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Overdose Treatment is Poised to Get Even Easier, But Hardly Cheaper

A naloxone nasal spray is as user-friendly as it gets, but whether the users that need it will have access is less certain.
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A heroin overdose is an easily reversible thing. An overdosee can be unconscious and not breathing and, still, the introduction of a drug called naloxone will go to work, blocking the brain's opioid receptors and basically shutting the whole heroin/brain interaction down. The overdosee wakes up, a recovery most any bystander would deem miraculous. Naxolone, which is available currently as an intramuscular injection, is relatively ancient and off-patent; historically, it's gone for about $3 a dose, but, as the recent opioid-abuse epidemic has raged on, that price has gone up to $30. When public health agencies are your primary clients, it becomes rather easy to charge whatever for a drug.

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The past few months have seen the introduction/promised introduction of two new naloxone delivery devices, both promising to put overdose treatment in the hands of really anyone with half a brain. One features a talking box, and the other goes up the overdosee's nose.

In April, an at-home naloxone autoinjector kit, marketed as Evzio, was approved by the FDA to much applause. Despite the real-life ease of giving a standard, conventionally-administered naloxone dose—something oft pointed out by substance abuse advocates—persistent perceived barriers to the casual administration of a deep muscular injection have kept the common form of the drug out of the hands of the civilian population. More so, it remains a tool of paramedics and ER staff, albeit for no good reason.

Evzio promises to change that, offering something more like the EpiPen autoinjector carried by some patients with severe allergies. But a projected per dose cost upwards of $400 has cast a shadow on what should be a revolution in overdose death prevention at precisely the time that revolution is needed. Its manufacturer is offering a patient assistant program, but, while removing the cost barrier for some patients, such a program instead adds a time barrier (four to six weeks for any assistance program I've utilized) for something that, for so many users one hit away from never waking up, is needednow.

Help does exist now in the form of naxolone at-home kits available with a prescription, but still require a full-on intramuscular injection. The latter barrier is mostly psychological, with the process requiring about the same skill level as "basting a turkey," according to theNew York Times.

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"I wish that the FDA would have fast tracked over-the-counter naloxone instead of an expensive product for a private company," Cassie Castillo, of the North Carolina Harm Reduction Coalition, toldVICE in April. "Intramuscular and intranasal naloxone are already available, easy to use, and much less expensive than Ezvio, so I don't see how the addition of a machine that talks will improve access for anyone."

This week it was announced that another, still even easier naloxone delivery device is on the fast-track for FDA approval. Developed by researchers at the University of Kentucky, this one ditches the needles entirely, coming in the form of a nasal spray. A user overdoses and stops breathing, and it should just be a matter of delivering a mist of naloxone up their nose. Overdose over. And, unlike its Evzio competitor, the University of Kentucky device doesn't require a talking box to dispense instructions.

"The goal is to make the medication available to patients at high risk of opioid overdose, and to caregivers, including family members, who may lack specialized medical training," Daniel Wermeling, the device's lead developer, said in a statement issued by the University of Kentucky. "The treatment could be given in anticipation of EMS arrival, advancing the continuum of care and ultimately saving lives." One might speculate such a device could be prescribed by doctors to accompany painkiller prescriptions, or even better, be distributed for free like condoms or sterile IV needles.

Wemeling, through his start-up AntiOp, has already licensed the device to Reckitt Benckiser Pharmaceuticals, who will actually bring it to market once approved. With the competition (or pseudo-competition) going for $400, there's no great reason to expect the AntiOp device to be nearly as cheap as naloxone in its current form. That said, intranasal drug delivery is a world apart from an overly fancy machine that talks, and it seems reasonable that it will at least cost less than Evzio. At the University of Kentucky (research) end, the team was circumspect about discussing costs, which, in fairness, is a position shared by most everyone whose work involves a laboratory and not marketing.

It needs to be noted, however, that we shouldn't even be in the current situation. Opiate-related deaths are skyrocketing, but this is not a new phenomenon in itself. If there was something that could rapidly reverse the effects of a heart attack and that thing happened to be a very old and cheap drug, you'd expect it to be on shelves in every store going for next to nothing. Except, wait, there is: aspirin.

In the realm of substance abuse, patients aren't so much patients as users. Still. Even needle-exchange programs remain hard-fought, despite mountains of evidence supporting their role in curbing IV drug-related diseases. Nowhere else in medicine is preventing death and disablement seen as "encouraging" behavior and, in a more-just societal climate, you can be assured that we would not be here now, at the devastating peak of an overdose epidemic, finally seeing mass-market antioverdose products at any cost.