Naloxone & Baltimore’s Fight Against Opioids

In an area known as “The Block” in Baltimore, city health workers and volunteers have put up a table next to peep shows, strip clubs, and City Hall. This location at the intersection of North Gay and East Baltimore streets often provides HIV testing, reproductive counseling and needle exchange. Today, it will provide passersby with a drug known as naloxone – a lifeline for those who are overdosing on opioids, like heroin, Oxycontin or Percocet.

Opioids are largely publicized for their impact on rural white America, but in Baltimore, where the population is 60% African American, 393 of the city’s residents died of drug or alcohol overdoses in 2015. On the bright side, 400 overdoses survived as a result of naloxone.

Unfortunately, the cost of the lifesaving drug is skyrocketing. Just ten years ago, a dose of naloxone was $1; now it is around $40.

Despite these high costs, 14,000 people have been trained by Baltimore officials, and 10,000 doses of naloxone have been distributed. After teaching passersby how to use naloxone, volunteers on The Block gave out kits that included a practice injection device with instructions, alongside two doses of naloxone. One dose of naloxone can combat a heroin overdose, while two are needed to combat fentanyl, which is fifty times more potent than heroin. A third of the drug overdose deaths in Baltimore in 2015 were caused by fentanyl.

Baltimore health commissioner Dr. Leana Wen wants to make naloxone more accessible to all of Baltimore’s 620,000 residents. She said in a statement, “There are very few antidotes that exist in modern medicine; I can count them on two hands. And if this medication is available then we should make it available to everyone.”

Although Baltimore negotiated a rate of $1 for those on Medicaid, donations were necessary to assist with distribution programs, and the progress that Baltimore has made in preventing overdosing may be stalled by this price hike.

One of the four companies that produces naloxone, Amphastar pharmaceuticals, claimed that a hike in costs of labor and material has caused the skyrocketing price of the antidote. Meanwhile, Amphastar spent millions to modify and expand its factory and produce a nasal form of its product.

An Amphastar spokesperson said that it had not raised the drug’s prices since October 2014, unlike the company’s competitors. The company also has rebate agreements with nine states and is currently working on one with Maryland.

Baltimore is hit hard by opioid use, with a reported 24,000 or more residents using opioids. Moreover, the city’s ongoing fight with heroin addiction has led to thousands of drug overdoses, with a US total of 28,647 opioid deaths in 2014, alone.

Wen declared a public health emergency in the city regarding opioid addiction, which laid the foundation for a powerful treatment and prevention program, one of the strongest in the U.S. The results of this program are positive. Wen signed a petition calling for warning labels on opioids, and they are now required by the Food and Drug Administration on 400 opioids and benzodiazepines. In December, Wen urged Congress in her testimony before the U.S. Senate to call for more transparency in the pricing and regulation of drugs, including naloxone.

As quoted by US News, Wen stated: “At the time of a public health crisis, it’s unconscionable that our ability to save lives is limited by the price of a medication. That should not happen…We shouldn’t be reliant on charitable donations.”

The fact that drug overdosing now results in more fatalities than motor vehicle accidents has finally caught Congress’ attention. This year, Congress passed the Comprehensive Addiction and Recovery Act which, according to the CADCA, is “the first major federal addiction legislation in 40 years, and the most comprehensive effort undertaken to address the opioid epidemic, encompassing all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.”

The White House announced this week that it will provide state grants of $53 million. Some of this sum will be used to purchase naloxone.