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  June 25, 2017

Big Pharma Puts the Squeeze on Cities Battling Opiate Crisis


Exponential price increases for the life saving drug Narcan have pushed Baltimore to the brink of running out as overdose deaths soar by Taya Graham and Stephen Janis
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Taya Graham: This is Taya Graham reporting for The Real News Network in Baltimore City, Maryland.

In Baltimore, two people a day are dying from drug overdoses, and the city is running out of a drug that is critical to saving their lives. But the question is, why? Especially in the light of the latest news that the opiod crisis has only gotten worse. A new report revealed that emergency room visits tied to opiate overdoses have soared to nearly 1.3 million across the country, a 99% increase since 2005.

That news coupled with the recently released statistics that overdose is now the leading cause of death for people under 50 only underscores the fact that addiction in the U.S. is now a full-scale epidemic, which raises questions as to how a city agency is running out of the best way to save people who take too much of an opiod: the life-saving drug Narcan.

Narcan is what's know as an agonist. It quickly rids the body of opiates, which cause respiratory arrest. But the drug's price is skyrocketing just as the need for it grows. Evzio, one of the most popular versions, has had its price increase seven-fold in two years and now costs nearly $4,500 per dose. The price for the Narcan spray has skyrocketed nearly 60% since last year, which is why Baltimore City health commissioner, Dr. Leana Wen, made an unusual public plea for more funds from both state and federal governments to keep Narcan available and the addicted out of the morgue.

Naloxone, it's the injectable and spray that can save people's lives when they're overdosing on an opiod. Why is the city running out?

Dr. Leana Wen: Let me start with the background for where we are today. We are facing an unprecedented opiod overdose epidemic. Last year, two people died from overdose every single day in our city. That's more than the number of people who died from homicide, more than the number of people who died from car accidents and suicide. This is a public health emergency, which is even made more tragic by the fact that there's one medication, naloxone or Narcan, that can save people's lives at the point that they're overdosing.

As an ER doctor, I've given naloxone hundreds of times, and I've seen how someone who is overdosing has stopped breathing and would otherwise be dead, they'll be walking and talking within seconds. Already in the city, we have trained over 23,000 people in the last two years on how to use this medication, and everyday people, neighbors have saved over 800 other people in the city. So this is something that we should all carry with us in our medicine cabinet, in our first aid kit.

The problem is that we are being priced out of the ability to save lives. The price of naloxone has more than doubled. It's a generic medication. The price has more than doubled, and with the increased demand, with the high number of people who are overdosing, especially because of fentanyl, which is a medication that's many times stronger drug, many times stronger than heroin, because of fentanyl, because of heroin, because of other prescription drugs that are killing our residents, we need Narcan more than ever.

We just don't simply have enough. We don't have the resources to purchase it, and we need the assistance from our state and federal partners to help us to meet the high demand, the high urgent need that there is in Baltimore City.

Taya Graham: Governor Hogan said that the opiod epidemic in Maryland is absolutely one of his top priorities. Have you asked him for money?

Dr. Leana Wen: We at the Baltimore City Health Department have made numerous requests to our state partners for funding. This is a public health emergency. There are tens of millions of dollars of funding that will be released as we understand from the state. We have not yet received these emergency funds, and there are people dying every day in our city. So we are looking for guidance, we're looking for a continued partnership with our state so that we are able to get the resources that we desperately need in order to save lives here in Baltimore City.

Taya Graham: The Bloomberg School of Health said the city would save millions of dollars if there was a safe space for people to use drugs. Do you agree with creating a safe space for people to shoot up?

Dr. Leana Wen: There are many things that are necessary for us to fight the opiod epidemic. Getting naloxone or Narcan into everyone's hands is one sure way because people are dying right now, and there is an antidote that's available right now. We should make sure that everyone carries this in their medicine cabinet, in their first aid kit right now.

