The next big overdose drug might already exist
Critics say the Schedule I classification is heavy-handed, based on fear rather than evidence. “It bypasses the science,” says Maritza Perez, director of the Drug Policy Alliance, a nonprofit focused on drug policy reform. Frustrated by this blanket ban and eager to develop new overdose treatments, a growing number of scientists, doctors and other researchers are opposing it.
“A class-wide ban based on chemical structure alone would prevent a lot of research that could lead to life-saving drugs,” says Gregory Dudley, professor of chemistry at West Virginia University and one of the co -authors of the open letter to Biden. In the letter, Dudley and other scientists argue that Schedule I permanent status could “inadvertently criminalize” important tools to tackle the overdose crisis.
Dudley supports a bill introduced last week by U.S. Sen. Cory Booker (D-New Jersey) called the Temporary Emergency Programming and Testing (TEST) Act, which would temporarily extend the Schedule I classification, but would also require the government to evaluate individual fentalogs, deprogramming those for therapeutic use or without risk of abuse. Booker hopes he can present his bill as a sensible approach to the issue. “This bill offers common ground to ensure that we do everything we can to save lives,” he told WIRED via email.
Even some experts who support permanent programming acknowledge that the status quo does not work. “I believe that fentanyl-related substances should definitely be put on schedule I. But I also believe very strongly that research on schedule I drugs – and it’s not just fentanyl-related substances – should be facilitated,” says Victor Weedn, medical examiner and professor at George Washington University. In addition to fentalogs, drugs like cannabis and psilocybin are also classified as Schedule I, which has also hampered research on these substances.
The discovery of a new anti-overdose drug would be a major victory for public health. Naloxone, often referred to by its brand name, Narcan, is currently the only drug widely available to reverse opioid overdoses. Molecularly similar to the opioid oxymorphone, naloxone works by binding to opioid receptors, thereby blocking the effects of other opioids. It’s not a silver bullet, but it’s become an important tool in keeping people alive. However, it is often rare and can be expensive.
“Anything we can do to increase the variability of products in the marketplace could potentially help overcome supply chain issues and hopefully lower prices,” says Stacy McKenna, risk reduction officer. at the libertarian-leaning think tank R Street Institute. “And there might be something that works better to help reverse fentanyl overdoses.”
Although naloxone can reverse fentanyl overdoses, it is not always as effective as less potent opioids. “One problem is re-narcotization,” says Traynor. A dose of naloxone that would revive someone who took too much heroin might fade for someone who took fentanyl, causing their overdose symptoms to return. That means multiple doses of naloxone may be needed to stop fentanyl overdoses — bad news for people who might only have one dose on hand. If there is another, more effective option for specifically reversing fentanyl overdoses, it could have a life-saving seismic effect.
