A price hike

In 2009, one vial of naloxone sold by the pharmaceutical company Amphastar cost roughly $20. By 2016, its price had nearly doubled, to $39.60.

This company’s pricing is not an anomaly. The cost of some forms of naloxone has “skyrocketed in the past several years,” Mr. Fisk said. In particular, the price of the intranasal form of the drug has increased recently, while the intramuscular drug has remained cheaper.

Some say this rising cost poses a tough obstacle as groups try to acquire more doses to distribute throughout Pittsburgh.

Naloxone used to be a “very cheap” generic drug that cost a dollar or two per dose, Mr. Fisk said. Now, an intranasal device with two doses costs $150, according to Mr. Fisk, and an automated naloxone machine that speaks instructions on how to administer the medicine sells for over $600.

These trends are unusual considering that the drug company’s patents on naloxone expired long ago, yet prices have continued to rise, according to Michael Hufford, co-founder and CEO of Harm Reduction Therapeutics. This nonprofit pharmaceutical company aims to sell naloxone at the lowest possible cost to increase access to the drug.

“In theory, you get 20 years of exclusivity, you go off patent, then prices fall,” he said.

Naloxone was first patented in 1961 and approved for opioid overdoses by the federal Food and Drug Adm i n i s t r a t i o n in 1971. Although the patent for generic naloxone expired decades ago, some companies currently own patents for naloxone delivery devices, such as the intranasal Narcan system. Narcan’s patent expires in 2035.

Naloxone prices continued to increase after the generic patent expired because drug companies realized they could make huge profits off the drug, Dr. Hufford said.

“It definitely has an impact on the organizations in Pittsburgh and it’s unnecessarily increasing the profits of drug companies,” Mr. Fisk said.

Karen Hacker, director of the Allegheny County Health Department, said she does not have difficulties “meeting the demand” for naloxone. But she acknowledged that it may be expensive for some county residents to buy it in pharmacies, even though most health insurance providers cover it.

Mr. Lettrich said it is important to ensure that other Pittsburgh residents have access to affordable intranasal naloxone because some people do not know how to administer the intramuscular version or are afraid to do so.

A possible solution? Over-the-counter naloxone — a product Dr. Hufford’s company is working to develop. Harm Reduction Therapeutics is currently raising money and preparing for a clinical trial of the over-the-counter drug.

Dr. Hacker said she supports over-the-counter naloxone and recently raised this idea with some “legislators at the federal level.” She noted that an over-the-counter version would be feasible because risks associated with the drug are “incredibly low.”

In developing an overthe-counter version of naloxone, Dr. Hufford said his goal is to make the drug widely available at minimum cost.

“Just like you can go anywhere and buy Band-Aids and Tylenol, we think naloxone should be that available,” he said.

A turning point?

“In 2017, there was easily twice as much naloxone given out to the community as there was in 2016,” said Alice Bell, coordinator of Prevention Point Pittsburgh’s Overdose Prevention Project.

Prevention Point, a local nonprofit, works to combat the opioid epidemic and has distributed over 3,500 doses of naloxone throughout the city since 2005, Ms. Bell said. Prevention Point hands out naloxone at needle exchanges it runs throughout the city.

Since 2005, Prevention Point’s naloxone has reversed at least 2,500 overdoses.

“When naloxone is available and given to people, there’s really no opioid overdoses that can’t be reversed,” Mr. Fisk said. “It’s incredibly helpful.”

In recent years, the county has increased efforts to provide the drug to residents. In 2017, the Allegheny County Health Department gave out 2,122 doses of naloxone, while emergency medical services distributed an additional 2,411 doses. Those figures do not include naloxone picked up at pharmacies or prescriptions written by doctors.

In May 2015, Dr. Hacker issued a countywide standing order that granted permission to pharmacies to sell naloxone to people who are at risk of overdosing or likely to witness an overdose. The state also has issued a standing order.

The increased availability of naloxone in the county means that Pittsburgh organizations can distribute multiple doses of the drug to residents. While a single dose of naloxone revives some people, others sometimes require up to six or seven doses. A typical naloxone kit includes two

As naloxone distribution has increased, so have efforts to distribute the drug strategically. Nonprofits and government officials have designed distribution plans to make sure the drug ends up in the hands of people who likely will be in a position to make a “save.”

Getting the drug to first responders was a major goal behind Mr. Wolf’s naloxone funding. From