When surgeon General Jerome Adams called for more people to be naloxone-not just people at risk of overdose, but friends and family-experts and lawyers were almost dizzy.
This is a "clearly positive" move, said Leo Beletsky, associate professor of law and public health at Northeastern University.
And not necessarily a surprise. Adams, who was previously Indiana's Health Commissioner, was recruited to become the nation's best doctor, in part because of his work with the then Gov. Mike Pence, now the vice president. In Indiana, Adams pushed for harm-reduction approaches, including expanded access to naloxone and the introduction of a needle exchange to combat the country's much-noted HIV outbreak, which began in 2015 and has been linked to drug use. Others warned, however, that his recommendation to administer naloxone is limited in the best case, what it can achieve, partly because the drug is relatively expensive.
Kaiser Health News puts together what consulting means, expert interests and what policy approaches are in the pipeline?
Many public health advocates welcome the surgeon's position.
Naloxone, a drug that keeps drug users alive by reversing opioid overdoses, is seen by many as the cornerstone of harm reduction in the epidemic. Experts say that people with addiction problems should wear it, as well as their family, friends and acquaintances.
"We want to bring it closer," said Traci Green, Associate Professor of Emergency Medicine and Health Sciences at Boston University, who has been researching the opioid abuse crisis. "It could not have been better confirmation."
Others, including Diane Goodman, who wrote a recent Medscape commentary on counseling, wonder if this is a "rational" answer to the scourge, as opioid dependence is one of many health problems, which people could encounter in their daily lives and for whom treatment options are still limited.
"I'm not sure if it makes much sense to carry a bottle of nitroglycerin to treat patients with end-stage angina," wrote Goodman, an acute care nurse referring to chest pain.
"What exactly do we offer addicts when their condition is reversed?" She asked, noting that without treatment and treatment programs that help wean people out of addiction "Survival rates remain low for a long time, no matter how many drugs to be kept close to the reversal. "
The results would probably be limited by the price of naloxone.
Take Baltimore, whi The opioid epidemic hit her particularly hard. His health department has already urged more people to wear naloxone.
But the price of the drug is a problem, Dr. Leana Wen, city health commissioner, and an ambulance. She suggested that the federal government negotiate directly for a lower price or make more money available to organizations such as agencies so that they can afford adequate care.
"Every day people call us in the Baltimore City Health Department and I call for Naloxone and I have to tell them that I can not afford them to have it," Wen said.
The drug is available in generic form, which can be stored in a vial and injected via a needle, as well as in patented products such as Narcan Nasal Spray, sold by ADAPT Pharmaceuticals, and Kaleos Evzio, a talking autoinjector.
Generic Naloxone costs $ 20 to $ 40 per dose. Narcan, the nasal spray, costs US $ 125 for a two-box carton, according to the ADAPT website. According to GoodRx, a pack of two from Evzio costs just under $ 4,000.
Health departments and first responders receive a $ 75 discount per Narcan carton. Kaleo has made Evzio vouchers available to consumers so that some get no money, and it offers a discount to federal and state agencies.
Skeptics point out that similar methods have been used to build brand loyalty and possibly make a particular product a household name. Epi-Pen has become synonymous with epinephrine for the treatment of anaphylactic shock.
"There is a clear overlap between the pricing strategies of the naloxone manufacturers and the epi-pen dealer Mylan," said Richard Evans, co-founder of SSR Health, which tracks the pharmaceutical industry.
But it's not a perfect match. The presence of inexpensive generics changes the calculus, he said, as well as the different levels of demand.
Non-profit organizations and healthcare providers are feeling the pressure of rising demand and rising costs.
Experts say price breaks for Naloxone are not enough to cover the costs on the ground.
"Sixty-four thousand people lost their lives [nationally in 2016] – that's someone every 12 minutes," said Justin Phillips, managing director of Overdose Lifeline, a non-profit organization in Indianapolis. "Ten free kits will not be enough."
Phillips said her organization relies on generic naloxone, which is the cheapest formulation. It is the only viable option that uses dedicated grants that the group receives from the Attorney General's office under a program funded by an agreement with pharmaceutical companies.
But the money is almost dried up. "We need to have access to Naloxon – which they tell me there are pennies – for the pennies it costs to do it," Phillips said.
Phillips, who worked with Adams when he headed Indiana's health department, said she has discussed the need for naloxone funding with the surgeon general, but never paid her price.
Pharmacies assess the hurdles of distribution.
Local pharmacies are the key in this chain, but the overdose antidote is virgin territory for many pharmacists, said Randy Hitchens, executive vice president of the Indiana Pharmacists Alliance. He said in 2015, when Adams started bringing naloxone into the hands of drug users and their families, only one or two pharmacies wore it.
"This has always been an emergency room drug, and retail pharmacists were not usually used to handling [it]," Hitchens said. "Many probably said," What the hell is naloxone? "
Today, he estimates that 60 to 70 percent of Indiana's more than 1,100 pharmacies carry the drug, and Walgreens, the pharmacy chain, has pledged to store Narcan.
However, access is always subject to retail pressure.
"If pharmacies do not see a steady stream coming, they will not get any incentive to carry them on their shelves," said Daniel Raymond, deputy director of politics and planning for the Harm Reduction Coalition.
A patchwork of others decentralized sources of naloxone exists: syringe exchange vehicles, state and state health departments, churches and community centers, all of which try to get overdose medicines into the hands of people who need them.
This supply stream "meets people where they are" Raymond said, but these little programs do not have the muscle to negotiate discounted prices.
"Individual le health programs are trying to control the crisis alone, but if you see … growing demand and limited supply, it's a role for federal intervention, "said Raymond.
He would l I see the federal government intervene to negotiate prices where smaller programs can not exist.
The surgeon's message is part of Washington's broader response to the epidemic. But even if Congress is preparing an opioid epidemic package, it is not clear that it will address these concerns.
In the House Energy and Commerce Committee, a bill would require that all state Medicaid programs cover at least one form of naloxone. At present, these are not all state Medicaid programs.
A Senate bill would authorize $ 300 million a year to equip first responders with naloxone.
But critics say that these approaches are not yet addressing the underlying issues: costs and funding. 19659047] "You can either provide Naloxone at a much cheaper price, or we need to have a lot more resources to buy it," Wen said. My only concern is the health and well-being of our residents. "
Kaiser Health News (KHN) is a national health news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not associated with Kaiser Permanente.