I walked into a CVS across the street from WBUR this week to get some naloxone, which you might know by the brand name, Narcan. It temporarily reverses the effects of an opioid overdose and restores breathing.
For me, the purchase is not urgent. But I saw a woman in a cafe restroom recently who was in rough shape, I have a cousin who's managing his addiction to heroin, I'm reporting on this issue, and I have three teenagers. I decided I wanted to be ready to help.
I asked the pharmacist for Evzio. It's a newish option, an injectable form of naloxone, kind of like an EpiPen. Mark Herzog, a VP at Kaleo, the company that makes Evzio, handed me the "trainer" (pictured above) at a conference. It comes in a kit along with two injection canisters.
The trainer talks you through the injection process. Here's what it says:
Figuring out what to do in that moment when you realize someone has overdosed "can be very scary and emotional," Herzog said in an interview. "So the idea is that you have a drug device combo that helps assist while you are waiting for the EMTs to arrive."
That sounded good to me. I don't plan to do this very often, so having some on-site assistance would be helpful. But my local CVS doesn't stock Evzio. The pharmacist offered me a pre-filled nasal spray unit (pictured below) instead. Assembly instructions are in very small print on the back of the box. Hmmm, I thought, this would be a bit more complicated in that moment of panic.
The pharmacist offered to order the Evzio. OK, I said, what's the price difference? I knew Evzio would be more expensive.
- Evzio: total cost, $570; my co-pay (under a Blue Cross plan), $70. (Evzio's website offers a coupon, too.)
- Naloxone spray: total cost, $20; my co-pay, $8. (I bought it; I had to sign a release to get it.)
The cost difference is why Dr. Alex Walley, who specializes in addiction medicine at Boston Medical Center, says most patients get the nasal spray version of naloxone.
"There's a lot of promise with the auto-injector because it has the audio recording that instructs people on how to use it. It's very innovative in that way," Walley said. "But the cost currently is high enough that it's too much of an out-of-pocket expense."
Kaleo donated 2,000 Evzio kits to the state Department of Public Health. Walley, who's also medical director for the state's opioid overdose prevention program, says first responders who've used Evzio like it. But when they need to buy more, it may be hard to justify the additional cost.
Naloxone is free for patients and their families through patient support groups, clinics and needle exchange programs.
Walley pointed me to a website with how-to videos for the three ways to use naloxone: needle and syringe (intramuscular), nasal and the auto injector. It's a good thing I watched the nasal spray video. The instructions on the box are quite basic, with not a lot of detail.
Naloxone rescue kits come with two applicators in case the first one doesn't work.
Use naloxone if you encounter someone who is unconscious, not breathing, and you see painkillers, a needle or have other reason to think they have overdosed. The potential benefits outweigh some small risks.
Anyone have other tips to share?