Anna Nash

March 23, 2015

Policy
The Costs of Naloxone

Heroin and other opioid overdoses are increasing to alarming rates

nationwide and the state of Iowa is no exception to the growing problem.
Blackhawk, Johnson, and Scott counties have experienced doubled rates of
overdose which as nearly doubled since 2012. In fact, Half of all heroine
drug users report at least one nonfatal overdose during their lifetime (Piper,
et. al., 2008). The principle risk factor for heroin overdose is a prior heroin
overdose. Approximately 10% to 25% of heroin users overdose annually and
33% to 70% overdose over a lifetime of use (Coffin & Sullivan, 2013).
Naloxone offers a safe and effective way to reverse overdose temporarily
while an overdose victim seeks help. Opioids can be identified in all bodily
fluids. If opioids are not present in the body, naloxone has no effect on the
victim (Fareed, et. al., 2011). If administered, an overdose victim can have
20 to 90 minutes to seek emergency help and increase his or her chances for
survival. Naloxone is low-cost, low-risk option that can effectively save the
lives of those in need due to an opioid overdose.
Though it is low-cost, naloxone, name brand Narcan, requires a
prescription from a doctor that must be obtained from a retail pharmacy.
Users may also obtain naloxone from local overdose-prevention programs
that are available in most cities (Doe-Simpkins, et. al., 2009). Naloxone is

obtained through contractual agreemenets in the United States with

programs traditionally paying approximately $6 per dose, $15 per kit of
injectable naloxone, and $25-$30 per kit of intranasal naloxone (Coffin &
Sullivan, 2013). Naloxone comes in a kit form and each kit [is] usually
[a] wallet-sized packet containing 2 doses of naloxone and other items,
including syringes, brochures, clean needles, simple rescue breathing masks,
and brief educational materials about overdose risks and management
(Coffin & Sullivan, 2013). Each kit of naloxone costs about $25 [if obtained]
from a pharmacy, a cost that many insurance companies will cover.
However, some insurance companies may not cover the cost of naloxone and
the overdose victim may not have the money to pay for it rendering the
victim helpless and possibly dead (Zaller, et. al., 2013). Despite sound
medical rationale and evidence of positive outcome the widespread use
of naloxone has yet to catch on. Possible reasons for many refraining to use
naloxone are the lack of widespread access to naloxone and the fear of
civil liability and criminal prosecution by prescribers, bystanders, and first
responders who would administer naloxone to overdosed drug users (Straus,
et. al., 2013). Allowing for increased access to naloxone and tweaking
liability laws for the general public has the cost-free potential to save lives.
For over 20 years, community-based organizations have distributed
naloxone to thousands of injection drug users and their friends and families
(Zaller, et. al, 2013). In a 2006 study of a Boston, Massachusetts overdose
prevention program, 385 potential bystanders were trained to recognize

signs of opioid overdose and administer naloxone in the event of an overdose

as well. The overdose-prevention naloxone distribution program was
implemented without substantial funding. Space, printing, and staff time
were provided by the existing needle-exchange program which was
funded by a city-wide initiative to reduce the sharing of needles and the risk
of overdose (Doe-Simpkins, et. al., 2009). For the most part, program
participants reported success stories thanks to proper training. However,
during other follow-up interviews, it was found that During 4 overdoses,
bystanders could not connect the mucosal atomization device to the
syringe Two bystanders reported that naloxone induced withdrawl
symptoms, two people have naloxone confiscated at a homeless shelter, 1
reported being expelled from a residential drug treatment program, and 3
reported negative interactions with emergency personnel (Doe-Simpkins,
et. al., 2009). Despite the few negative reports, prevention programs have
effectively and greatly reduced overdose deaths throughout the nation
making communities and citizens safer.
In some states, naloxone administration by bystanders and medical
professionals carries legal concerns. In 1997, Congress enacted the
Volunteer Protection Act declaring that the willingness of volunteers to offer
their services is deterred by the potential for liability action against them
(Ahronheim, 2009). This means that any person that is properly licensed
and trained can act, or not act, in a medical emergency outside of their
workplace without being held liable should death or serious injury result as

long as they are acting in good faith. Each state has the ability to change
Good Samaritan Laws so that unlicensed, but trained, bystanders can help in
an emergency without being held liable (Ahronheim, 2009). These state level
laws also allow community members to obtain or administer naloxone and
call for help without legal repercussions regardless of their own intoxication
levels or possession of drugs or paraphernalia related to the impending
overdose (Straus, et.al., 2013). Over half of the United States have enacted
laws protecting bystanders but Iowa is not one of them. In fact, studies show
that 88% of opioid users would be more likely to call for help if they knew
they would not be arrested or receive criminal charges related to an
overdose victim (Straus, et. al, 2013). Because Iowa has not passed laws
protecting citizens, many people are too scared to call for help for fear that
they might get in legal trouble or face the possibility of murder charges
should death occur from the incident.
Naloxone offers a safe and cost-effective option for saving lives due to
a opioid related overdose. Though there are legal concerns related to
naloxone, the kits are low cost, low risk, and buy time to receive emergency
medical attention. Should Iowa legalize naloxone for bystander
administration, overdose rates would greatly decrease just as they have in
other states across the country. Naloxone offers a second chance at life, one
that overdose victims may not otherwise have without the use of naloxone.
Naloxone offers the option to save lives and make communities safer for
everyone. Truly, no cost is too great.

References
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