Giving HOPE

WASILLA — The State of Alaska is trying to get free anti-overdose med kits into the hands of ordinary Alaskans with a program it’s calling Project HOPE.

The acronym stands for Harm reduction, Overdose Prevention and Education, Alaska Dept. of Health and Social Services section chief Andy Jones said.

On Thursday, he drove to MyHouse in Wasilla with enough supplies to put together 1,600 of the kits, to host a community get-together with volunteers who would assemble them.

The kits contain naloxone, better known under the brand name Narcan. The drug is an antidote to opioid drug overdose that was approved by the FDA in 1971.

“It’s like watching somebody being raised from the dead, when you give them that medication,” said Mat-Su Borough EMS deputy director Lisa Behrens. “If we got there in time. There are some people who have been in respiratory or cardiac arrest too long, and we can’t get them back. Or we might get their heart back, but not their brain.”

The brain can only survive without oxygen for four to six minutes, Behrens said. Getting naloxone to overdose patients quickly means the difference between life and death.

That’s led advocates in the fight against Alaska’s opioid epidemic to push for wider access to the drug. It was only recently approved to be sold to individuals at pharmacies in Alaska thanks to Senate Bill 23, signed into law in March of last year.

It’s taken some time for the state regulations to be formed for the pharmacy sales, and for local pharmacies to offer it.

But reduced access comes in another form: higher prices.

“The price last I heard was $110 per dose,” said Kim Whitaker, president of REAL About Addiction. “Which, to me, is ridiculous.”

A mother of a heroin addict and an anti-opioid epidemic activist, Whitaker assists people with home detox when an inpatient detox isn’t available, and refers them to treatment options, to the extent that they’re available.

Whitaker said she used to purchase black-market naloxone to give to active addicts, addicts in recovery, and family members and loved ones of addicts, for use in an emergency.

She kept the overdose-antidote drugs in a box, with instructions. She’d have recipients read the instructions aloud to her before they left with the naloxone.

“These are life-saving tools, and they’re still out of reach for a majority of the people that need it,” Whitaker said.

Naloxone that comes in auto-injector form has made headlines for its skyrocketing price. But according to a July 2015 U.S. Food and Drug Administration report, “Market Structure for Naloxone,” prices for the regular injectable forms also have increased dramatically across the board.

The FDA analysis looked at price invoices for naloxone sold to hospitals and pharmacies from wholesalers, with price-reduction coupons taken into account. Internet sales and direct sales from manufacturers to EMS providers were not captured in the analysis.

Behrens said the price of naloxone to borough EMS hasn’t changed in the last few years – they’ve paid the same $$44.35 per dose since 2013.

Similarly, Alaska’s Project HOPE, funded by a $4.2 million grant from the federal Substance Abuse and Mental Health Services Administration to be used over five years, has what Jones called a “locked-in price” with a pharmaceutical company for just $75 per two-dose kit.

That’s half the usual $150 going price for that product, he said.

The price for Alaskans who want to get it through Project HOPE?

Free.

“We’ll buy 5,000 kits this year, and if demand is greater, we’ll increase,” Jones said. “This is our year of baseline data. We really don’t know how many people are going to want the kits.”

Jones said the kits are meant not just for active and recovering addicts, but also, for their friends and family or anyone who has an addict in their life, so that they can have naloxone on hand just in case.

Jones said he was encouraged by the volunteers who were coming together at MyHouse to help put together the kits. Each one includes two doses of nasal-spray naloxone, medical gloves, a CPR barrier device, and plain-language instructions for administration.

The kits, once assembled, will come in a small pencil-box that can be easily carried in a car glovebox or purse, he said.

Jones added that educating people about how naloxone should be administered, is as much a part of the program as just getting the overdose antidote meds out there.

Behrens said she’s concerned that people using naloxone might not fully understand how it works.

“Here’s the drawback,” she said. “It has a shorter half-life in the system than a lot of narcotics do. If people take it or administer it, it reverses the overdose. Narcan is good for a good 20 minutes to a half an hour. The opioid substance might be good for an hour to three hours. There’s amazingly potent street drugs. The person might temporarily reverse their overdose, then go right back into it.”

Behrens said it’s not uncommon for EMTs to administer multiple doses while responding to an overdose patient, and transporting the person to a hospital.

Emergency medical responders also administer CPR and ventilator assistance to the patient, she said, and after administering the drugs, they prepare to provide care during the potential aftermath.

“Very often one of the side effects of Narcan reversing a narcotic OD is severe vomiting,” Behrens said. “These people wake up really unhappy. They may also wake up violent.”

Whitaker said calling 9-1-1 after administering the medication is a necessity.

“Number one rule,” Whitaker said. “They still need hospital care. It’s a fine line between it helping them temporarily and the fact they could possibly need more than what you’ve got. Whenever I give these to people, I tell them, you can call 9-1-1 and you will not be prosecuted for drug possession or being involved in somebody overdosing if you’re trying to save a life.”

A bill passed in 2014 by the Alaska Legislature prevents people from being prosecuted when they are involved in reporting an overdose to emergency medical personnel.

Behrens said data for the Mat-Su Valley EMS does group overdose calls for service in with those for poisoning, so it can be hard to determine exactly how many reported ODs there are the Valley in a given year. But, most of the calls in the combined OD and poisoning category are for overdose, she said. In 2007, the number of such calls was 80. It steadily rose each year, and hit 272 in 2016.

Meanwhile, the price of naloxone for Mat-Su Borough EMS has stayed the same, but the borough’s expenditure on the drug has also gone up – from $2,500 in 2013, to $7,800 in 2016.

Jones said that once the kits are put together, Alaska DHSS will work with local non-profits to connect them with physicians that can sign standing orders for those groups to distribute them.

“It doesn’t fix the expense at the national level,” Jones said of the free kits.

But it gets naloxone to the people who need it, through non-profit agencies that have already built trust with people impacted by opioid addiction, Jones said.

“It’s only a tourniquet,” Jones said. “A tourniquet is designed to provide that lifesaving technique. If you don’t’ get them to a hospital for care, the individual could pass away. That’s the same with Narcan in Alaska. You’re giving someone a second chance to stay alive, to hopefully get into treatment. We need to build our treatment and recovery support services.”