“There’s no way not to respond to a 911 call,” said Brent Myers, president of the National Association of EMS Physicians. “And once there, there’s no way not provide a life-saving treatment.”
A city councilman in Middletown, Ohio, proposed doing just that earlier this year -- with a baseball-style strike-out rule where emergency response personnel wouldn’t be dispatched to someone overdosing for a third time.
Nine Doses
“We need to put a fear about overdosing in Middletown,” the councilman, Dan Picard, told his colleagues when he made his suggestion, which he quickly withdrew upon realizing the legal hurdles it faced.
There are about 50,000 people in Middletown, and there have been around 600 overdoses so far there this year, more than in all of 2016. And because the opiates are getting so much stronger, it can take up to nine doses of naloxone to revive a person, according to a report prepared by the city manager.
President Donald Trump has backed a recommendation in a report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis and said the epidemic is a national emergency. Declaring an emergency, the report said, will allow Department of Health and Human Services Secretary Tom Price to negotiate reduced pricing for government-issued naloxone.
The federal government and many cities and states have moved to make naloxone, first approved by the Food and Drug Administration in 1971, more easily available. It can be purchased over the counter in about 40 states.
Annual sales of all brands went from $21.3 million in 2011 to $81.9 million in 2015, according to QuintilesIMS Holdings Inc., which tracks drug sales. The brand that has gotten the most attention and criticism is Evzio from Kaleo Inc., an injectible that’s made for personal use and not widely used by hospitals or EMS crews. The two-dose package list price went from $690 in 2014 to $4,500 last year, according to research published in December in The New England Journal of Medicine. Kaleo said it did that to generate more revenue to expand its patient-assistance program, which covers insured individuals’ co-payments and most costs for low-income people.
Manufacturers such as Amphastar Pharmaceuticals Inc. and Hospira Inc. offer discounts and rebates and negotiate with hospitals and others, so that few buyers actually pay the list price, with out-of-pocket costs for people with insurance usually much less. Many companies, including Kaleo, donate batches of their products to public-health, emergency-services and nonprofit agencies.
The epidemic has reached critical proportions, said Gail D’Onofrio, chair of the emergency medicine department at the Yale School of Medicine. With overdose rates up and opioids more powerful, “it’s a perfect storm.”