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In the opiate epidemic, some cities are struggling to offer the antidote OD

BALTIMORE – On a corner of Baltimore Street, health workers deliver an overdose antidote that saves lives to residents painfully familiar with the ravages of the opiate epidemic in the United States . But the training ends quickly; all naloxone inhalers are claimed in 20 minutes.

"We could have delivered hundreds of doses today, but we only had 24 kits, that goes fast," said Kelleigh Eastman, a health department worker who attends the City's "Do not Die" overdose campaign.

Cities like Baltimore feel the financial bind as they depend on naloxone to try to counteract the increase in overdose rates. Some very affected communities across the country are struggling to pay the doses, even at reduced prices.

With more overdoses driven by synthetic opioids such as fentanyl and carfentanil, so potent that it is used as an elephant tranquilizer, naloxone is still rich enough that the Baltimore health department is rationing supplies, stretching a battery of decreasing inhalers. Last year, the city distributed more than 25,000 doses, compared to approximately 19,000 in 2016.

"Each week, we count the doses that remain and make difficult decisions about who will receive the medication and who will have to do without it," he said. Baltimore Health Commissioner, Dr. Leana Wen, who issued the city's innovative general prescription for the drug in 2015.

Since then, numerous states have passed laws that include bypassing prescription requirements and establishing training programs Community that restores a person's breathing while temporarily blocking opioid receptors in the brain.

"It's a bit of a pressure cooker environment for Baltimore, but also places in many other states that have been in the forefront of the overdose crisis and where the cost keeps going up. The challenge, at a structural level, is that there is no clear source of sustainable funding for naloxone, "according to Daniel Raymond, policy director of the National Harm Reduction Coalition.

In Charleston, West Virginia, the health department reported Monday that it only has 159 doses left, most of them assigned to community classes in the coming days. The spokesman for the Health Department of Kanawha-Charlestown, John Law, said that they requested more naloxone auto-injectors from the company that donated them in the past "but we have not had an answer".

Last week, the US Surgeon General UU Dr. Jerome Adams issued the first national public health notice of the office in 13 years, asking more Americans to start taking naloxone and urging more federal funds to increase local access to antidotes.

"The costs should not and, in the near future, not a barrier to access naloxone for anyone in the United States," Adams promised.

A two-dose box of Narcan, a brand for naloxone inhalers, has list prices of approximately $ 125. First responders and community organizations can buy Narcan with discounts of $ 75 per two-dose box, depending on the manufacturer Adapt Pharma. The Evzio autoinjector from the Virginia-based pharmaceutical company Kaleo currently has list prices of approximately $ 3,800 per box with two doses, up from $ 690 in 2014.

The surgeon general's advice was welcomed in Philadelphia, where Health authorities discussed internally whether "rationing" accurately describes their naloxone status. The city has one of the highest opiate mortality rates of any major metropolis in the US. UU And distributed 25,000 doses between July and December of last year.

"Given the tremendous scope of the opiate epidemic and (ours) we anticipate 1,200 overdose deaths in 2017, easier – and cheaper – access to naloxone for the general public and public safety agencies has the potential to save hundreds of lives, "said Philadelphia Department of Health spokesman James Garrow.

What is at stake could not be more. Growing anecdotal evidence shows that multiple doses of naloxone are needed to reverse an overdose caused by synthetic opioids, rather than the single dose to reverse an overdose of heroin.

Baltimore Fire Deputy Chief Mark Fletcher said first responders have discovered that "two doses" are needed. maybe even three doses "to restore breathing if a person used heroin mixed with fentanyl or carfentanil.

It is not yet clear how naloxone saturation is affecting deaths from overdoses in general. The National Bureau of Economic Research suggests that laws that increase access to naloxone are linked to up to 11 percent of deaths.

In a gritty Baltimore neighborhood, Shane Shortt, a heroin addict, said he could revive five drug buddies with Narcan over the past year and he swears he never goes anywhere without an inhaler.

"You never know when you're going to have to use it. It was actually used on me like last week, "Shortt said in front of a needle-change van in Baltimore, where a dozen people show the ravages of long-term drug use aligned with some younger people.

An addiction and recovery expert with the National Council on Behavioral Health, Tom Hill, said the conclusion is that naloxone is just "all we have" to fight overdoses.

"Anything to reduce the costs of a drug that saves lives is something very welcome, "he said from Washington.

Wen, who is one of many officials calling on the Trump administration to directly negotiate the price of naloxone with the manufacturers, was more direct: "We are in the middle of a national epidemic. We should not have a price beyond the capacity to save lives. "

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David McFadden on Twitter: https://twitter.com/dmcfadd

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