The New York Times: Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say

NYT

Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say

J. David Goodman | November 30, 2014

This year, police departments across the country, including in New York City, announced plans to stock up on a medication that reverses the effects of a heroin or opioid painkiller overdose.

The move signaled a shifting approach for officers more accustomed to fighting drug abuse with arrests than with a medical antidote.

But police and public health officials from New York to San Francisco are facing sticker shock: Prices for a popular form of the medication, naloxone, are spiking, in some cases by 50 percent or more.

“It’s not an incremental increase,” said Chuck Wexler, the executive director of the Police Executive Research Forum and a proponent of putting the lifesaving drug into officers’ hands. “There’s clearly something going on.”

In Georgia, police officials have seen the price of a kit containing the drug rise to $40 from $22. Departments in New Jersey, where heroin addiction has ravaged small communities, are facing similar increases.

In New York City, a spokeswoman for the Health Department said a more than 50 percent price increase for nasal naloxone has officials “concerned” over the future of its distribution programs.

That naloxone has rapidly gained acceptance, expanding from needle-exchange programs to police precinct station houses, underscores how widespread the twin scourges of heroin use and painkiller abuse have become in recent years.

While officials admit the drug represents only a temporary solution — without extensive treatment, many of those treated immediately return to using — rising prices represent a new challenge.

“It will decrease access,” said Dr. Phillip O. Coffin, director of substance abuse research at the San Francisco Department of Public Health.

Long used in emergency rooms and by paramedics, naloxone is increasingly being distributed by state health departments and local community groups, who train users and their relatives to administer the drug, also known by the brand name Narcan. It can be administered using a needle injection or with an atomizer that creates a nasal spray.

Indeed, part of the appeal for law enforcement officials has been the ability to deliver the drug through a nostril of an overdosing person using an atomizer attachment. After a successful pilot program on Staten Island, the New York Police Department said this spring it would outfit its roughly 19,500 patrol officers with the drug.

The spray requires a higher concentration of the drug, one milligram per milliliter.

It is in that formulation that higher prices have been seen, officials said.

“I would hope that with additional demand, there could be deals worked out with these companies,” said Christopher J. Gramiccioni, the prosecutor in Monmouth County, N.J., whose office this year paid to get the drug for local departments.

The form most often used by law enforcement and health departments, and held up prominently at news conferences, is the high-concentration formulation made by Amphastar. No nasal-specific naloxone product has been approved by the Food and Drug Administration. But it is used “off-label,” in combination with an atomizer, to administer the drug through the nose. (A naloxone injector, designed to be used by people without medical training and approved this year by the Food and Drug Administration, is many times as expensive.)

In an email, Jason B. Shandell, the president of Amphastar, declined to address the company’s pricing of its naloxone formulation “for competitive reasons,” but said that “manufacturing costs have increased on an annual basis.”

A spokeswoman for Hospira, another manufacturer, said its form of naloxone is “on average about the cost of a large pizza.”

For those who have worked with needle-exchange programs for years, price increases for naloxone appeared to coincide directly with the move by big-city police departments to outfit officers.

“We’ve had a pretty steady price for several years now,” said Matt Curtis, the policy director of VOCAL-New York, an advocacy group. “Then these big government programs come in and now all of a sudden we’re seeing a big price spike. The timing is pretty noticeable.”

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