Skyrocketing price of the “life-saving antidote” for the opioid epidemic in New York State; have the drug companies gone too far?

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 Figure 3-page-001(https://www1.nyc.gov/site/doh/about/press/pr2016/pr102-16.page)        

Data from the Center for Disease Control (CDC) shows a fourfold rise in overdose deaths related to prescription opioids in the United States since 2000 (figure 1). In New York State (NYS), opioid related hospital admissions peaked in 2014 (figure 2), prompting implementation of policies to address these concerns. One of the major executions by the NYS Department of Health was issuance of a standing order authorizing licensed pharmacists to dispense naloxone, an opioid antidote, to persons without needing a prescription.

Figure 1

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Figure 2

Figure 2-page-001

Source: https://www.osc.state.ny.us/press/releases/june16/heroin_and_opioids.pdf

Naloxone counteracts the dangerous effects of opioids with minimal or no adverse events if mistakenly administered to persons not suffering an overdose. The demand for naloxone has significantly increased now that the State has requested widespread availability for the public to administer naloxone in cases of suspected overdose. However, the rising costs of naloxone have made it difficult to meet these demands. The injectable version of the drug has increased significantly over the past few years. The price for naloxone nasal spray in the CVS chain’s New York stores is up to $110 for people who buy it without a prescription and insurance. An auto-injector version of naloxone called Evzio, that works like Epi-pen, is $2,250 for a single-dose injector.

Increasing access to naloxone for the public is inadequate if prices continue to rise. The State and the manufacturers of these products are our stakeholders. These parties may reduce costs by increasing manufacturers, and offering consistent prices and discounts. Pushback from the manufacturers to lower prices thrives in that they are limited in number and have raised costs to meet rising demand. The community may argue that increasing the availability of antidotes may promote drug overdose. Thus we appeal for an alliance between the state and the manufacturers to reduce prices of these life-saving medications to curtail the opioid epidemic.

Written by Asma Akter, Elan Gorshein, Nidhi Madan

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4 Responses to “Skyrocketing price of the “life-saving antidote” for the opioid epidemic in New York State; have the drug companies gone too far?”

  1. ryandlangblog Says:

    Thank you for writing this post and shedding light on this very important issue. The issue of drug overdose is a personal one as I had a patient who I saw in clinic a year ago who had relapsed on heroin and had overdosed in a hospital bathroom later that day. She unfortunately died from her overdose a few days later. I had prescribed naloxone at that appointment given her risk of overdose, but I am not sure whether she was even able to get it.

    I wonder how many patients at risk from opiate overdose choose not to purchase naloxone when prescribed due to the cost of the medication. It is shocking to see how rapidly the price of naloxone has risen in just the last few years. This is unfortunately a problem with countless other prescription drugs as well. It was encouraging to see that U.S. Rep. Elijah Cummings and Dr. Redonda Miller (president of Johns Hopkins Hospital) had recently met with President Donald Trump and HHS Secretary Dr. Tom Price to share how significant the issue of rising drug prices is and to advocate for policy solutions to this issue (https://www.washingtonpost.com/news/wonk/wp/2017/03/08/liberal-democrats-say-trump-promised-to-support-their-medicare-drug-price-effort/?utm_term=.d94254b305f2). This problem will require the commitment of pharmaceutical companies as well in limiting their profits in order to ensure fair and equitable access to drugs, especially life-saving drugs like naloxone.

  2. abrow170 Says:

    This is a very interesting post. I have been hearing alot about this issue and I understand that having the price decrease as you say could increase the overdose rates as people are less fearful because they know naloxone is available. May be a good approach would be that the drug is available for emergency uses only (i.e. hospitals and clinics) although I am not sure how ethical that would be medically to not allow it to be prescribed to individuals. My own rebuttal to that statement would be that if there is no prescription to individuals available who is to say they would make it in time to a location that has this drug for the treatment of overdose. I think its a hard policy as there is a feedback loop in terms of behaviors we can understand in that if you have this drug available, you worry less about overdose and therefore exhibit even riskier behavior.

  3. zcatanz Says:

    This is an excellent post and an increasingly topical issue that strikes at the core principles of healthcare. Specifically, our attention is drawn to the moral incompatibility of capitalism and care. In this case, the relationship is truly insidious. Those who are most at risk for an opioid overdose are often poor or economically constrained . This reinforcing relationship and the cost of opioids themselves mean that those most likely to benefit from Naloxone are simultaneously those least likely to afford the life-saving drug. Worse, as the post makes clear, a capitalist market orientation means that the cost of the drug necessarily increases in the event of an epidemic. In the case of opioids, this may be particularly problematic given that an increasing common pathway to opioid addiction and overdose begins with pharmaceuticals and legally obtained prescriptions. In this way, increasing opioid demand drives both increased price for opioids and increased risk for opioid overdose that in turn drives increased demand for Naloxone that then also increases with the rise in demand. Quite literally, it is one industry selling both poison and antidote, profiting from both and in proportion to the number of people harmed by their product- the more people the product poisons, the more profit the poison makes and the more profit they can make from the antidote. Meanwhile, the people who need the poison (and thus the antidote) are increasingly less able to access the antidote in large part because of the increasing addiction to- and cost of- the poison itself. Moreover, unlike a real “antidote,” Naloxone does not actually cure the opioid addiction that leads to the overdose nor does it cure whatever may have led to the opioid addiction in the first place.

  4. tamiloreareola Says:

    From your blog post, it seems there are many nuances surrounding the high prices, which problematize the idea of simply putting pressure on manufacturers to reduce their prices. Perhaps a multifaceted approach that first explores these nuances and seeks to address them for the end goal of price reduction. For example, the government might consider how to tackle what seems like an oligopoly among manufacturers in order to give the public more bargaining power in the market.

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