Narcan could save many from heroin overdoses every year. So, why is it so hard to get it to those who need it most? | News | Pittsburgh | Pittsburgh City Paper

Narcan could save many from heroin overdoses every year. So, why is it so hard to get it to those who need it most?

"They need to have it on site at the pharmacy.”

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Few legal barriers exist between naloxone and those who could benefit from its use and availability. With a prescription, an at-risk individual can acquire it. And Act 139’s “Good Samaritan” provision provides immunity from prosecution for individuals reporting overdoses. 

Moreover, on May 20, Karen Hacker, director of the Allegheny County Department of Health, issued a standing order for naloxone in Allegheny County. Under this provision, individuals can acquire naloxone in the form of nasal spray at participating pharmacies without a prescription. 

But so far, only 14 pharmacies in Allegheny County have opted to participate. While advocates say it’s not complicated for pharmacies to distribute naloxone, they are required to take a number of steps.

“They need to have [naloxone] on site at the pharmacy,” Hacker says. “We ask them to provide a pamphlet, and we recommend that they have the training that the state offers.”

And those aren’t the only requirements. The nasal spray covered by the county’s standing order requires assembly, which creates extra steps for naloxone providers and users. 

“That requires the pharmacy to stock naloxone, stock the syringes that naloxone goes in and stock the atomizer,” says Corey Davis, a lawyer with the National Health Law Program, a group that advocates for the health rights of low-income and underserved individuals and families.

Advocates say the exclusion of injectable naloxone from the standing order also fails to cushion buyers and users from the drug’s variable prices. 

“For a long, long time, intranasal was more expensive than intramuscular,” says Green, who has helped develop first-responder naloxone toolkits and training. “Then it switched, because there were shortages of the injectable and the actual cost of naloxone itself went up substantially.” 

Recently, “the price of these devices, of the intranasal for example, has skyrocketed,” says Janie Simmons, the creator of GetNaloxoneNow.org. 

For those with health-care coverage, the fluctuating price is not a problem. 

“Many of the states have it covered,” Green says. “Medicaid is really encouraging naloxone to be covered on every state formulary. A lot of the private insurers tend to follow suit.”

However, says Bell from Prevention Point, “For people with no insurance or a high co-pay on their insurance, the intramuscular is going to be a lot more affordable for them.”

Additionally, the unstable price of naloxone creates a considerable obstacle for organizations like Prevention Point, which has been providing free naloxone to intravenous drug users for more than 10 years. Prevention Point Pittsburgh is the only community organization in Pennsylvania, outside of Philadelphia, that engages in syringe exchange and naloxone distribution.

“We’ve given naloxone to over 1,600 people and have had over 1,300 documented [overdose reversals],” says Bell. 

Funding such an operation is no easy feat. Two-thirds of the program’s funding comes from private donations and grant money. And currently, federal and state governments are not providing funding for naloxone. 

“Because [the prices have] not been consistent, it’s been one of the single most difficult things for community organizations to handle,” says Green. “We’ve had shortages in the past — it will probably happen in the future.”

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