No prescription for overdose antidote
The California Department of Public Health on Thursday issued a statewide standing order for naloxone, the emergency antidote that reverses the effects of an opioid overdose.
The order, issued by agency Director Dr. Karen Smith, functions as a standing prescription that enables all California organizations that work to reduce or manage drug addiction — such as sober living facilities, needle exchange programs and residential treatment centers — to distribute naloxone to patients and members of the community. The facilities would no longer have to get a prescription from an individual doctor.
Naloxone, often sold under the brand name Narcan, is administered by injection or nasal mist. Public health officials have pushed in recent years to make the medication more accessible. State regulations that took effect in 2015 authorized California pharmacists to make naloxone available without a prescription, but not all pharmacies carry it. And many nonprofit groups that work in the drug addiction field already distribute naloxone under a standing order from a local physician.
But, in some parts of the state, particularly in rural areas like the northern counties, there are physician shortages and treatment facilities often struggle to find a doctor who will write a standing order for naloxone. Some physicians are reluctant to write a standing prescription for patients they have not seen in person, and addiction medicine is outside the purview of many doctors’ practices.
“If you’re a primary care doctor, being the medical provider for a local syringe program isn’t necessarily something you do,” Smith said.
Under the state order, Smith would now serve as the prescribing physician for naloxone for these facilities. The facilities must apply to the California Department of Public Health to receive the order.
“(The order) enables a statewide solution instead of a thousand local solutions,” said Kelly Pfeifer, director of highvalue care for the California Health Care Foundation.
The order does not address how naloxone is paid for. Needle exchanges and other harm reduction programs obtain naloxone many different ways. Some buy it, and some receive it from public health departments that paid for it with local or state dollars.
At pharmacies, generic naloxone costs as little as $20 per dose if purchased out of pocket. Narcan can cost as much as $70 per dose. Many health insurers cover the medicine.
Other jurisdictions, including Massachusetts and the city of Baltimore, have recently issued standing orders for naloxone.
Naloxone does not have any harmful effects if it is administered to someone who has not overdosed, health experts said. First responders, for instance, sometimes administer the medicine to a patient they initially suspect is unconscious because of an overdose, but is later found to have had other medical problems such as a diabetic coma.
A record 42,000 Americans died in 2016 after overdosing on opioids, according to the U.S. Centers for Disease Control and Prevention. That includes prescription pills, heroin and fentanyl.
In California, the number of people dying from opioid overdoses fell slightly in 2017 to 1,882 — down 7 percent from 2,031 in 2016, according to state data. That is the lowest number of opioid overdose deaths the state has seen since 2011.
But the number of people dying from fentanyl overdoses is skyrocketing — hitting a record 746 people in 2017. That is more than three times the 237 people who died from fentanyl overdoses in 2016, and nine times the 81 who died from overdosing on the drug in 2013.
Fentanyl has long been used in prescription pain patches and epidurals. But in recent years, it has started showing up more often in much higher doses in the illegal drug trade, mixed in with heroin, cocaine and methamphetamine. Users often do not know how much fentanyl is mixed in with the other drugs, making it easier to accidentally overdose.