Overdose Antidote Is Supposed to Be Easy to Get. It’s Not.

Naltrexone serves another purpose. At a very low dose, say 3 milligrams per day, it is an effective natural anti-depressant, causing the body to produce more endorphins. But it is too hard to find a doctor who will write a prescription, and then a pharmacy that can have it compounded, let alone have insurance cover its low cost.

As long as naloxone is a prescription only medication, there will be difficulties getting pharmacists' compliance with dispensing without a prescription. Ideally, it's prescription status should be removed. Yes this has been done for many drugs in the past- example cimetidine (Tagamet), some insulin, diphenhydramine (Benadryl), and others. If that cannot be done, the next best alternative would be for the for Boards' of Pharmacy in each state to establish a standard for naloxone availability and enforce it during pharmacy inspections. With clear guidance for pharmacists, I think that this appalling problem could be resolved. (Recently retired hospital RPh, and yes we do give out free nasal naloxone under the guidance our county health department.)

Same problem in Massachusetts. Folks are urged to let the Dept of Public Health know if a pharmacy is clueless about the standing order.

Naloxone is not the answer. It is now over six months since my daughter passed from an overdose. A few months before her passing she once overcame an overdose getting Naloxone. As I reflect on the nightmare of her addiction and our efforts to get healing I find it nearly impossible to imagine a scenario of long term survival (statistically) of people addicted, including my daughter. Yes, Naloxone may save the life one, two, three ... times. But as long as the environment is stacked against an addictive person, little will guarantee long term survival. We may be inclined to fault a person that is addicted and expect that they have the strength and abilities to fight their disease. They may in some cases, but in an environment where the justice system, job prospects, social stigma, empathy ... are so stacked against that person, how can they? My daughter and her fathers mutual love and care and associated efforts were not enough. Much more has to change in our institutions and the society than prescribing Naloxone as a quick fix. My worry is that we feel content at throwing large sums of money to the makers of Naloxone and pat ourselves on the back for the lives saved when indeed little was achieved other than enriching the maker of Naloxone.

According to the Surgeon General, everybody should be responsible for their fellow addicts and carry naloxone. I disagree, the addicts should be responsible to make sure they don't die of an OD in the middle of 42nd St, they should be forced to carry this antidote themselves. If it were free I wouldn't carry it.

Is it possible that we have so many young addicts because to be an addict is now quite acceptable. No stigma. They're "self-medicating." Their doctor (or all the many doctors they visited to get prescriptions for their drugs) did it to them. Or Big Pharma did it to them. The mantra of libertarians and such is that adults should be free to do what they want, take whatever drugs or whatever nicotine sources that they want, and be reponsible for the consequences. Now we have "medical" marijuana, or legal marijuana. So let's be consistent. You're an adult. You're an addict. Live the consequences. Survival of the fittest.

Bill their insurance companies? Without a prescription? So Tommy is addicted to opiates. His mom and dad, four siblings, his girlfriend and a half dozen of his best friends are going to bill an insurance company "just in case?" What about his co-workers or fellow students? This is ridiculous, there must be a better way. And I say this as an ER doctor who's given naloxone more times than you can count.

I’m much more concerned about non addicts (regular working middle class folks) who can’t afford healthCare or prescriptions. They have done the right things but make too much to get a subsidy w ACA. Totally screwed. Let’s help them and that help may even reach over to the addicts.

Re: "...Beth Kennedy hugs her daughter after a meeting at a drug-treatment program. Ms. Kennedy tried to buy naloxone at a pharmacy but was discouraged by the druggist’s response..." I DON'T understand! I dispensed a 'Pacific_ocean-by-volume' level of narcan during my paramedic career; (NYC-EMS '83-'94; Other EMS providers: '75-'97). In my EMS squad, we literally, dispensed it 'EVERY day, and twice on Sundays' to borrow ta cliche! Pardon my sarcasm, but, perhaps...if you smack, somebody in the chops with a case of Narcan...you Might injure them; other than that, (intentionally, absurd) example... I CANNOT imagine why Narcan is-/-remains a 'prescription, only' medication point! And I CAN'T imagine why any pharmacy would refuse or try to deter, vs. IMMEDIATELY honoring such a prescription, period...full, stop!

This seems like another one of DeBlasio's great ideas that doesn't work in practice. I'm so disappointed in his administration.

I agree that naloxone should be widely available, but I also think that it’s not enough. It is a fact that a typical dose of naloxone (AKA narcan) will not always reverse respiratory depression, especially if it is a synthetic opioid like fentanyl. When I worked as a paramedic, we would treat the overdose first by helping the patient breathe, then we would give them narcan. Breathing for someone suffering from an overdose will *always* work, even if the narcan doesn’t. Even as we expand access to narcan, it is critical that people know how to perform CPR. CPR classes teach rescue breathing, which is something you can do when narcan is not available or it doesn’t work. The “ick” factor is negligible considering that many overdoses are witnessed by family or friends. So learn CPR, people.

