If anyone knows how Narcan can save a life, it’s Justin Phillips.
Since 2014, Phillips has helped distribute the overdose-reversing drug through Overdose Lifeline, which she founded to combat Indiana’s heroin epidemic after her son died from an overdose in 2013.
Since then, she’s heard stories of how Narcan, also known as naloxone, instantly saved the life of someone on the verge of death from an opioid overdose.
Just in Indianapolis, first responders have saved around 1,000 people using naloxone.
Now, Phillips is hopeful the drug will save even more lives.
On July 1, a new law took effect that allows anyone to buy naloxone without a prescription. Pharmacies, local health departments and other entities can register with the Indiana State Department of Health to sell or distribute the drug to anyone who wants it.
So far, 90 entities have registered as naloxone dispensers, and between them there are 590 locations currently dispensing it throughout the state, according to state health officials.
Phillips called the law a “humongous step forward” in getting Narcan into the hands of those who need it, and made Indiana a national leader in providing easy access to the drug.
Naloxone may be more accessible than it’s ever been before, but that doesn’t mean more people have it, she said.
Despite the new law, there are still substantial barriers preventing people from getting their hands on what most health experts consider the “antidote” for overdoses.
Price spike
Phillips said the biggest factor preventing people from buying Narcan is its hefty price tag. The drug commonly comes in two forms: an injectable dose that requires a syringe, and an easier-to-use dose that comes as a nasal spray.
For an injectable dose, people can expect to pay between $40 and $50. The nasal spray can cost double that, retailing between $75 and $150, depending on the location of the distributor.
Those prices are double or quadruple what they were just a few years ago, Phillips said.
“That’s a big burden and a barrier to families,” she said.
State officials have started a push to train more people on how to properly use Narcan, but that training won’t do any good if people can’t afford to buy it, said Carrie Ann Lawrence, the director of Project Cultivate at Indiana University’s Rural Center for AIDS/STD Prevention and a researcher on social justice and health disparities.
“It’s as safe as a box of Band-Aids, but it’s way more expensive,” she said. “That cost has been the biggest barrier. For someone to muster up the money, it’s a pretty great cost to incur. How much of the public is willing to incur the cost of something they don’t know how to use?”
State Sen. Jim Merritt, R-Indianapolis, who filed the legislation making naloxone available without a prescription, said there’s little lawmakers can do to bring the cost down.
“I think trimming the cost by state government would be difficult, because it goes up and down,” he said. “I would hope the makers of Narcan would feel some kind of responsibility to make it affordable, but I’m not expecting that with the economy we have.”
Merritt said it might be possible to set up a grant program through the Indiana State Department of Health, which would buy naloxone and then give it away for free or at a substantially reduced price.
“I think that would be something we need to consider,” he said. “I would be on board with that.”
The next step
The skyrocketing price of Narcan comes at a time when it is needed more than ever in Indiana, Phillips said.
In 2014, 1,172 people died from overdoses, an increase of nearly 10 percent from the year before, according to the Centers for Disease Control and Prevention.
Nationally, opioids were involved in more than 28,600 deaths in 2014, and opioid overdoses have quadrupled since 2000.
Many of those overdoses happen out in public view, Phillips said.
A case in point: In January, police in Bloomington responded to two opioid overdoses that occurred within 30 minutes of each other. One man was found in the bathroom of a Taco Bell. The other overdose occurred at the Monroe County Public Library. Both were revived using naloxone.
Phillips said with so many overdose deaths, it’s time lawmakers and local health officials start making Narcan available in public spaces such as schools, libraries and government buildings.
“I think we need to look at access to naloxone the way we look at EpiPens and AED [automated external defibrillator] machines,” she said. “Large public spaces need to have this. It’s only purpose is to stop an overdose, and it’s such a wide range of people who are overdosing.”
Sen. Merritt said, from a legislative perspective, mandating public facilities to carry Narcan would require a detailed, thought-out plan to educate and train people at those facilities to use it, and lawmakers haven’t taken any steps to do that.
But, he said, beefing up the state’s effort to educate the public about using naloxone is something that needs to happen soon.
“We’re going to have to teach everyone how to use this,” Merritt said. “We have to educate people on the fact that we’ve granted you the ability to save someone’s life and not be prosecuted because you’re around drugs.”
In the end, Merritt said, he hopes tracking the use of Narcan will lead to a better approach for getting drug users help to kick their addiction.
“I see Narcan as being so valuable because, one, it saves a life and, two, it gives us a chance to find that individual who made a mistake and gives them the gateway to freedom,” he said. “That’s how you get rid of a scourge. You understand the problem and people’s life situations, and offer a system where people can get clean, because people don’t want to be dirty.”