Antidotes can’t handle ODs in age of synthetics

Ralph Battels figured it out when one of his patients woke up and tried to punch him in the face: A single shot of naloxone often really isn’t enough to do the trick anymore.

Addicts in Pagosa Springs, where he’s an emergency-room doctor, are downing such incredibly powerful opioids that the overdose-reversal agent may have to be applied two or three times — or more — to revive them and calm their sometimes violent highs. The budget at Pagosa Springs Medical Center is taking an unanticipated hit, another victim of a raging national epidemic. “It’s a problem that frankly we should be able to control,” Battels said. “But it’s a big challenge. It’s everywhere.”

Hospitals and emergency-services agencies nationwide are confronting higher bills for the chemical compound that can block the effects of painkillers and heroin, as super-strong synthetic opioids like fentanyl and carfentanil grow increasingly popular. Not only are more doses of the remedy often required, prices for some brands of naxolone have been ticking up.

“You try and balance product cost and care — and that creates obvious problems,” said Nilay Shah, a consultant in the Division of Health Care Policy and Research at the Mayo Clinic and one of the authors of a study published in the New England Journal of Medicine that warned escalating costs threaten efforts to save lives.

The number of naloxone recipients getting multiple doses has grown more than 25 percent since 2012, according to research published in May by the National Association of EMS Physicians. Some medical centers have increased their routine doses just to be safe, with Danbury Hospital in Connecticut, for example, now giving 4-milligram rather than 2-milligram applications of Adapt Pharma Inc.’s Narcan as a matter

of course. Some can’t keep up: St. Vincent Hospital in Leadville recently ran out and had to borrow supplies from a nearby facility.

It all adds up to a drain on health-care resources. In Florida, the Manatee County Emergency Medical Services department gave 432 applications of Narcan in June compared with just nine in the same month four years ago, with a 650 percent cost increase to $109,650.

“We have noticed an ebb and flow of different synthetics, some requiring multiple doses to bring patients around,” said Paul DiCicco, the department’s chief. The synthesized opioids, often manufactured il- legally and available over the internet, can be dozens of times stronger than heroin.

EMS crews save money by stocking the cheapest naloxone available and buying low-cost nasal dispensers instead of purchasing the medication in pre-filled injectors. But they’re legally, and ethically, bound to try to save lives no matter the cost.

“There’s no way not to respond to a 911 call,” said Brent Myers, president of the National Association of EMS Physicians. “And once there, there’s no way not provide a life-saving treatment.”

A city councilman in Middletown, Ohio, proposed doing just that earlier this year — with a baseballstyle strikeout rule where emergency response personnel wouldn’t be dispatched to someone overdosing for a third time.

“We need to put a fear about overdosing in Middletown,” the councilman, Dan Picard, told his colleagues when he made his suggestion, which he quickly withdrew upon realizing the legal hurdles it faced.

There are about 50,000 people in Middletown, and there have been around 600 overdoses there this year, more than in all of 2016. And because the opiates are getting so much stronger, it can take up to nine doses of naloxone to revive a person, according to a report prepared by the city manager.

President Donald Trump has backed a recommendation in a report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis and said the epidemic is a national emergency.