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Surgeon General wants to have Naloxone at his disposal as much as possible. Is that possible?



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When Surgeon General Jerome Adams called for more people to be counseled about carrying naloxone – not just people at risk of overdose, but friends and family too – experts and advocates

This is a "clearly positive" step forward said Leo Beletsky, adjunct professor of law and health sciences at Northeastern University.

Dr. Jerome Adams is waiting to be sworn in by US Vice President Mike Pence during a ceremony at Pence's White House Washington office on Tuesday, September 5, 2017 as the 20th US General Surgeon. (AP Photo / Susan Walsh) [19659006] Susan Walsh / AP

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. However, others warned that his urinary naloxone-transfer recommendation is limited in the best case, what it can achieve, partly because the drug is relatively expensive.

Kaiser Health News breaks down what the counseling means, expert concerns and what policy approaches are in the pipeline?

Many public health advocates welcome the surgeon's position.

Naloxone, a drug that can keep drug addicts alive by reversing opioid overdoses, is considered by many to be 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 make it more tangible," said Traci Green, associate professor of emergency medicine and health sciences at Boston University, who has been intensively researching the opioid abuse crisis. "There could not have been any 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 the 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 nurse referring to chest pain.

What exactly do we offer addicts when their condition is reversed? "She asked, noting that weaning without treatment and treatment programs is" people of addiction "chances of survival remain low for any length of time, no matter how much reversal medication is kept nearby.

The results would likely be limited by the price of naloxone.

Take Baltimore, which has been hit particularly hard by the opioid epidemic – its health department has already urged more people to wear naloxone.

But The price of the drug is a problem, said Dr. Leana Wen, the city's health commissioner, and an emergency physician. She suggested that the federal government directly negotiate for a lower price or give more money to organizations such as agencies so that they can afford adequate care.

"Every day people call us from 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 B. in the nasal spray Narcan sold by ADAPT Pharmaceuticals and the talking autoinjector Kezia Evzio.

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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 two-pack 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 some are not spending money and offering 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 naloxone manufacturers and epilap distributor Mylan," said Richard Evans, co-founder of SSR Health, which tracks the pharmaceutical industry.

But it's not a perfect match. The presence of low-cost generic drugs 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 local costs.

"Sixty-four thousand people have lost their lives [nationally in 2016] – that's someone every 12 minutes," said Justin Phillips, managing director of Overdose Lifeline, a nonprofit organization based 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 if the group that received it from the Attorney General's Office receives earmarked grants under a program funded by a comparison with pharmaceutical companies

But this money has almost dried up. "We need to have access to Naloxon – which I'm told is pennies – for the pennies it costs," 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 their 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 began his push to bring naloxone into the hands of drug users and their families, only one or two retail pharmacies wore it.

"This has always been an emergency room drug – retail pharmacists were not usually used to handling [it]," Hitchens said. "Many probably said," What the hell is naloxone? "

" Sixty-four thousand people lost their lives [nationally in 2016] – that's someone every 12 minutes. "

" Sixty-four thousand people lost their lives [nationally in 2016] – this is someone every 12 minutes.

Today, he estimates that 60 to 70 percent of the more than 1,100 pharmacies in Indiana carry the drug. Walgreens, the pharmacy chain, has committed to stocking 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.

There is a patchwork of other decentralized sources of naloxone: syringe trucks, state and state health departments, churches and community centers, all trying to get overdose drugs into the hands of people who need them.

This supply "meets people where they are," said Raymond, but these little programs do not have the muscle to negotiate discounted rates.

"Individual health programs try 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.

The surgeon's message is part of Washington's broader response to the epidemic. But while 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. 19659004] "You can either offer 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 inhabitants. "

This story was written by Shefali Luthra and Rachel Bluth and by Kaiser Health News, one This is an editorially independent part of the Henry J. Kaiser Family Foundation, a non-profit, nonpartisan public health research and communications organization not affiliated with Kaiser Permanente.


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