There are many other tools that are necessary, too. After you save someone's life, they also have to get into treatment because we know that treatment works, that recovery is possible, and that there are signs showing that there are millions of people who are living in long-term treatment, who are treating their addictions that they're able to resume their normal lives. We don't nearly have enough treatment to meet the high demand in our city.

We await legal guidance from our federal partners, from the Attorney General's Office as to whether safe injection facilities would be legal here in our city. If they are deemed to be legal, then they are one additional tool that we would love to be able to employ once they are determined to be legal and evidence-based.

Taya Graham: Thirty years ago, Mayor Kurt Schmoke said that we should decriminalize all drugs. Last year, Delegate Morhaim said we should decriminalize all drugs. Do you think this would actually help make our citizens safer?

Dr. Leana Wen: Addiction is a disease. The signs shows that addiction is a chronic disease just like diabetes, heart disease, high blood pressure. We don't incarcerate people who have other illnesses, and incarcerating people who have the disease of addiction and hoping that they'll somehow get better and recover, it just doesn't work. That's why we've been working with our police departments, state's attorney's office, and our other partners on programs like LEAD, Law Enforcement Assisted Diversion, where individuals who are caught with small amounts of drugs will be offered treatment instead of incarceration.

Taya Graham: What other strategies is the Baltimore City Health Department using to help deal with the opiod crisis?

Dr. Leana Wen: First, we are getting naloxone or Narcan into the hands of every individual because we believe that that is the antidote that will save lives. The problem is that we're running out of funds, so we desperately seek assistance from our state partners to be able to alleviate this huge shortage. We are having to ration. We're having to decide who are the most likely to die from overdose, and we're giving Narcan to those individuals, but there are still tens of thousands more people who need to carry this medication with them.

Second, we have to increase access to treatment. We're starting something called a stabilization center, which is a 24/7 treatment option for us so that individuals who need treatment for addiction and mental health are able to get help at the time that they need it. We're also working on increasing treatment options and getting people referrals into treatment. For example, we started a 24/7 phone hotline for anyone with addiction and mental health needs.

Third, we're reducing stigma and fighting stigma with science.

You can go to any pharmacy, and if you're on Medicaid, naloxone is $1. If you are unable to pay that $1, it's free. So we encourage everyone to go and get those resources. Also, our 24/7 phone line with give you the phone number for afterwards as well.

We would love to get Narcan or naloxone into the hands of every single resident in our city, everyone who can possibly encounter someone who's overdosing, which is really every resident in our city. When we have 21,000 people in our city who use heroin, many more who are addicted to other prescription drugs, everyone needs to carry this medication with them.

We are having to give Narcan to those who are the very highest risk. For example, individuals who visit our needle exchange vans, our clients at our needle exchange vans are at the very highest risk. We also have individuals in our jail systems and other individuals, family and friends of those individuals who are high risk for overdose, we also give them this medication first.

However, that doesn't account for all the tens of thousands who want to carry this medication. Every single day, I get dozens of calls to the Baltimore City Health Department asking us for this medication. Non-profit groups, neighborhood associations, faith leaders, they're saying that they have people overdosing in their congregation outside of their facility, and they want to have this medication available. I have to say that I'm sorry, I just don't have enough available.

And that's the tragedy. In a time of a public health emergency, we should not be running out of a life-saving medication. We should not be priced out of the ability to save lives. We desperately need resources, we've been requesting them from our state and federal partners, and we desperately need these emergency resources because there's something we can do today to save a life.

Nearly 700 people died from overdose in Baltimore City in 2016. That's about two people a day in our city who died when we could've saved their lives. In our city, there are over 21,000 people who use heroin, many tens of thousands who use other drugs including other opiod prescription drugs. These are all individuals who are at risk for overdosing.

And remember, too, that a person could overdose after having surgery and being prescribed narcotics and overusing those. A person could overdose who is recreationally using drugs, and we don't condone drug use, we don't approve of drug use, but if someone has an addiction, they have a disease, and it's our job to save their lives today.

