Pennsylvania’s health secretary, Dr. Rachel Levine, has issued a new standing order to allow residents to receive naloxone (Narcan), the opioid overdose antidote, by mail. The order says that community organizations can collect naloxone kits from the state, and either mail them or give them in person to those who want them.
This policy change could help more naloxone get to more people faster and easier, saving lives. Depending on where you live, getting naloxone can often be challenging—and of course, the pandemic and mandatory social distancing exacerbate such difficulties. So this measure is arguably more important now than ever, as the pandemic coincides with a spike in overdoses across North America.
Pennsylvania’s government has previously distributed naloxone through public community events. These have been held at places like libraries, health department offices or colleges. The state has also made naloxone available to first responders, medical clinics and addiction treatment centers. It reports that it gave out 10,000 naloxone doses directly to residents in 2019.
A 2016 policy allows anyone in Pennsylvania to get naloxone for themself or someone else in need, without a prescription. It applies to individuals who are at risk or their families, friends or associates. But pharmacies don’t give it away; if it isn’t covered by health insurance (or you are uninsured), you have to pay the difference.
Data show that there were nearly 4,500 drug overdose deaths in Pennsylvania in 2018, about 12 deaths per day. That was an 18 percent decrease from 2017. Overdoses involving either a prescription or illicit opioid caused 82 percent of these deaths. The most common drug involved was fentanyl, followed by heroin. Pennsylvania remains one of the hardest-hit states in the country, ranking fourth in overdose deaths per capita.
Price remains an obstacle to getting naloxone—in Pennsylvania and elsewhere. Naloxone prices range widely and have spiked dramatically in the past few years. They may be as low as $25 for a generic vial, up to $150 for a nasal spray with two doses, or as high as $4,500 for a special “auto-injector.”
A 2016 New England Journal of Medicine analysis found that the annual number of naloxone prescriptions increased by less than a half million between 2009-2016. It explained that stigma around drug use was partly responsible for this slow adoption of the drug—but that high prices and a small handful of suppliers were also factors. Only three manufacturers are approved by the FDA to produce the different formulations of the drug, and most naloxone is sold by Hospira (since bought by Pfizer), which increased its prices by 129 percent between 2012 and 2016.
In Pennsylvania, not all pharmacies offer naloxone yet, as many are still adapting to new regulations and standing orders. But people can also get free naloxone from certain syringe programs, like Prevention Point in Pittsburgh and Philadelphia. Syringe exchanges are still technically illegal in the state, but about 20 centers operate because the government has deemed them “life-sustaining.”