Should OD rescues be limited? Questions rise as Narcan’s cost soars

Could multiple drug overdoses by the same person prompt first responders to stop giving that person Narcan?

One Martin County commissioner raised that prospect during a budget meeting this week. He isn’t the first to do so nationwide, as counties, cities and towns grapple with the opioid epidemic and the soaring cost of the antidote, which saves lives by blocking the effects of heroin and other drugs. And it’s likely not the last time authorities across the U.S. will be pressed to consider the option to “play God,” as one Palm Beach County commissioner termed it.

During public comments archived on the county’s website, Commissioner Ed Fielding discussed the possibility of limiting the number of times Martin County Fire Rescue crews would use Narcan to revive a person who has overdosed on multiple occasions. Fielding, who was speaking about the Fire Rescue budget, said the idea was mentioned by Palm Beach County State Attorney’s Office representatives during their recent visit to Martin County to discuss the region’s opioid epidemic.

According to Fielding, Alan Johnson, assistant state attorney for Palm Beach County, “suggested that they have a cut off,” for patients who overdose multiple times. “He says what we’ve had to come up with is, after so many, we do not administer Narcan again.”

However, Palm Beach County State Attorney’s Office spokesman Mike Edmondson said Fielding’s comments were not accurate and the agency has had no discussions about restricting the usage of Narcan.

“The sober homes task force has no recommendation to ration the drug Narcan,” Edmondson said Wednesday.

Fielding was away from his office Wednesday and unavailable for further comment, an aide in his office said.

Palm Beach County Commissioner Melissa McKinlay, who this year wrote a letter to Gov. Rick Scott asking him to declare a public health emergency because of the opioid epidemic, said she would not support any effort to limit the use of Narcan, saying the county’s first responders have an obligation to save lives.

“It’s the most horrific, disgusting proposal I have ever heard in my life,” she said. “It’s not our job to play God.”

But as cities and municipalities struggle to keep up with the drug’s rising costs, others have raised the idea. This past month, Middletown, Ohio, City Council member Dan Picard told The Washington Post he supports a three-strikes style policy for overdose victims in his city, about 40 miles northeast of Cincinnati.

“It’s not a proposal to solve the drug problem,” he told The Post. “My proposal is in regard to the financial survivability of our city.”

The Dayton Daily News reported Thursday that Picard has dropped the issue, saying the cost of lawsuits the policy would invite could be even greater than the cost of the drug. He has apologized to fellow council members for creating what the Daily News called “a national controversy.”

According to the New England Journal of Medicine, as demand for Narcan — also known as naloxone — has skyrocketed, some forms of the drug have risen in cost by more than 500 percent in the past few years. The cost for a two-pack of single-use, prefilled auto injectors rose from $690 in 2014 to $4,500 by the end of 2016, the publication reported in December.

The average price of the most widely used injectible, a 0.4 mg vial, rose from $62.29 in 2012 to $142.49 in 2016, the report said. The average price of the nasal spray version, used by many police agencies, is $150 for a two pack.

This past year, Palm Beach County Fire Rescue spent $205,000 on naloxone, compared to $55,ooo in 2015. In May, Boynton Beach paramedics, who typically use $1,000 worth of Narcan in a month, used nearly that much in a single weekend.

Despite such costs, McKinlay said she does not envision an effort to limit its use by Palm Beach County’s first responders.

“That is not something the Palm Beach County Commission would consider,” she said. “When you start having conversations like that, you need to look at other illnesses. … Are you going to tell a diabetic that if they don’t change their diet, you’re not going to give them insulin?”

In his public remarks, Fielding noted that the opioid crisis is more severe in Palm Beach County, which has nearly 10 times the population of Martin County. However, Fielding cautioned that Martin officials should remain vigilant.

“We’re not as exposed to it as they are to the south, where they’ve got so many people dying every day,” he said “Fortunately, we don’t have that.”

Palm Beach County’s 590 opioid overdose deaths in 2016 were an all-time high for the county and nearly twice as many compared to 2015, according to a Palm Beach Post analysis of records from the Medical Examiner.

In a letter similar to McKinlay’s, Martin County Commission Chairman Doug Smith wrote to Scott this year asking the governor to declare the overdose crisis a public-health emergency.

Martin County sheriff’s officials noted a sharp decrease in overdose calls at the beginning of this year, but said the numbers have begun to rise again in recent months. The agency, which began equipping deputies with Narcan this past year, reported more than 30 overdoses call through the beginning of June.

Sheriff William Snyder this week told WPTV NewsChannel 5, The Palm Beach Post news partner, he has no plans to impose limitations for his deputies. A sheriff’s spokeswoman said that Snyder was not available for interviews Wednesday.

Martin County spent $23,100 on Narcan in the 2016-17 budget year, $5,000 of which came as a donation, sheriff’s spokeswoman Laurie Weber said. It bought 308 dosages. The sheriff has budgeted $7,500 toward purchases in the 2017-18 budget year and will order dosages on an as-needed basis.

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