Highlight on Hawaii: Lawmakers say aloha to stronger overdose measures

More people in Hawaii die from drug overdoses than car crashes—a reality that is driven by an excess of opioid abuse. However, recent efforts are directed at reducing the state of Hawaii’s opioid crisis. A key component of the state’s fight against drug abuse is a piece of legislation (S.B. 2392) which creates immunity for those who describe and dispense overdose reversal medication such as Naloxone. Additionally, the law authorizes a greater range of individuals to administer such medications to individuals experiencing an overdose.

Drug abuse

In 2015, Hawaii saw 158 deaths from drug poisonings/overdoses, adding to the total of 1,523 over the past 10 years. Drug overdoses are a greater problem in Hawaii than in other U.S. states. For example, drug overdose deaths increased by 83 percent between 2006 and 2014—an increase which more than doubled the 37 percent average rise nationwide. There is speculation that Hawaii may be particularly susceptible with respect to overdoses due to its isolation and the inconsistency in the quality of drugs brought to the islands.

Naloxone

The FDA approved Naloxone to prevent overdose by opioids such as heroin, morphine, and oxycodone. The drug reverses the toxicity of an overdose by blocking opioid receptor sites. The medication is administered when a patient is showing signs of an opioid overdose. The drug is an important life-saving medication, according to a community health outreach worker who has heard stories about “people trying to help friends overdosing on narcotics like opioids, injecting them with everything from saltwater to milk.”

Law

The law encourages the prescription, distribution, and administration of Naloxone through a variety of measures. A key provision of the law is immunity that it provides for health care professionals and pharmacists who prescribe, dispense, distribute or administer overdose medications like Naloxone. The legislation also authorizes several kinds of individuals—police, firefighters, lifeguards, all emergency medical technicians, family, and friends—to administer drugs like Naloxone to individuals experiencing opioid-related drug overdoses.

Bigger than Hawaii

The opioid crisis is a problem that stretches far beyond the island chain of Hawaii, with overdose deaths from prescription painkillers claiming 165,000 lives in the U.S. since 2000. Part of the problem is the widespread prescription and use of opioids. In 2015, 227 million opioid prescriptions were written, enough for 9 out of 10 American adults to receive a bottle of opioids.

Influence

An investigation by the Associated Press and the Center for Public Integrity discovered that the prevalence of opioid use and abuse may be, in no small part, related to the financial efforts of pharmaceutical manufacturers. For example, the investigation found that “drug companies and allied advocates spent more than $880 million on lobbying and political contributions at the state and federal level over the past decade.” The figure is staggering when juxtaposed with the $4 million spent by organizations advocating for limits on opioids and the fact that the pharmaceutical lobbying is eight times higher than spending by the gun lobby over the same period. Additionally, the pharmaceutical industry maintains an average of 1,350 lobbyists covering all 50 state capitals.

A step forward

However, despite these significant and growing challenges, states like Hawaii are taking steps to reduce the impact of opioids. Authorizing greater utilization of drugs like Naloxone is an important move in the journey towards eliminating opioid abuse, one that all states can benefit from.

As naloxone prominence increase in opioid fight, so does price

The price of naloxone, a drug used to reverse the effects of an opioid overdose, has skyrocketed in the past few years. Despite complaints from lawmakers and national advocacy groups such as Harm Reduction Coalition, the price increases have come at a time when public health officials cite the record number of overdose deaths – more than 27,000 in the U.S. in 2014 – with almost 19,000 from prescription opioids and over 10,000 heroin-related, 16 and 28 percent increases from the previous year.

President Obama recently signed a law aimed at addressing the growing opioid crisis in the U.S. and naloxone is at the forefront of the conversation, as it is often the drug of choice to reverse the effects of opioids on the brain and can limit or stops a heroin or prescription opioid overdose. The Comprehensive Addiction and Recovery Act of 2016 increases the availability of naloxone, strengthens prescription drug monitoring programs (PDMPs) by assisting states with monitoring and tracking prescription drug diversion, and expands prevention and educational efforts with teens and other adult populations.