I don't have those numbers with me. I will say that we have enough funding through July of 2017 for several thousand doses of Narcan. That's all that we have, though, for all the outreach workers who are on the streets, who are doing trainings, every one of our needle exchange vans, all of our clinics, all of our non-profit partners and our federally-qualified health centers. That's all that we're able to give to people. We need many more tens of thousands more. If you give me several thousand doses today, I'll be able to distribute them this week. That's how desperate our need is and how high the demand is in our city for this life-saving medication.

We have been fortunate to get donations from the pharmaceutical companies to assist us with our need. We're glad that they gave us these donations, but we should not be dependent on the charity of drug companies in order to fulfill this urgent public health need. We have made many requests, and we'll continue to make many requests from our state partners so that we're able to get this life-saving medication. This is a time of a public health emergency. It is a crisis, and we need to get these resources urgently and desperately.

I also want to point out that in Maryland, Baltimore City constitutes over one-third of all the overdose deaths. We are the area that is the hardest hit because of overdose, because of addiction, and we need for resources to be distributed to areas of greatest vulnerability, greatest severity, and greatest need, especially in Baltimore City.

I signed two weeks ago a standing order, yeah, so I'll ... But I'll just mention that anyone can walk into any pharmacy in Baltimore City and get Narcan. They don't need to have a prescription because I signed a blanket prescription for every single resident in our city, so you do not need a prescription. You do not need to prove that you have the training, although we encourage everyone to go to our website at dontdie.org in order to get training. But you can now go to any pharmacy and walk out with Narcan, this life-saving medication in hand.

Because there are multiple forms of Narcan. The generic form of the Narcan, which we do not show here, but the generic form of the Narcan has increased in price, has more than doubled in price. The other forms of Narcan are relatively new, but one of them is worth thousands of dollars, and the other one is available at about $100 or so. They are expensive, but they have not increased in price because they are relatively new medications that have just recently received FDA approval.

Speaker 3: So the drug companies are really putting you in a bad position, I guess. In terms of raising the prices, this is why the prices [inaudible 00:12:54] drug companies is the price increase. I'm just making sure that I understand the basis of this crisis.

Dr. Leana Wen: The basis of the crisis is complicated. Yes, it is true that these medications are very expensive, but we also have to take into account the fact that there is high demand. There are people overdosing, the number of people overdosing is at crisis proportions higher than we've ever seen. So we have higher demand, and therefore, we also need to increase the resources that are available to target this emergency. We have not yet received those relief resources even when people are dying everywhere around us.

The problem is that we are being priced out of the ability to save lives. The price of naloxone has more than doubled. It's a generic medication. The price has more than doubled, and with the increased demand, with the high number of people who are overdosing, especially because of fentanyl, which is a medication that's many times stronger drug, many times stronger than heroin, because of fentanyl, because of heroin, because of other prescription drugs that are killing our residents, we need Narcan more than ever. We just don't simply have enough. We don't have the resources to purchase it, and we need the assistance from our state and federal partners to help us to meet the high demand, the high urgent need that there is in Baltimore City.

Nearly 700 people died from overdose in Baltimore City in 2016. That's about two people a day in our city who died when we could've saved their lives. In our city, there are over 21,000 people who use heroin, many tens of thousands who use other drugs including other opiod prescription drugs. These are all individuals who are at risk for overdosing.

And remember, too, that a person could overdose after having surgery and being prescribed narcotics and overusing those. A person could overdose who is recreationally using drugs, and we don't condone drug use, we don't approve of drug use, but if someone has an addiction, they have a disease, and it's our job to save their lives today.

Taya Graham: We asked the office of Maryland Governor Larry Hogan for comment on Dr. Wen's assertion that the state had not release emergency funds. They told us that $10 million of the $50 million set aside for the opiate crisis would be available soon. However, they did not specify when or how much money Baltimore will receive.

This is Taya Graham and Stephen Janis reporting for The Real News Network in Baltimore City, Maryland.



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