The Knock on Naloxone: It’s a Crutch

Recently signed into law, the Comprehensive Addiction and Recovery Act of 2016 (CARA) allocates $181 million for the war on non-medical opioid use. The bill funds research on pain management, physician education on prescribing opioids, and expansion of treatment programs and facilities.

It also expands the availability of the controversial drug naloxone — which can reverse overdose effects.

As many as 6 percent of youth ages 12 to 17 have used or are using opioids. About 9.5 percent of 12th-graders have also used opioids.

Naloxone has been around since 1971. It reverses the respiratory depression that suffocates drug users during an overdose, giving them time to recover and minimizing oxygen deprivation to their brain. Moreover, it isn’t addictive and has no negative affects if administered accidentally. The drug is credited with saving more than 26,000 lives between the years 1996 and 2014.

Since naloxone must be administered within the first few minutes of an overdose, CARA aims to increase the availability of the drug to first responders, including police, EMTs — and school nurses.

Yes, that’s right. According to some estimates, as many as 6 percent of youth ages 12 to 17 have used or are using opioids. About 9.5 percent of 12th-graders have also used opioids.

The first spike in opioid use is seen among 13-year-olds, according to Dr. Michael Kilkenney, physician director of the Cabell-Huntington County Health Department in West Virginia. His state has the highest rate of fatal drug overdoses and made news last month when a surge of overdoses hit 28 people. However, 26 out of the 28 people survived because first responders had naloxone on hand.

“Are you creating an environment where you’re giving them permission, or are you creating an environment where you’re trying to prevent use in the first place?” said one ER nurse.

“The average age of first use is really closer to 17 or 18, but that first peak on the graph is at 13,” Kilkenney told LifeZette. “That’s as early as middle school. You’ve got to do prevention in elementary school.” Rhode Island passed one of the most aggressive laws on the books last year: It requires all public middle schools, junior high schools, and high schools to maintain on-site naloxone.

But when it comes to naloxone in schools across the nation, some question whether it is doing more harm than good; they wonder if it’s providing a false sense of security for children at risk of overdose.

Related: Opioid Addiction in the Spotlight

“It’s no different than having condoms available,” said Nancy Adams, an ER nurse at Missouri Baptist Medical Center. “Is it permission for teenagers to have sex? Are you creating an environment where you’re giving them permission, or are you creating an environment where you’re trying to prevent use in the first place?”

She worked previously as a school nurse and holds a doctorate in public health, so she sees both sides of the argument. Teens curious about opioids might gain some false sense of security from knowing a life-saving shot is nearby. However, from a medical standpoint, she can’t help but think that having naloxone available is a good idea.

“I think you could make the argument it’s an appropriate medication to have on hand if you have a large population at risk,” said Adams.

Related: How Much to Curb the Opioid Epidemic?

That is what Joseph Wendelken, a spokesperson for the Rhode Island Department of Health, said officials are trying to do in his home state — noting the medication isn’t just there for students.

[lz_bulleted_list title=”Naloxone Prices Soar” source=”http://www.businessinsider.com”]One version of the drug, Evzio, an auto-injector that works like an EpiPen, was introduced at $287.50 for each single-dose injector in July 2014. In November 2015, the price went up to $375, followed by an increase to $1,875 in February 2016. Since then, the price has soared to $2,250 for each single-dose injector, according to Truven.[/lz_bulleted_list]

“There are EpiPens and defibrillators out there in case of an emergency. And there are all kinds of people coming through the schools — people for school meetings, parents. It’s a central meeting place for people in the community,” Wendelken said.

Keeping a steady supply of naloxone on hand, however, isn’t as simple as it sounds. While the drug has been on the market for decades, pharmaceutical companies have hiked prices significantly in recent years. The drug itself isn’t in short supply; it costs about as much to produce as salt water. Prices remained steady until 2008, when other drug manufacturers dropped out and Hospira and Amphastar gained a quasi-monopoly on the business.

Since then, some prices have jumped as much as 1,000 percent. One naloxone product, Evzio, is an auto-injector that back in November 2015 cost $375. As of February 2016, the price increased to $1,875. The current price is closer to $2,250 for a single-dose injector. The naloxone business is booming — from $21.3 million in 2011 to $81.9 million in 2015.

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Because so many government programs are now requiring schools and first responders to keep a supply of this medication, companies could be capitalizing on the renewed demand. And most bills, such as the Rhode Island legislation, don’t provide extra funding for schools to absorb the cost.