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With more than 115 people dying each day from opioid overdoses across the country, the United States is in desperate need of a targeted approach to reduce the number of opioid-related fatalities. I wrote previously about medication assisted treatment and about the potential use of cannabis for reducing opiate use and overdose potential. The use of the opiate antidote (blocker) Naloxone is one of these targeted approaches used by medical professionals, but it’s in very high demand with the massive increases in overdoses around the country and, as demand increases, so does the cost of the Naloxone.
And that’s causing problems for the availability of the drug for those who need it.
What role does Naloxone play in opioid addictions?
You may be surprised to learn that Naloxone has been around for several decades. It was first approved in 1971 by the Food and Drug Administration (FDA) for treating opioid intoxication and overdose. Presently, there are two injection doses available (0.4mg and 1mg).
In 2013, at least 80 percent of naloxone injections were used for heroin overdose, though deaths from prescription opioids are just as common. There was a push to increase access to Naloxone, particularly for prescription-drug-users, which informed the Substance Abuse and Mental Health Services Administration, who went on to develop an opioid prevention guideline (2013), which recommended clinicians prescribe Naloxone to people taking opioids after assessing their particular situation.
In 2014, the FDA approved the first-response injection formula Evzio, which was designed to be used by people who aren’t necessarily medically trained. This allows people who are at risk of opioid overdose increased access and faster responses to reverse the effects. A year later, in 2015, the FDA approved the first nasal-spray (Narcan) for the market. Narcan made administration of Naloxone substantially simpler for non-medically-trained individuals.
It’s easy to think of Naloxone as a cure for opioid addictions, but it works more like a vaccine than a cure. Think of it like a defibrillator for someone who has had an opioid overdose. It stabilizes them but won’t do anything stop their cravings or reduce their risk of relapse.
It’s a life-saving tourniquet, not a treatment.
What is the economic impact of Naloxone?
It's a fact that a lot of time, research and money go into the development of pharmaceuticals. And when these drugs save people's lives, it's no wonder that users have to pay up, and sometimes in hefty dollar amounts.
In the case of Naloxone, there are four formulations (two injection doses, Evzio auto-injection, and the Narcan nasal spray) and they basically all come from the same supplier. Even though there are three approved manufacturers for the smaller injection dose (0.4mg), most of these are sold by American pharmaceutical company Hospira who was bought out by Pfizer in 2015. Since 2012 the price of even the generic version of Naloxone has tripled and is now $11.87 per dose. The cost of the Naloxone nasal spray (Narcan) has remained relatively stable since 2016 at approximately $150 per two-pack (analysis HERE).
American manufacturer, Amphastar sells the naloxone nasal spray for $39.60 which has almost doubled in price since 2014.
The auto-injector formulation Evzio is made by the drug company Kaléo. It came on the market in 2014 at $575 for a two-pack and now it costs a scandalous $4,100! As of April 2018, Kaléo announced a new "Virtual Standing Order" for people with health insurance to access Evzio without a prescription at NO cost. Delivery is arranged via your local pharmacist and can be sent directly to your home. It's available for individuals in California, Arizona, Colorado, Nevada, Missouri, and Ohio, but they plan to expand the program nation-wide. At the same time, Kaléo introduced a reduced wholesale purchase price to federal and state government agencies who purchase from the company directly. This means that services who are trying to address the opioid epidemic can purchase a two pack of auto-injectors for $360 instead.
It seems the newer and easier to use formulations such as Narcan and Evzio are more expensive than the initial Naloxone formulations on the market.
Despite initiatives to increase the distribution of naloxone, the relatively slow adoption of naloxone may be due in large part to stigmatization and lack of familiarity with the treatment among clinicians and opioid users. The other reason is the rising cost. Some states such as Vermont are fighting back against increased prescription drug costs. Unfortunately, the economic issues of Naloxone have not garnered the same kind of attention or outrage inspired by cases such as the EpiPen's manufacturer, Mylan.
WHY? Because of addiction stigma!!!!
I mean, these are drug addicts, right? Isn’t it their fault they’re almost dying? So why should tax-payers help?
There was actually a proposal in an Ohio town to limit Naloxone administration for overdose cases to two. This would be the ultimate “three-strikes” rule – overdose for a third time and the EMT won’t help you stay alive… The rationale for this was the increasing cost of naloxone and the burden of helping “people who don’t care about their own life.” Machiavellian government in the extreme.
These price increases came when the opioid epidemic was at its peak, and they came without any explanation. The exorbitant cost of these drugs crosses an ethical boundary because the demand curve was growing.
Prices of most naloxone products have increased, sometimes drastically, as more people are dying from overdoses of prescription painkillers and other opioids. And someone is picking up the tab, including taxpayers who foot the bills for government purchases.
Naloxone is a profitable market for pharmaceutical companies. It has increased from a $21 million dollar a year industry pre-2014 to a now booming $274 million-dollar industry. It takes advantage of people who are in general need of help, and the initiatives in place that are trying to support these people toward recovery.
What does this mean for people with an addiction?
Access to these drugs is mostly limited to those with health insurance, and even then, most prescriptions require a co-payment. The data substantiates that many individuals cannot afford and are not buying the drug. Cost and accessibility prevent people with an opioid addiction from accessing the Naloxone vaccination. Simply put, those most at risk can’t afford this lifesaving drug. So they’re dying.
What can the United States do to reduce opioid overdoses?
Firstly, the availability of Naloxone has to be expanded to those who are in desperate need of help, not just the people with health insurance or who can afford it.
Other strategies to help reduce the number of heroin and prescription-opioid overdose deaths in the United States may include:
1. We have to reduce the stigma surrounding opioid addiction and addiction in general. This is the number one barrier to accessing recovery treatment.
2. We need high profile individuals such as celebrities and those with influence to speak out about addiction. This will help break down the barriers of stigma and shame and people will learn that addiction can affect anyone.
3. Avoid stigmatizing labels like “addict.” Instead, use first-person language such as “person struggling with addiction.” It’s all about a mindset change. When we see a person first rather than the problem, then we are better able to draw on compassion instead of contempt.
4. Alternative treatment options are required. We need more programs like SMART Recovery, IGNTD Recovery and other easy-to-access options that are affordable, accessible, and shame-free so that the people who are in need of help can get it.
5. Lastly, prevention. We need to treat the underlying causes of addiction BEFORE it gets out of hand. Access to mental health treatment and support for childhood trauma are essential as a large majority of people who are using substances are dealing with trauma and mental health issues.
While Naloxone is a drug that is critical in saving the lives of those who have an opioid addiction, it is not the ONLY option. This unjust medical industry profits from overdoses and addiction, but we need to focus more on prevention and reducing the stigma of opioid addiction, and addictions in general.
You can find out more about my IGNTD Recovery Course at my website or by reading my book - The Abstinence Myth.
