The next big drug that reverses an overdose may already exist

Science Fentanyl Trials 521677654

Critics say the Schedule I classification is heavy-handed, based on fear rather than evidence. “It bypasses the science,” said Maritza Perez, a director of the Drug Policy Alliance, a nonprofit organization focused on drug policy reform. Frustrated with this blanket ban and eager to develop new treatments for overdose, a growing number of scientists, physicians and other researchers are pushing back.

“A class-wide ban based on chemical structure alone would preclude much research that could lead to life-saving drugs,” said Gregory Dudley, a West Virginia University chemistry professor and one of the co-authors of the open letter to Biden. In that letter, Dudley and other scientists argue that permanent Schedule I status “unintentionally criminalizes” key tools to combat the overdose crisis.

Dudley supports a bill introduced last week by US Senator Cory Booker (D-New Jersey) called the Temporary Emergency Scheduling and Testing (TEST) Act, which would temporarily renew the Schedule I classification but also require the government evaluates individual fentalogs, delaying those with therapeutic use or with no risk of abuse. Booker hopes he can pitch his bill as a logical approach to the issue. “This bill represents a middle ground to make sure we do everything we can to save lives,” he told WIRED by email.

Even some experts in favor of permanent planning recognize that the status quo doesn’t work. “I believe that the fentanyl-related substances should be permanently placed in Schedule I. But I also strongly believe that research into Schedule I drugs – and this is more than just the fentanyl-related substances – should be made easier be made,” said Victor Weedn, a forensic pathologist and professor at George Washington University. In addition to fentalogs, drugs such as cannabis and psilocybin are also classified as Schedule I, which has also hindered research into those substances.

The discovery of a new drug to stop overdose would be a major public health win. Naloxone, often referred to by the brand name Narcan, is currently the only widely available drug to reverse opioid overdoses. Molecularly similar to the opioid oxymorphone, naloxone works by binding to opioid receptors, blocking the effects of other opioids. It is not a panacea, but it has become an important tool in keeping people alive. However, it is often scarce and can be expensive.

“Anything we can do to increase the variability of products in the marketplace can potentially help solve supply chain problems and hopefully lower prices,” said Stacy McKenna, a harm reduction fellow at the libertarian-leaning think tank the R Street Institute. “And there may be something that works better to reverse a fentanyl overdose.”

While naloxone can reverse a fentanyl overdose, it is not always as effective as less potent opioids. “One problem is re-narcotics,” says Traynor. A dose of naloxone that would revive someone who has overdosed on heroin may decrease for someone who has used fentanyl, causing overdose symptoms to return. This means that multiple doses of naloxone may be needed to stop a fentanyl overdose — bad news for people who may only have a single dose on hand. If there is another option that is more efficient at specifically reversing fentanyl overdoses, it could have a seismic life-saving effect.

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