Over­dose re­ver­sal drug nalox­one made avail­able statewide with­out pre­scrip­tion

Maryland Independent - - Front Page - By MATTHEW KUBISIAK mku­bisiak@somd­news.com

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.

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