It’s been 13 years since a United States Surgeon General issued a public health advisory, but on Thursday Jerome Adams did so to urge every person to carry the overdose-reversal medication naloxone.
“Neither this [advisory] nor naloxone is a panacea,” said Surgeon General Adams at the National Rx Drug Abuse & Heroin Summit. Instead, the advisory serves as a way to draw attention to a public health crisis, where more Americans have died of drug overdoses in 2016 than the entirety of the Vietnam War. And naloxone, which comes as a nasal spray or auto-injector, is intended to keep more people alive.
The national emphasis has typically been on getting paramedics and law enforcement to carry the overdose-reversal drug, but the problem is that they often arrive too late to save someone’s life. So, for the surgeon general to ask that friends and family members of people at risk of overdosing to carry naloxone is critical.
And the policy decision is also evidence-based. The adoption of naloxone access laws at the state-level is associated with a nine to 11 percent decrease in opioid-related deaths, according to a national survey. And a majority were administered by other drug users, not by emergency responders.
Despite the research, there’s stigma. In Maine, Gov. Paul LePage (R) just approved in February a standing order that permits individuals to obtain naloxone without a prescription, after months of resisting. He’s said that naloxone “enables those suffering from substance use disorders to keep using drugs.” But LePage isn’t an outlier. A recent working paper, titled “The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime,” sparked a heated debate online, as the paper raised questions on whether the medication is doing more harm than good. The research was immediately rebuked and debunked by prominent addiction experts.
Moreover, the point of passing out naloxone, as the surgeon general emphasized on Thursday, is to keep people alive so you can get them into treatment.
Another issue is funding. In response to Thursday’s announcement, Baltimore City Health Commissioner Dr. Leana Wen, arguably naloxone’s most ardent advocate, asked for more financial assistance as local officials have already been trying to get the medication into the hands of every person — and that’s been costly.
“Unfortunately, we are having to ration naloxone because we simply don’t have the resources to purchase this life-saving antidote,” said Wen in a statement. “The Federal Government needs to follow their policy guidance with specific actions to actually ensure access: they can either negotiate directly with the manufacturers of naloxone so that it’s available at a much-discounted rate, or they can provide direct, sustained funding to local jurisdictions like ours so that we can provide evidence-based, effective treatment.”
Many states and localities have tried to dispense naloxone to the public, but the rising price of naloxone is an issue. The surgeon general said on NPR that “49 of 50 states have standing orders for people to be able to access and to use [naloxone] in the home setting.” But states and localities need money to pay for this — and Narcan nasal spray is sold at a list price of $125 for two and Evzio auto-injector is $4,500 for two injectors and an informational recording devise.
Adams said his office has been working with Evzio “to help improve broad and affordable access” and that Adapt Pharma, the manufacture for Narcan, is partnering with retail pharmacies and health plans to also expand access. He also highlighted during Thursday’s announcement that Harvard Pilgrim Health Care will provide Narcan at zero cost, meaning no co-pay, to members.
Roughly 95 percent of people with insurance coverage, including Medicare and Medicaid, are able to get naloxone at little-to-no cost. With Medicaid insurance, Narcan costs $1. But as cheap as that seems, sometimes a small copay acts as a barrier. Most people don’t think they need naloxone as overdosing can be abstract. This is why state and localities purchase naloxone so that they can hand out the medication for free.
Meanwhile, local officials like Wen are waiting. Wen first spoke with ThinkProgress in October 2017, before the Trump administration declared a public health emergency over the crisis, and expressed her frustration over funding. Local officials were hoping the declaration would mean they wouldn’t have to ration naloxone, but that didn’t happen. The next opportunity for more dedicated funds will be when Congress votes on an opioid bill, and both the Senate and House are currently working through bills. Another possibility — which advocates have asked for and is granted under declaration authority — is for the Department of Health and Human Services to negotiate prices and purchases where the government is the direct purchaser.