Overdose reversal drug naloxone made available statewide without prescription
As Maryland continues the battle against the opioid addiction crisis impacting residents across the state, the life-saving opioid overdose reversal drug naloxone has just become more accessible.
Pharmacists in Maryland can now dispense naloxone to people without a prescription, according to a statewide standing order issued by Dr. Howard Haft, deputy secretary for public health services with the Department of Health and Mental Hygiene.
“Pharmacies play an important role in providing access to naloxone and counseling on how to recognize and respond to an opioid overdose,” Dr. Haft said. “This order is yet another tool to fight the crisis and provide immediate assistance to overdose victims.”
The order comes with a recent report by the DHMH showing that there were 2,089 overdose deaths across Maryland in 2016, a 66 percent increase from 2015’s number. Officials say this the most severe jump in overdose deaths ever recorded in the state. The largest chunk of overdose deaths resulted from heroin, with 1,212 deaths statewide, closely followed by fentanyl-related deaths, recorded at 1,119 statewide.
According to the report, Charles County saw 45 total overdose deaths last year, along with 28 in Calvert County and 15 in St. Mary’s County.
Health officials say a single dose of naloxone can be effective in reversing a heroin overdose. However, officials warn that naloxone is not a miracle drug. One dose may not be enough when the overdose is the result of substances like fentanyl or carfentanil, which are more potent than heroin alone; multiple doses of naloxone may be needed for effect, or, in some cases, the victim may simply be too far gone to be revived.
Though training is recommended for administering naloxone, Waldorf pharmacist Dipen Patel at High Street Discount Pharmacy says naloxone nasal spray, sold under the brand name Narcan, can still make a difference in a heroin overdose if administered by someone without experience.
“If someone can use cough and cold nasal spray, it’s somewhat similar to using that,” Patel said. “Even if they use it improperly, they could give enough medicine to prevent a loss of life.”
Patel says so far he has only dispensed Narcan once since the prescription requirement was lifted.
Two doses are contained in one package of Narcan, with each package costing about $35 for the pharmacy to purchase, Patel said. According to him, most insurance plans will cover naloxone, but the price to consumer without insurance would vary from pharmacy to pharmacy. Health officials confirmed that naloxone is covered by Maryland Medicaid.
While Patel says some people on prescription opioid medications should definitely have naloxone available as a precaution, he worries its easy availability could be a double-edged sword for others.
“The fact that it’s available to anybody who can walk in will, in my opinion, increase the abuse of other substances, like heroin or street abuse of the opioid pain medicines,” Patel said. He’s concerned there might be a dangerous mentality of, “if something happens, at least we have this, so at least we won’t die.”
“This is not a solution to the epidemic we have for opioids,” he said.
Pharmacist Jonathan Lee, pharmacy manager of My Express Care Pharmacy in White Plains, says he thinks positively of the standing order.
“Having something lifesaving on hand is always a good idea,” Lee said, comparing the use of naloxone to using an EpiPen to save someone’s life during a severe allergic reaction.
He says he previously worked in New York, where naloxone has already been available without a prescription since last year.
In March, Gov. Larry Hogan (R) declared a state of emergency regarding Maryland’s opioid crisis, which came with the announcement of $50 million in new funding to combat the issue.
Clay Stamp, executive director of the Opioid Operational Command Center, itself created out of an executive order by Gov. Hogan in January, says readily available naloxone is helping to save lives.
“We must remember though, that ultimately, those suffering from the disease of addiction or substance use disorder must be linked to additional treatment to aid in their recovery,” Stamp said.
Dr. Dianna Abney, a health officer with the Charles County Department of Health, echoes this sentiment.
“When someone survives an overdose, that provides another opportunity to get them into recovery,” Dr. Abney said. “There are also wraparound services provided statewide and here in Charles County to make it easier for survivors of opioid overdose get recovery services and to stay in recovery.”
One of the programs Dr. Abney listed is the Overdose Survivors Outreach Program, the purpose of which is to connect survivors of opioid overdoses to treatment services, such as medication assisted treatment and contact with peer recovery specialists.
If someone is experiencing an overdose, health officials urge people to call 911 regardless of whether naloxone is administered. With Maryland’s “Good Samaritan Law,” officials say callers are greatly protected from arrest and prosecution when alerting authorities and assisting someone during an overdose.
Training on how to recognize an overdose and administer naloxone is held Monday evenings at the Charles County Department of Health. Anyone can register or find out more information by calling 301-609-6661.
Marylanders impacted by opioid abuse and looking for prevention, treatment and recovery options are also encouraged to visit BeforeItsTooLateMD.org or call the state crisis hotline at 1-800-422-0009.