Does a Narcan implant exist?
One that can detect an overdose when it’s happening, and automatically deliver a lifesaving dose of Narcan?
We may be closer to that reality than we realize.
We recently published an article with promising news about the opioid overdose crisis. In 2023, for the first time since 2018, overdose rates decreased. The decrease – around 3 percent – falls short of the 2017-2018 decrease of around 4 percent, but it’s real cause for optimism. To learn more, please navigate to the blog section of our website and read this article:
Did Overdose Rates Increase or Decrease in 2023?
We have another piece of encouraging news to report. It’s about the overdose reversing drug, naloxone, brand name Narcan, which can reverse an opioid overdose after it starts. We’ll share the news in a moment, but you can deduce where we’re headed by reading the title of this article. First, we’ll share information about fatal and nonfatal overdose in the U.S.
Fatal and Nonfatal Overdose: Facts and Figures
While most of us know about fatal overdose, one thing most of us don’t pay attention to is non-fatal overdose. It’s important to understand that a person who experiences one overdose is at elevated risk of a second overdose, and the second overdose has an increased risk of death.
That’s why close monitoring of people who’ve experienced a non-fatal overdose is essential.
Let’s take a look at the numbers of fatal and nonfatal overdose between 2010 and 2020, reported in the peer-reviewed journal article “Estimating the Ratio of Fatal to Non-Fatal Overdoses Involving All Drugs, All Opioids, Synthetic Opioids, Heroin or Stimulants, USA, 2010–2020.” The researchers examined hospital records for overdose-related emergency room visits to identify trends in the ratio of fatal to nonfatal overdoses.
Here’s what they found.
Fatal and Nonfatal Overdose: All Drugs, 2010-2020
Totals:
- Fatal Overdose, all drugs: 628,277
- Non-Fatal Overdose, all drugs: 9,442,850
- Fatal/Non-Fatal Ratio: 0.07
2010:
- Fatal Overdose, all drugs: 38,329
- Non-Fatal Overdose, all drugs: 780,981
- Fatal/Non-Fatal Ratio: 0.05
2020:
- Fatal Overdose, all drugs: 91,799
- Non-Fatal Overdose, all drugs: 926,326
- Fatal/Non-Fatal Ratio: 0.10
Between 2010 and 2020, the ratio of fatal/non-fatal overdoses increased by 100%.
Now let’s look at the data for opioids only.
Fatal and Nonfatal Overdose: Opioids, 2010-2020
Totals:
- Fatal Overdose, opioids: 408,970
- Non-Fatal Overdose, all drugs: 2,419,835
- Fatal/Non-Fatal Ratio: 0.017
2010:
- Fatal Overdose, opioids: 21,089
- Non-Fatal Overdose, opioids: 133,501
- Fatal/Non-Fatal Ratio: 0.16
2020:
- Fatal Overdose, opioids: 68,630
- Non-Fatal Overdose, opioids: 295,649
- Fatal/Non-Fatal Ratio: 0.23
Between 2010 and 2020, the ratio of fatal/non-fatal overdoses for opioids increased by 44%.
As the data indicate, the proportion of fatal to nonfatal overdose increased significantly for all drugs and for opioids, but the increase was greater for opioids. That’s why naloxone, a.k.a. Narcan, is an important medication: it can help us drive these numbers in the right direction.
Narcan (naloxone) for Overdose Reversal: How it Works
Currently, the process for reversing an overdose with Naloxone follows this general sequence:
- A person takes a dose of an opioid or another drug containing an opioid, such as fentanyl.
- When the dose is too high, they show signs of overdose: loss of consciousness, unresponsive, respiratory depression, pale clammy skin, blue/purple tinged lips and fingernails, gurgling/snoring type noises while breathing.
- A bystander must recognize the signs of overdose and have Narcan on hand, or call 911 for emergency assistance.
- Bystander or emergency responder administers Narcan via auto-injection, prefilled syringe, or nasal spray.
- In many cases, a potential overdose victim requires ventilation support to survive.
This process works and can save lives. However, there are two potential problems with this process:
- A bystander must recognize the signs of overdose and either deliver the naloxone or call 911 and wait for EMS to deliver naloxone.
- This is a problem because there aren’t always bystanders
- Not all bystanders know the signs of overdose
- Not all bystanders are willing to get involved by administering naloxone, if they have it at hand
- If no one is present, there’s no one to call 911
- Even when the process works as it should, the lag time between recognizing the signs of overdose and administering naloxone – either by a bystander or a first responder – may be too great, resulting in death.
That begs a question:
Is there a way to recognize the signs of overdose and deliver naloxone more quickly?
A group of scientists at the Massachusetts Institute of Technology (MIT) may have an answer.
A Narcan Delivery Implant: Robotic First Responder
In the research paper “An Implantable System for Opioid Safety,” the MIT research team reports on a new medical device they developed, which they describe as:
“An implantable system that detects opioid overdose and automatically delivers naloxone.”
The system – called an implantable system for opioid safety (iSOS) – monitors physical signs of overdose and delivers naloxone when specific metrics indicate distress. The device continuously monitors the following physiological factors:
- Body temperature
- Heart rate
- Blood oxygen
- Respiratory rate
When the metrics associated with these key physiological functions reach predetermined thresholds that indicate an opioid overdose, the iSOS system automatically delivers a dose of naloxone. The delivery occurs within 80 seconds of detecting an overdose, and full recovery from overdose occurs within five minutes of detection.
This device is not ready for humans, though: we have to wait.
It’s currently in the testing phase in a large animal model, where it was 96 percent effective in reversing opioid overdoses. If it passes all subsequent trials and receives approval by the Food and Drug Administration (FDA), the device could make a significant impact on rates of fatal overdose.
The primary advantages of iSOS compared to delivery of naloxone are the speed and accuracy of detection and the speed of delivery.
Consider the following.
A human bystander may not know what to watch for. If they do know what to watch for, they may not have naloxone on hand, and if they have naloxone on hand, they might not know how to administer it effectively.
If a human bystander is present and recognizes the signs of overdose but doesn’t have naloxone and calls 911, the average response time – according to the national NEMSIS Dashboard – is 12.8 minutes. Depending on how quickly the bystander recognizes the overdose calls 911, that may or may not be fast enough to reverse the overdose.
A Possible Step Forward in Overdose Prevention: The Narcan Implant
There’s another advantage to the iSOS system.
If a person overdoses alone, with no one else present to recognize what’s going on, administer naloxone, or call 911, the iSOS delivery system has the potential to save their life.
That would be a very big deal – and could add another effective strategy to mitigate the ongoing harm caused by the opioid crisis, which has claimed over a million lives since 1999. Our new national strategy for addressing the opioid crisis – harm reduction – shows promise, with a decrease in fatal overdoses from 2022 to 2023 for the first time since a small decrease from 2017 to 2018.
That’s the right direction. If researchers continue developing new ways to prevent fatal overdose, like the iSOS implant for automatic naloxone delivery, there’s hope for the future, and hope for individuals, families, and communities impacted by the opioid crisis.
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