West Virginia pharmacies to dispense Narcan without a prescription

The new law to sell Narcan over-the-counter also calls for patient counseling and educational materials


By Wendy Holdren
The Register-Herald

BECKLEY, W.Va. — According to the Department of Health and Human Resources’ Bureau for Public Health, more than 700 West Virginians died from drug overdoses in 2015. Raleigh County alone lost 55.

Although it’s not the only solution to the ever-growing problem, many public health officials believe access to naloxone, a lifesaving drug used to treat narcotic overdoses, may help decrease those numbers.

A nasal-administered dose of Narcan.
A nasal-administered dose of Narcan. (AP Photo/Stephan Savoia)

In March, the West Virginia Legislature passed a bill allowing pharmacies to dispense naloxone without a prescription. The law goes into effect June 10.

The bill also called for the Board of Pharmacy, along with the Bureau for Public Health, to develop a protocol for patient counseling, educational materials and documentation through the West Virginia Controlled Substances Monitoring Program.

Officials with both organizations said this week that protocol specifics are still being developed, and will be relayed to pharmacies across the state when they are finalized.

While residents will be able to get the lifesaving drug for the first time without a prescription, first responders in the area have carried naloxone for a number of years.

“Any ambulance that responds to you, at least from Jan-Care, will have it,” said Paul Seamann, director of operations at Jan-Care Ambulance Service.

“Yes, it is lifesaving, and yes, we endorse that it’s out there,” Seamann said. “But it won’t cure the drug addiction problem. It’s one tool in the toolbox.”

Unresponsive
The number of overdose deaths, both statewide and countywide, can be easily tallied by the “cause of death” reported on death certificates certified by the Chief Medical Examiner’s Office.

The numbers reported from the April 29 analysis may even increase due to time delays in obtaining toxicology results and reporting to the Health Statistics Center.

But overdose call numbers are a bit more difficult to nail down.

When calls come in at the Raleigh County Emergency Operations Center in Beaver, they may be logged as an overdose, but they may also be logged as “unconscious,” “unresponsive” or even as “seizure” because of the host of medical problems associated with overdoses.

Raleigh County EOC Director John Zilinski said sometimes callers simply don't know what happened to the victim they're calling about. Other times, they may fear prosecution for being involved with drugs or a potential overdose death.

For this article, Zilinski pulled the numbers for "overdose" and "unresponsive" calls. In 2010, there were 802 calls in Raleigh County. Five years later, the calls were just over 1,000.

But Zilinski was quick to note, "Our data is not an accurate statement of what's going on."

While the numbers aren't county-specific, Jan-Care's overdose numbers are more precise — they keep track of how many times they've administered naloxone.

Seamann said from January 2013 to October 2015, numbers rose 47 percent, from 220 patients to 327 across Raleigh, Fayette, Nicholas and Wyoming counties.

“Eighty percent of patients receiving it were over 30 years of age,” he said. “That was interesting to us. Some people may perceive it as something younger people do.”

Transport and shelf life
Local emergency medical technicians have carried naloxone for some time now, but local police departments are not yet equipped with the drug, largely because of the cost, but also due to storage concerns.

Seamann said since the widespread adoption by first responders in the past two years, the cost per unit of naloxone has increased from $16 to $36.

"There's not a huge benefit for us to carry it," said Beckley Police Chief Lonnie Christian. For emergency medical calls, he said ambulances generally respond just as quickly as law enforcement.

If the city received a grant that would cover the cost, Christian said he would be willing to have the officers trained to administer naloxone.

Raleigh County Sheriff Steve Tanner said his office is looking into equipping deputies with the lifesaving drug, but sheriffs statewide are trying to figure out the best way to transport it.

Extreme temperatures can affect the shelf life of naloxone; Tanner expressed concerns about how officers could properly store the drug during the summer and winter months in their cruisers.

Seamann said the shelf line of the drug is up to two years if stored properly, ideally at room temperature. He said anything extreme will shorten the effectiveness.

Funding is a concern for the sheriff's office as well, but Tanner said, "At some point, you buy what you have to have."

Even if one life is saved, he said it's worth it. He's anticipating grant opportunities, and he expects a mandate in the future requiring all officers to carry it.

Rep. Evan Jenkins said some funding will be available to support the distribution of naloxone to first responders in a recent package of bills related to the opioid epidemic.

"It's clearly a lifesaving drug and a lot of attention has been paid to getting it into the hands of those who can save lives," Jenkins said.

Temporary measure
With the drug soon available over the counter, Seamann said it's important to know that while naloxone reverses the effects of an opiate for a short time frame, it does not remove the opiate from the body of the victim.

"It's important people understand this is immediate lifesaving medication, but it doesn't go as far as to cure someone. They still need to seek medical care."

After an EMT administers naloxone, Seamann said the patient is still transported to the hospital to be monitored and further treated if necessary, as the half-life of the opiate is longer than the half-life of naloxone.

Just as a tourniquet is only a temporary measure for a deep wound, naloxone is only a temporary measure for an overdose victim.

While the drug has the potential to save lives, the widespread availability of it raises other concerns. For example, Seamann said opiate users may look at the drug as a safety net. They may feel they can experiment more freely, or even with higher doses.

"We don't want people to look at it as if opiates are safer," he said.

Dr. Leana Wen, health commissioner for the City of Baltimore, who led the charge to issue every Baltimore resident a naloxone prescription, heard these concerns from legislators as well.

Wen argues that the benefits outweigh the risks, and she likens giving naloxone to an overdose patient to giving an EpiPen to someone having an allergic reaction.

Education about naloxone is key, so the City of Baltimore launched a website, dontdie.org, filled with information and frequently asked questions.

The website shares that naloxone can reverse an overdose on opioid drugs like heroin, OxyContin, Percocet or Fentanyl; the drug cannot get someone high and it is not addictive; and it will have no effect on someone who does not have opioids in his or her system.

Videos are also posted on the site to show users how to administer the drug.

Multi-faceted approach
"Naloxone has to be one part of the overall solution, an important part," Seamann said. "But there is no one thing that will change this... If that person doesn't change their life or lifestyle, (naloxone) may be administered over and over."

West Virginia's drug overdose death rate is more than double the national average — 34 drug overdose deaths were reported per 100,000 residents from 2011-13. Seamann said from his perspective, southern West Virginia does not have enough resources to combat the problem.

"I think the hospitals and health care facilities in the region would echo that. We're all in agreement that there has to be a statewide plan of finances and resources to combat this problem."

He said the state must create a multi-faceted approach, including a plan on how to treat addiction early on and how to get people safely off of prescription drugs.

"The big problem with opiates is once it has you, it's very, very difficult for people to get off without substantial help."

Anyone suffering from addiction can call or text 1-844-HELP4WV (1-844-435-7498) or visit help4wv.com to learn more about treatment options throughout the state.

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©2016 The Register-Herald (Beckley, W.Va.)

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