as a society we have to think of this more than just a moral failing,” Ghilarducci said. “I think this is an important step in that direction.”
“If it is openly available, it is more likely normalized,” said Hastings.
