Ky. pharmacists can now fill orders for a lifesaving anti-overdose drug without a doctor's order, but at greater expense

By Melissa Patrick
Kentucky Health News

Pharmacists across Kentucky can now fill orders for naloxone, including the nasal-spray Kentucky-developed version, used to treat opioid and heroin overdoses, without a prescription. Training to help them do that is in progress.

But even if this life-saving drug, often known by the brand name Narcan, is more readily available, that doesn't mean it is affordable; its cost has recently doubled, NPR reports.

That has caused concern not only for individuals, but also for government agencies on tight budgets like first responders, police departments and health departments.

At the Aug. 25 Woodford County Fiscal Court meeting, the ambulance director Hunter Shewmaker said the Bluegrass county has 10 to 15 drug overdoses a month, and ?Our Narcan use is going through the roof,? at $40 a dose. ?We may give two or three doses to one patient? to counteract an overdose, he said.

Lt. David Bahler of the Cincinnati Fire Department told WXIX-TV that his agency was well on its way to over 200 uses of naloxone for the month of October, having already administered 50 doses as of Oct. 7. Covington reported using naloxone 40 to 50 times a month, the station's Michael Baldwin reports.

The cost of one dose of naloxone is between $35 and $39, up from under $2 a dose many years ago, Covington ambulance director David Geiger told Baldwin, predicting that the cost of naloxone "will take 17 percent of our supply budget."

Amphastar Pharmaceuticals is the only company that makes naloxone in the dosage that can be delivered nasally, the method most agencies prefer because it doesn't require the use of a needle.

Amphastar has said that it raised the prices because of "increased manufacturing costs, including a rise in the prices of raw materials, energy and labor," NPR reports.

Other experts say that "heightened demand, a limited number of producers and an expensive new product are a recipe for price increases," Kristina Fiore writes for MedPage Today.

Daniel Raymond, policy director for the Harm Reduction Coalition, told NPR, "They can have a narrow market at higher prices, or a much broader market at lower prices. Either way, they're going to be making money. The latter way, they're saving more lives."

Kentucky training

Kentucky pharmacists can now fill naloxone orders, working with physician protocols, because of recent legislation meant to tackle the heroin-overdose epidemic in Kentucky. Last year, more than 1,000 Kentuckians died from an overdose.

The naloxone training programs for pharmacists, which will run through October and November, were developed by the Advancing Pharmacy Practice in Kentucky Coalition and are expected to reach more than 500 pharmacists, according to a University of Kentucky news release.


The nasal spray version of naloxone was developed by UK pharmacy professor Dan Wermeling through his startup company AntiOp Inc.

?This project is a great example of pharmacists putting patients first,? said Wermeling, a College of Pharmacy alumnus and native Kentuckian. ?This college began its work in naloxone because we saw how opioid overdose was wreaking havoc on Kentucky communities. We approached this as a public-health problem, and we sought to leverage the resources and capacity we have at the college to help save lives right here in the commonwealth. I am proud that our work is starting to pay dividends, and I am proud that Kentucky pharmacists are leading the way.?

Remaining dates on the coalition's training tour are: Oct. 27 in Owensboro; Oct. 29 in Lexington; Nov. 3 in Pikeville; Nov. 12 in London/Corbin; and Nov. 19 in Louisville. The coalition will also offer training  Oct. 11 at the Jefferson County Academy of Pharmacy's fall seminar at Sullivan University in Louisville; Oct. 23 at the UK College of Pharmacy and Sullivan University College of Pharmacy preceptors meeting, at the pharmacy college in Lexington; and Nov. 14 at the Kentucky Pharmacists Association Legislative Conference at the Hyatt Regency Hotel in Lexington.

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