New York State officials being lobbied to embrace Opvee, a Narcan alternative to combat opioid overdoses

ALBANY — A newcomer in the fight against opioid overdoses is lobbying to receive the state’s approval to be more widely distributed, with supporters saying its fast-acting medication was designed for fentanyl overdoses.

A “standing order” from the state now only allows first responders and authorized health care professionals to obtain Narcan without getting individual prescriptions and at a reduced price under a state subsidy. Supporters of the new overdose-reversal agent, produced under the brand name Opvee, want to be included in that order.

But the state says the new option hasn’t yet been tested enough to promote its widespread use under the state order. Opvee can be obtained in the state through individual prescriptions. Opvee, a nalmefene nasal spray, also is more expensive than Narcan.

The so-called opioid antagonists counter overdoses of drugs such as codeine and oxycodone that are prescribed to relieve pain, but which are highly addictive.

Last May, Opvee was approved by the federal Food and Drug Administration, 10 months after the state placed Narcan, a brand name for a device that delivers naloxone, on its standing order. The FDA now recommends Opvee along with Narcan to combat opioid overdoses.

New option works fast

Opvee’s manufacturer, Indivior Inc., contends the product acts faster and is better suited to attack the spike in opioid overdoses triggered by cheap and deadly synthetic opioids, such as fentanyl.

Opvee can revive a person suffering an overdose in as little as five minutes, compared with 20 minutes for Narcan, said Judi Dane, spokeswoman for Indivior and Opvee.

“Given that synthetic opioids such as fentanyl work fast to induce respiratory depression, which may lead to death, the speed of action of a reversal agent is an important consideration,” Dane said.

Several recent studies show Opvee can counter overdoses that involve fentanyl faster than Narcan. For example, the Journal of Clinical Pharmacology in March reported: “This rapid onset of action may prove particularly valuable in an era when over 90% of fatalities are linked to synthetic opioid overdose.”

The first test of Opvee in the field has been in Oakland County, Michigan. There, the sheriff was seeking a better way to reverse opioid overdoses increasingly triggered by stronger fentanyl.

“What we were seeing more and more is when we went to an overdose, it was taking multiple doses of Narcan without effect,” Sheriff Michael Bouchard said. “We are seeing stronger and stronger fentanyl, and Opvee is the only FDA-approved agent for synthetic fentanyl . . . you need to have a tool in your toolbox that can handle fentanyl.”

Exclusive deals in NY

In New York, Narcan’s manufacturer, Emergent BioSolutions, has received $66 million in exclusive state contracts since 2017 to provide the product to state and local authorities, state records show. Over the years, Narcan has become so enmeshed with the state’s opioid overdose response plan that the drug it uses, naloxone, is often mentioned in state legislation.

In Nassau, Narcan kits have been placed in county buildings and parks since 2023. Suffolk put Narcan kits in its county buildings beginning in 2020.

In New York State, opioid deaths have been driven by synthetic opioids, primarily fentanyl, according to the state’s 2023 Opioid Annual Report. The report found between 2015 and 2021, opioid deaths involving synthetics rose 587.7%, to 4,595 deaths in 2021 statewide.

New York State’s first field test of Opvee is underway.

Broome County Sheriff Frederick Akshar in April started equipping road patrols and correction officers with Opvee in addition to Narcan. His decision came after he said almost every time Narcan was used, multiple doses were needed.

That observation is backed up in the state’s 2023 Opioid Annual Report, which stated: “Due to the potency of these [fentanyl] substances, multiple doses of naloxone, a drug that can reverse the effects of an opioid overdose, are often required.”

Action in Albany

A bill in Albany would require the state to accept all FDA-approved reversal agents to create “a comprehensive tool kit to effectively combat the overdose crisis.”

The bill’s sponsor, Sen. Pete Harckham (D-South Salem), a survivor of addiction, long has supported the use of Narcan, but now is pushing to make Opvee part of the state’s weapons against opioid overdoses.

“We are in the depths of the worst overdose crisis our nation has ever seen and the numbers continue to trend up,” Harckham said. “We’re not telling people what they have to use . . . but to save lives, we need every tool in the tool kit.”

But the state Health Department remains committed to using Narcan over Opvee, in part because Opvee doesn’t yet have a track record in the field.

“Based on current science and clinical judgment, we believe that the products available under the standing order are appropriate formulations to keep New Yorkers safe,” said Cadence Acquaviva, spokeswoman for the Health Department, referring to Narcan.

She said Opvee, although federally approved, isn’t approved under state health law. That means Opvee can’t be added to the standing order or used in any pilot program without legislative and executive action.

Acquaviva said an overdose victim who is addicted to opioids will face nearly 11 hours of withdrawal with Opvee’s drug, compared with one to two hours for the drug in Narcan, “creating an undue burden on emergency rooms and medical personnel.”

The price is also a concern. Opvee can cost twice as much as Narcan, which often retails at $44.99 per dose. But studies show Opvee’s higher cost can be mitigated because it requires fewer doses than Narcan.

The company that makes Narcan points to extensive study and field testing of its brand.

“We have collected nearly a decade worth of real-world evidence of using naloxone safely as a first-line opioid overdose reversal antidote,” said Assal Hellmer, spokeswoman for Emergent and Narcan. “Today, naloxone remains an effective option in the current landscape.”

By comparison, she said Opvee “has a higher half-life than naloxone, which means it can stay in the body for longer,” Hellmer said. “This can make withdrawal symptoms more severe and last longer.”

The state Health Department isn’t alone in its reluctance to embrace Opvee.

“These data support the notion that stronger, longer-acting agents may be unnecessary, and their existence may cause undue harm, such as more severe and/or prolonged withdrawal symptoms,” said a February report by a nonprofit group of researchers and universities worldwide called the Open Researcher and Contributor. The group called for further study of Opvee before it’s widely used.

By Michael Gormley

michael.gormley@newsday.com@GormleyAlbany

Michael Gormley has worked for Newsday since 2013, covering state government, politics and issues. He has covered Albany since 2001.