Reversing An Overdose Isn't Complicated, But Getting The Antidote Can Be

May 7, 2018
Originally published on May 8, 2018 5:41 pm

A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.

"I kind of recall saying, 'No man, I've got Narcan,' " she says, referring to the brand- name version of the opioid overdose antidote, naloxone. "Which sounds so silly, but I'm pretty sure that's what came out."

Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.

"As they were walking towards us, the driver started slowly moving," she says. Both people survived.

Sturgeon had the drug with her because she works for Overdose Lifeline, a non-profit devoted to distributing naloxone, but many bystanders would be unprepared to help.

Last month, U.S. Surgeon General Jerome Adams issued an advisory urging more Americans to learn to use naloxone, and carry it with them in case they encounter someone who has overdosed.

With the increase in overdoses nationwide, the advisory suggests that lay responders — people who may witness an overdose before police or EMS arrive — can play a critical role in saving lives.

But if you're not a medical professional, getting a dose of naloxone can be difficult. It is a prescription drug and normally a doctor or nurse would have to directly prescribe it for the person at risk of overdosing. Corey Davis, an attorney for the National Health Law Program, says that creates a barrier for people with addiction.

"A lot of people at risk of an overdose don't have contact with a medical provider or they're afraid because of stigma," he says.

To broaden access, every state and Washington, D.C., have passed laws making it easier for friends and family members or bystanders to get and use naloxone. Just how easy it is still depends on your state, or even the pharmacy you go to.

Davis says most states allow something called third-party prescribing, which lets doctors prescribe naloxone to someone who knows the person at risk of an overdose. And most states have also passed some kind of Good Samaritan law providing legal immunity for people who administer the drug or call 911.

Davis says another type of law allows a kind of prescription called a standing order.

"But instead of having a person's name on it, it has a group of people," says Davis.

A standing order could apply, for example, to anyone who takes opioid painkillers, or suffers from addiction. Or, Davis says, "Anybody who might be in a position to assist someone, which unfortunately, today means essentially everybody."

In his home state of Indiana, Jerome Adams signed a statewide standing order in 2016, while serving as the state's health commissioner. It allows pharmacies, local health departments or nonprofits that register with the state and follow certain requirements to dispense the drug to anyone who requests it.

But two years later, only about half of Indiana pharmacies are registered, and local advocates say many people, even some pharmacists, are still unaware of the law.

Even if you understand the laws regulating naloxone in your state — and you feel comfortable asking for it at the pharmacy counter — there's still the cost, which has gone up in recent years. Two pharmacies near WFYI in Indianapolis, stock naloxone. One charged $80 for two doses of the generic form of the drug. The other charged $95 for two doses of Narcan, the brand-name version.

"It's expensive," says Brad Ray, a researcher at Indiana University's School of Public and Environmental Affairs. "People who are users are scraping money together to buy drugs. They're not prepared to buy naloxone with that money."

Several U.S. Senators have signed on to a letter urging Health and Human Services Secretary Alex Azar to negotiate with drug companies to lower the price of naloxone.

For people who can't afford the drug, Ray says health departments and nonprofits can help. Laws in many states allow these organizations to dispense naloxone to lay responders.

Indiana's health department used federal and state funds to purchase nearly 14,000 naloxone kits since 2016, the state reports. The state distributes those free doses through county health departments. But nearly half of Indiana counties didn't request kits. And the majority of the kits went to first responders.

Local health departments, Ray says, need to work harder to get naloxone to people who might use it. People who use drugs, after all, may not feel comfortable going to the government for naloxone.

"Getting it in the hands of users — that's the trick we need to figure out," Ray says.

Corey Davis says there is one change that could really help. The Food and Drug Administration or Congress could make naloxone an over-the-counter medication to make it easier to access, and maybe cheaper. FDA Commissioner Scott Gottlieb has the authority to do so, Davis says, but so far he has not.

This story is part of a reporting partnership with NPR, WFYI, Side Effects Public Media and Kaiser Health News.

Copyright 2018 Side Effects Public Media. To see more, visit Side Effects Public Media.

STEVE INSKEEP, HOST:

As you may have heard, the United States surgeon general issued an advisory recently. More people, he says, should carry naloxone, the opioid overdose antidote. Every state and the District of Columbia now have laws to increase access to this lifesaving drug. But it can be hard to get it to people who need it most. Jake Harper with Side Effects Public Media reports.

JAKE HARPER, BYLINE: About four months ago, Kourtnaye Sturgeon was driving in Indianapolis.

KOURTNAYE STURGEON: And I saw ahead of me a car had veered off to the curb.

HARPER: Some had people surrounded the car. Inside, the driver and passenger were still. She asked if she could help.

STURGEON: And the guy walked over to me, and he said, no, ma'am. It's an overdose - heroin. They're dead.

HARPER: But they weren't dead. And Sturgeon works for Overdose Lifeline, a nonprofit that distributes naloxone and trains people how to use it. She had a dose with her. She sprayed it up the driver's nose and waited for the paramedics.

STURGEON: And as they were walking towards us, the driver started slowly moving.

HARPER: Both people survived. Surgeon General Jerome Adams wants more people to carry naloxone so they can act before first responders arrive. That can include people who use drugs or their friends and family. But it can be hard to get. Naloxone is a prescription drug. Normally, a doctor or nurse would have to prescribe it. Corey Davis is an attorney with the National Health Law Program. He says that's a problem.

COREY DAVIS: A lot of people who are at risk of overdose either don't have contact with a medical provider or they're afraid because of stigma or other reasons.

HARPER: Many people don't want to admit that they use drugs. So Davis says states have passed laws to get around that. One type of law allows something called third-party prescribing. Providers can give a prescription to friends or relatives of someone at risk of an overdose. Davis says another type of law allows a kind of prescription called a standing order.

DAVIS: But instead of having a person's name on it, it has a group of people.

HARPER: That group could be anyone who, for example, takes opioid painkillers or suffers from addiction or, Davis says...

DAVIS: ...Anybody who might be in a position to assist someone which, you know, unfortunately, today, means essentially everybody.

HARPER: In fact, Davis says about half of states, including Indiana, have statewide standing orders. About half of the pharmacies here participate. But if you want naloxone and you know about these rules and you're not embarrassed to ask for it at the pharmacy counter, there's still the cost.

I was just wondering if you guys carry it and, if so, like, how much it costs.

UNIDENTIFIED PERSON: We do carry it.

HARPER: Ninety-five dollars for two doses of Narcan at a drugstore in Indianapolis - that's with a discount. Across the street - $80 for two doses of the generic. Even with insurance, copays can vary. Brad Ray's a researcher at Indiana University.

BRAD RAY: People that are users are scraping together just enough money to buy drugs. I mean, they're not preparing to buy naloxone with that money.

HARPER: Indiana and other states have used federal and state funds to purchase naloxone. But county health departments here distribute most of those free doses to first responders. Corey Davis says the FDA or Congress should make naloxone over-the-counter. It'd make it easier to get and maybe cheaper.

DAVIS: There's nothing to stop them from doing it except that's not generally how things work.

HARPER: But he says if there were ever reason to move a drug over the counter, the opioid epidemic is a good one. For NPR News, I'm Jake Harper in Indianapolis.

(SOUNDBITE OF PETER BRODERICK'S "BROKEN PATTERNS")

INSKEEP: That story is part of a partnership with NPR News, Kaiser Health News and my hometown station, WFYI. Transcript provided by NPR, Copyright NPR.