Pubdate: Thu, 01 Oct 2015
Source: Baltimore Sun (MD)
Copyright: 2015 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Andrea K. McDaniels

NEW LAW ALLOWS WIDER ACCESS TO OVERDOSE DRUG

Statute Gives Physicians Permission to Issue Blanket Prescriptions for Naloxone

Thousands of people have been trained to use a drug that prevents 
heroin overdoses, but many have faced a hurdle to obtaining naloxone 
- - a doctor's prescription.

Under a Maryland law that takes effect today, doctors at local health 
departments can write a blanket prescription that covers anyone who 
is trained on how to administer the drug, also known as Narcan. They 
simply need to present a card at the pharmacy showing they had been 
taught by a state-certified trainer.

Baltimore Health Commissioner Dr. Leana Wen lauded the law Wednesday 
as a way to more widely distribute the lifesaving drug and curb the 
number of overdose deaths. Last year, 303 people in Baltimore died 
from overdoses, and most had taken opioids. Statewide, 578 deaths 
were attributed to heroin last year, compared with 464 the previous year.

"Until now, policy has tied our hands," Wen said. "People should not 
have to go to a doctor and justify why they need the ability to save 
a loved one or a friend. Nobody has to go to a doctor to explain why 
they need to use a defibrillator if somebody's heart has stopped 
beating and they need to save them in that moment. So why should we 
treat overdose any differently from something else that is killing 
our citizens?"

Wen, trained as an emergency room physician, planned to issue a 
"standing order" today, to become the first jurisdiction in the state 
to take advantage of the new law.

About 4,000 Baltimore residents have received training this year to 
administer Narcan, which blocks the effects of opioids and stops 
respiratory depression during an overdose.

State lawmakers passed legislation in 2013 allowing nonmedical 
personnel to be trained to administer the drug and receive a 
prescription for it, and then last year approved the measure allowing 
for blanket prescriptions.

Also under the new law, doctors don't need to be present at training 
sessions in the use of Narcan. The chief medical director for Health 
Care for the Homeless said that will enable the nonprofit to have 
training sessions in the streets and shelters - where their clients 
live - rather than at its downtown headquarters.

Naloxone "really puts power in people's hands to save those around 
them," said Dr. Nilesh Kalyanaraman. "It allows the community to take 
care of themselves. And with the standing order it makes it that much easier."

While the new laws remove some barriers, Wen said cost remains an 
obstacle. The price has skyrocketed just as cities like Baltimore 
have made naloxone a key component of drug prevention strategy.

Rep. Elijah E. Cummings, a Baltimore Democrat, along with Sen. Bernie 
Sanders of Vermont, who is seeking the Democratic presidential 
nomination, recently urged cities and states to push drug companies 
to charge less for the drug.

Officials in New York and Ohio have reached agreements with 
California-based Amphastar Pharmaceuticals to allow public agencies 
to purchase naloxone at a lower price. Maryland made a similar 
request, and negotiations are continuing.

Richmond-based pharmaceutical company Kaleo also has given injector 
kits with naloxone to the Baltimore and state health departments, 
which has offset costs.

But Wen said prices still are too high. The city paid about $20 a 
dose for the drug in February, and that price jumped to $40 by July. 
Officials expect another price increase this week, Wen said.

"This very much hurts our ability to hand out or to be able to 
distribute this life-saving medication," Wen said.

Baltimore residents on Medicaid in the city pay $1 for a dose of 
naloxone, and the city health department distributes the drug to the 
most vulnerable populations.

Drug companies have declined to talk about their pricing strategies, 
but some said manufacturing costs have risen.

Policymakers are trying to encourage addicts and friends and family 
members of drug users to have naloxone on hand.

Local pharmacists said they regularly see people whocould benefit 
from the drug, but they can't help them immediately without a prescription.

"This allows your pharmacies who support your communities to have a 
tremendous impact," said Steve Wienner, a pharmacist and owner of 
Mount Vernon Pharmacy in Baltimore.

A representative with Walgreens, which has 21 pharmacies in the 
Baltimore metro area and 73 statewide, also praised the law.

"Working together, we can help combat the growing problem and trend 
of opiate overdoses by creating better access to naloxone," said 
Steve Bouyoukas, the health care supervisor for Walgreens' retail and 
pharmacy operations in the Baltimore region.

Baltimore became the first jurisdiction in the state this summer to 
begin giving naloxone in drug treatment court.

But some health care workers warn about an over-reliance on naloxone.

Mike Gimbel, a former drug user who served as director of Baltimore 
County's substance abuse office, called Narcan an "amazing drug," but 
said that without immediate drug treatment many addicts will use 
again. He believes that Narcan should only be used by paramedics and 
police who ensure that an addict is hospitalized or gets treatment.

"We are giving the public a false sense that Narcan will solve our 
heroin epidemic, and it won't," Gimbel said. "We have tens of 
thousands of heroin addicts in Maryland who are spreading diseases 
and committing crimes every day, and most of them will not overdose. 
We need to have more long-term treatment for all addicts."

Wen also agrees that treatment is part of the solution but emphasized 
the need to address overdose deaths.

"Naloxone has already prevented hundreds of deaths across Baltimore," 
Wensaid. "If we don't save lives today, there is no chance for a 
better tomorrow."
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MAP posted-by: Jay Bergstrom