Maybe we need to focus on getting people off opioids instead of making it easier to recover from an overdose.

I don't understand why we should be expected to carry narcan around with us "in case" - yet not be expected to carry around epipens "in case". Why not a portable defillibrator "in case", too? There are a lot of "in case" products that could be used to weigh us down. I am not a physician and I cringe at the thought of being in any way responsible for identifying and resolving a life or death drug overdose situation. Yes, I took some CPR training long ago, but that in no way makes me an expert and I've had no opportunity to prove myself using it, I think I would try my best if needed, but that intention on my part should not be used as permission to engage in risky behavior. Asking me to indemnify a stranger's self-inflicted actions using a medication obtained for a not insignificant amount of money is amazing to me. Make the drug abusers plan ahead and provide their own rescue equipment.

I just checked a drug price comparison site and found naloxone at many major pharmacies for much lower prices than the rates in these anecdotes. The site offered coupons for prices ranging from $21 to 37. The lowest price was offered at Walgreen's (same company as Duane Reade), but other major pharmacies, including CVS, Costco and Walmart, had similar offerings. It's a shame that people in greatest need are presented with the worst options.

I work with recovering injection drug users as a public health researcher. This population has already self-selected avoiding injection drugs, but relapses happen. In fact relapses among people who have been sober are often relapses that are fatal. Since I sometimes interview them away from treatment centers where naloxone is readily available I thought it was prudent to carry naloxone. I went to a local RiteAid and was informed that the cash price for one dose of naloxone nasal spray was $147.00. I understand that using my insurance would cover at least some of this cost, but I am reluctant to charge naloxone to them. The naloxone isn't for me or a member of my family, and I haven't squared charging them with the "greater good" argument. I'm still thinking about this. In response I sought out a city-sponsored program for naloxone training, which I don't need (I'm an RN, too) and which will provide a dose to those who complete it. No spots until June, so I hope nobody ODs in my presence until after then. The issue of who pays for naloxone is important. If every American needs to carry this, Americans need wide and easy access to low cost or free naloxone. Concerned individuals charging their health insurers is not practical on a wide scale, and it may not be ethical. Fentanyl, widely found in my city, can make multiple doses necessary. This is a public health emergency which requires practical solutions to help keep people who overdose alive.

I have a better idea. Why take opoids at all? Then the antidote won't be needed. Addiction to these drugs is a sign of weakness, moral, spiritual, and physical weakness. Thank you.

I now have four close friends who have lost their children to an opioid overdose. At the rate our young people are dying due to our nationwide opioid epidemic, Narcan should be in car glove compartments, available in public buildings, and anywhere else where it can be used immediately to save lives. There should be absolutely no delay, no excuses for peopletoget ahold of this live-saving antidote.

Buried in this article is the statement that some of the confusion at the pharmacies is over whose insurance will cover the drug. So there you go. The price of the approved delivery devices for naloxone for lay responders is so high that the drug becomes unavailable. When and if we decide that this society values human life over massive profits for the few, get back to us with the news. Until then, maybe people should start to die, and we should hire some group like the Syrian white helmets to catalog it so that the fact that people die when life saving drugs are too expensive will hit the front page.

Cindy, at the end of the article, is right. Removing the risk of abusing addictive drugs like heroine can only promote their use. When you have "safe injection sites" and remove the stigma of drug use, you will get more of it. Not to say you should not save the life of someone who has overdosed, but "prevention is worth a pound of cure". Sadly this may go the way of the sexual revolution, where abstinence is mocked and we hand out condoms to children at school. Not surprising opioid use is as widespread as it is, there is more social pressure to remove the consequences of bad choices than promoting personal responsibility, stigmatizing bad choices and promoting and rewarding good ones.

As an anesthesiologist and author of numerous scientific articles and textbook chapters on opioids I can speak with some accuracy concerning naloxone and its opioid reversal actions. Naloxone's ability to reverse opioid overdose is remarkable and almost immediate, as long as cardiovascular function and circulation is adequate. While it can cause adverse effects, some of which are serious, as it abruptly reverses opioid effects, it has minimal to no effects in opioid-free individuals. This is the reason why in controlled settings, such as the operating room, opioid reversal is more judiciously done by titrating naloxone in small doses. The adverse effects in true emergencies, where overdose may very well result in immediate death, are significantly outweighed by the potential benefit of rescuing someone who is experiencing significant opioid overdose by giving them a full reversal dose of naloxone. This dose can be given intramuscularly when intravenous access is not available. Reversal actions will take a bit longer after IM administration. As far as I can surmise, there is no reason why everyone, everywhere, should not have immediate access to naloxone. While this will not prevent or eliminate the current epidemic, the power to save the life of anyone, and especially a family member or friend, is so great, and potentially so life-changing, that any obstruction of tactics to the strategy of making naloxone available to all is wrong and misguided.