The most common formulation of naloxone used by police departments, hospitals, and addiction advocacy organizations is made by Amphastar Pharmaceuticals, which raised concerns after it increased the list price of 10 injectable naloxone from $120 to $330 in October 2014. In the last decade, Hospira’s injectable dose has gone from 92 cents in 2005 to more than $15 in 2014. Meanwhile, Kaleo Pharma raised the price of its naloxone product, Evzio, several times in since 2015. In November 2015, the price went up to $375, followed by an increase to $1,875 in February 2016; the single-dose auto-injector price is now at $2,250.

According to Truven Health Analytics, the rise in price has been partly driven from the lack of competition. The price hikes jumped in frequency and volume in 2008 after several manufacturers stopped producing the drug, leaving Hospira and Amphastar as the sole manufacturers of naloxone. Mylan and Kaleo only introduced naloxone products in 2014, but only Mylan, Amphastar, and Hospira make the cheaper, injectable versions. Kaleo makes the auto-injector.

The demand for naloxone is not likely to decrease in the near future, as Congress is considering requiring that physicians co-prescribe the drug with every opioid prescription.

Highlight on Pennsylvania: State hit hard by opioid addiction, struggles to find solutions

Although Pennsylvania is due to receive $1.8 million in federal funding to combat opioid abuse, none of that money is going to Pittsburgh. Although the rising number of heroin deaths in the city may seem to indicate that the area is in drastic need of the funding, heroin use is a widespread problem throughout the state.

Federal funding

On March 11, 2016, HHS announced a $94 million award to health centers across the country to be directed toward combating the heroin epidemic. This funding was made available by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and went to 45 states, Washington D.C., and Puerto Rico. Estimates of opioid-related deaths have risen sharply: unintentional overdoses from pain medications has almost quadrupled since 1999, and the agency believes that deaths related to heroin increased 39 percent in one year, from 2012 to 2013.

Pennsylvania’s overdose journey

The University of Pittsburgh Graduate School of Public Health studied accidental overdose deaths in the state over time and found that the number has increased 14 times in the last three-and-a-half decades. The deaths were concentrated in southwestern Pennsylvania, around Philadelphia, and near Scranton. The Lehigh County Coroner was forced to request more money to cover drug overdose autopsies in 2015, Northampton County had 50 percent more opiate related deaths in the first three months of 2015 than the entirety of 2014. Although adults ages 34-44 had the greatest increase in overdose death rates since 1979, the younger 25-34 year old age bracket had the highest death rate in 2014. Death rates were higher in men than women, but the death rate in young white women was the fastest-climbing demographic. The report also noted that non-fatal overdoses requiring hospitalizations surged dramatically.

Small towns not exempt

An NPR reported traveled to a rural Pennsylvania county to see how a small town is impacted by addiction. A paramedic revealed that heroin is cheap and easily available from surrounding towns, and that there is no pattern to the addiction. He spoke of seeing young and old, well-off and poor using the drug. The paramedics are familiar with using naloxone, a rescue drug that reverses an overdose and can wake an unresponsive patient. As of the second week of March, they had already used the drug on ten patients. He admitted that they never have to worry about their stockpile expiring because they go through it so quickly.

Schools shaken by tragedy

High schools in the area reported losing six students to heroin overdoses in a two-year span. Some believe that small-town boredom lends itself to drug use, and Kutztown Area High School has formed a group to provide diversion for students, such as basketball tournaments. The state mandates a student assistance team, which includes teachers, counselors, and a contracted specialist, who keep an eye out for at-risk kids. Although it is difficult to know whether these groups help at all, the staff believes their efforts are crucial.

Pittsburgh left out of funding, despite high overdose rates

Pennsylvania received a $1.8 million chunk of the $94 million in federal funding, but the Pittsburgh region is left out in the cold. Philadelphia is the number one area in the state for heroin overdoses, but Allegheny County, where Pittsburgh is located, runs second. A local Pittsburgh paper reported that the county lost 157 people to heroin overdoses in 2014, which rose to 217 in 2015. An HHS spokesman stated that the funding awards were competitive, but did not say whether any southwestern Pennsylvania health centers applied. He did note that several Pittsburgh treatment centers are already federal funding recipients.