Opioid antidote: How does naloxone reverse overdoses?
78 people die each day from opioid overdoses. There’s a quick-acting antidote to save them called naloxone or Narcan. Find out how it works
Baltimore averaged around two opioid-related overdose deaths a day last year — an inordinately high number for a city of just over 622,000.
City health officials, however, say that number could have been even higher if not for the availability of naloxone, the overdose reversal drug that has been used hundreds of times over the last few years amid the ongoing opioid epidemic plaguing Baltimore and other U.S. communities.
But with an estimated 21,000 active heroin users in Baltimore and only about 4,000 doses of naloxone to last until next May, officials in Maryland’s largest city are concerned that they will run out of the lifesaving drug by the end of July.
“Naloxone is a pure antidote to opioid overdoses,” Leana Wen, the Baltimore city health commissioner, told Fox News. “It’s safe, effective, easy to administer and brings somebody back from overdose literally in seconds.”
Wen added: “There is plenty of the medicine around. The problem is we simply don’t have enough funding to pay for it.”
How to pay for the drug has become a major concern for officials in Baltimore and other communities hard-hit by the nation’s escalating opioid epidemic, especially as the price of naloxone continues to rise.
Naloxone, which works by blocking opioids from interacting with the brain's receptors and counteracts the drugs' dangerous side effects, has been on the market since 1971, and for most of that time an injectable dose of the drug cost less than a dollar. Over the last decade, coinciding with the spike in opioid use, the price has jumped to around $15 a dose, with the cost of an auto-injector version of the drug coming in at more than $2,000 a dose, according to Truven Health Analytics.
While drug users on Medicaid can get a dose of naloxone for only $1, and those with private insurance for between $15 and $40, the price jump has hit hardest local governments and nonprofit organizations that provide naloxone for free to drug users, their family members, and other nonmedical personnel.
“We have to ration, which is a horrible word to use in this case, but it’s what we have to do now,” Wen said. “The amount of money we’re allotted to spend on naloxone has not changed, but the scope of this issue has increased tremendously.”
A nasal injection containing the overdose-reversing drug naloxone. (REUTERS/Gretchen Ertl)
To combat the rising costs and looming shortages some health officials in municipalities have issued standing orders and blanket prescriptions for naloxone, which allows anyone to buy the drug from a pharmacy.
The blanket prescription has been implemented in Baltimore and also statewide in Pennsylvania, but the problem is that drugstores are not required to stock naloxone and some pharmacies are unaware of the updated regulations. There is also the concern among some pharmacists that making naloxone freely available could serve as a kind of insurance policy for drug users.
In Philadelphia — a city that saw 900 overdose deaths in 2016 — a survey of pharmacies in neighborhoods that suffer the most overdoses found that fewer than one in eight had the opioid antidote available. About half of those drugstores surveyed reported either not knowing about the standing order or not understanding it.
Both health officials and human rights groups have called on state and federal lawmakers to increase the funding to programs and organizations that distribute naloxone to counter rising cost of the drug.
“While in 2005 naloxone cost less than $1 per dose, price increases by manufactures in recent years have resulted in prices that now range from $20-$4,500 per dose depending on the format, making it unaffordable to many community organizations, harm reduction programs, and law enforcement agencies without subsidies or additional funding,” Human Rights Watch noted in a recent report. “Federal officials have expressed concern over these price increases but have not acted to counter them.”
President Donald Trump listens during an opioid and drug abuse listening session, Wednesday, March 29, 2017, in the Cabinet Room of the White House in Washington. From left, New Jersey Gov. Chris Christie, Trump, Attorney General Jeff Sessions, and Education Secretary Betsy DeVos. (AP Photo/Evan Vucci) (Copyright 2017 The Associated Press. All rights reserved.)
Earlier in June, Sens. Susan Collins, R-Maine, and Claire McCaskill, D-Mo., — the Senate Special Committee on Aging’s chairwoman and ranking member, respectively — pressed five major drugmakers, including Pfizer and Amphastar Pharmaceuticals, to explain the rising cost of naloxone.
The healthcare bill currently being debated in the Senate lists an appropriation of $2 billion for fiscal year 2018 to provide grants to states to support treatment and recovery services for opioid abuse.
This number falls far short of the reported $45 billion some Republicans senators had sought over 10 years.
President Trump, who made combating the opioid epidemic one of the cornerstones of his campaign, has asked for $500 million for treatment expansion as part of his budget proposal, and in March tapped New Jersey Gov. Chris Christie to head up a new addiction commission.
“We want to help those who have become so badly addicted. Drug abuse has become a crippling problem throughout the United States,” Trump said. “This is a total epidemic and I think it’s probably, almost un-talked about compared to the severity that we’re witnessing.”
Health officials like Wen, who work in areas suffering the worst from the epidemic, say that there is enough talk about the epidemic, and instead of Senate inquires and presidential commissions what’s needed is more funding and more action.
“We hear a lot of rhetoric, now we need to need to see the resources,” Wen said. “It’s hard to watch two of our citizens die every day when there is something out there that can save them.”
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