EHS Administration, Health and Wellness, Injuries and Illness

FDA Approves OTC Overdose Treatment

On March 29, the U.S. Food and Drug Administration (FDA) announced the approval of an over-the-counter (OTC) nasal spray for the treatment of opioid overdoses. Narcan, a 4 milligram (mg) naloxone hydrochloride nasal spray, is the first naloxone product approved for use without a prescription.

The National Safety Council (NSC) said it “is thrilled workplaces can now easily obtain this lifesaving drug for First Aid kits.” Nearly 10 percent of all workplace deaths are due to an opioid overdose, according to the NSC.

According to the National Institute for Occupational Safety and Health (NIOSH), opioids include natural opioids such as morphine and codeine derived from the opium poppy; semi-synthetic opioids that include the illicit drug heroin and prescription drugs hydrocodone and oxycodone; and synthetic opioids, such as fentanyl, methadone, and tramadol.

“NSC believes access and the proper training to administer naloxone can save countless lives,” the group said in a statement on the FDA approval.

Unintentional workplace overdose deaths reached an all-time high in 2021 of 464, according to the NSC’s Overdose Deaths injury facts page.

Narcan’s manufacturer will determine the timeline for the availability and price of OTC naloxone. The switch from prescription to OTC status may take months, according to the FDA, but the agency said it would work with all stakeholders to help facilitate the continued availability of naloxone nasal spray products during the transition.

The NSC offered a set of five recommended steps employers can take to address workplace overdose issues:

  • Assess workplace readiness for having naloxone in the workplace.
  • Ensure all legal and liability concerns are addressed.
  • Establish workplace policies and procedures for responding to an opioid overdose with naloxone. (Pre-, present, and post-overdose scenarios should be addressed.)
  • Get trained on how to respond to an opioid overdose with naloxone and necessary CPR after naloxone administration.
  • Obtain naloxone.

The group offers first-aid training to help employers obtain and maintain naloxone in the workplace. The NSC also offers a free toolkit for employers that includes 5-minute safety talks, fact sheets, posters, presentations, sample policies, reports, videos, and white papers to help employers implement a workplace program for opioids. 

Opioids are often initially prescribed to manage pain arising from a work-related injury, according to NIOSH. Workplace conditions, such as slip, trip, and fall hazards or
heavy workloads, can lead to injuries associated with prescription opioid use. Some people who use prescription opioids may misuse them and/or develop a dependency, according to NIOSH. Prescription opioid misuse may also lead to heroin use.

First responders may also be at risk of accidental opioid exposure requiring overdose treatment. In 2019, NIOSH released a video, since removed, showing a Blacksburg, Virginia, police officer being exposed to fentanyl during a response to an overdose. The officer was at first visibly distressed, then had difficulty breathing and soon could no longer stand.

NIOSH investigators conducted a Health Hazard Evaluation (HHE) of an incident in 2018 when several police officers suffered exposure to opioids. While the officers wore half-facepiece respirators with P100 filters, NIOSH investigators concluded they incorrectly donned their respiratory protection and that glasses, police radio earbuds, cameras, and hats worn by the officers prevented a secure respirator seal.

Another officer in the Blacksburg response administered prescription Narcanto counteract an overdose.

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