PHILADEPHIA — If it were possible to put a dollar value on human life, few would argue that $37.50 is too high.
But that’s all it cost to purchase the drug that saved Michael C. Meeney’s life when he overdosed on heroin earlier this year on a crowded bus in suburban Philadelphia.
Meeney gained fleeting notoriety in February when video of his near-death experience went viral—making headlines as far away as Britain. Footage shows Meeney falling out of his seat onto the floor, then rising Lazarus-like within seconds of receiving a single nasal blast of the anti-overdose drug naloxone from an Upper Darby police officer.
Overnight, Meeney became the unwitting poster child for a “miracle” drug that public health officials say has the potential to prevent tens of thousands of fatalities a year by reversing the effects of opioid-related respiratory distress.
But Meeney may not be so lucky next time. Since the Upper Darby Police Department began outfitting its cops with naloxone, at the end of 2014, the cost of the drug has skyrocketed. Sources of funding remain tenuous; and some cities are beginning to find their stores of the drug running low before they’ve found a way to pay to replace it.
That has public safety officials worried that their efforts to stem the rising tide of opioid deaths could be undermined by the age-old law of supply and demand.
Since it was first introduced, in 1971 under the brand name Narcan, the price of naloxone has grown 4,000 percent even as more manufacturers have entered the market.
Since 2013 the average wholesale cost of a dose of injectable naloxone has more than doubled, according to data provided to The Daily Beast by Truven Health Analytics. This is putting pressure on state and local government to find new sources of money to fund the purchase of naloxone kits, which only has a shelf life of 18-24 months.
Last week, Baltimore’s Health Commissioner Leana Wen called it “unconscionable” that the increasingly prohibitive cost of naloxone is limiting the city’s efforts to combat drug overdoses.
According to one report, Baltimore spent $118,236 on naloxone in fiscal year 2016, more than triple the $33,540 the city spent in 2014.
Wen has been sounding the alarm over naloxone price gouging since accepting her post in January 2015. During testimony in March before the House Oversight Committee she called on Congress to enact price controls on the drug in the name of public safety.
“The cost of naloxone skyrocketing means that we can only save a fraction of the lives we were able to before,” she said. “Manufacturers have claimed that this price increase is related to increased demand. However, it is unclear why the cost of a generic medication that is available for much lower costs in other countries will be suddenly so expensive.”
Lawmakers are paying attention. In June, following a number of critical media reports on naloxone pricing, top members of the Senate Special Committee on Aging issued a letter to the five leading manufacturers of naloxone asking them to explain the rationale for increasing the cost of the drug.
Letters were sent to the chief executives of Amphaster Pharmaceuticals, Pfizer, Adapt Pharmaceuticals, Kaléo Pharma, and Mylan Inc.—the manufacturer of the EpiPen that has jacked up prices for years, resulting in numerous complaints to the Federal Trade Commission.
For the most part, naloxone makers chalk up the price increases to the additional burdens they face in meeting skyrocketing demand for the drugs. But some health care advocates say that doesn’t pass the smell test.
“We’re not talking about a limited commodity. Naloxone is a medicine that is almost as cheap as sterile sodium chloride—salt water,” Dan Bigg, the executive director of the Chicago Recovery Alliance, told Business Insider.
In a rush to head of a growing epidemic of fatal opioid overdoses, many state and local government tapped into emergency funds to get naloxone to their first responders. Or else they took advantage of limited-run programs like the federal government’s Rural Opioid Overdose Reversal Grant Program, which distributed just $1.5 million to 15 communities.
With grant dollars running out, public health officials across the country are now scrambling to secure the funding they’ll need to continue saving lives in 2017. And they are calling on the federal government to step in and assume more of the cost.
“If we don’t get some federal funding to help us put this in the street then we are not going to be able to get those people the help they need,” said said Rick Fontana, New Haven, Connecticut’s deputy director of emergency operations, in a July interview.
States are authorized to draw on federal Substance Abuse and Mental Health Block Grants to subsidize naloxone purchases. But that often means shifting funds from other addiction prevention and treatment programs.
“That’s not new money, that’s money that’s already there, you’re just diverting it from one program to another,” Peter Luongo, executive director of the Pittsburgh-based Institute for Research, Education & Training in the Addictions, told The Daily Beast. “There is no reliable stable source of funding other than those channels that are here right now.”
The bipartisan Comprehensive Addiction and Recovery Act (CARA) signed this summer by President Obama calls for expanding first-responder access to Naloxone, but lawmakers in Congress have yet to provide any funding for the effort.
The Department of Health and Human Services announced at the end of August that it will provide up to $11 million to fund the purchase and distribution of naloxone, but only a dozen states will see any of that money.
In states like Pennsylvania, where drug overdoses tied to opioids rose nearly a quarter last year, communities will remain largely dependent on the goodwill of charitable organizations and health insurance companies to step in to fill the void. In many cases this involves small, one-time grants that can only do so much.
For instance, the Pittsburgh-based Highmark Foundation donated $50,000 in the first quarter of last year to the Pennsylvania District Attorney’s Institute to distribute to local law enforcement agencies for naloxone purchases. But it didn’t renew the grant this year.
Health insurers contributed a total of $500,000 in Pennsylvania alone to fund naloxone distribution. Cigna Foundation donated $50,000 this year to fund naloxone purchases in the state. Independence Blue Cross joined the Pennsylvania District Attorneys Association in a providing $50,000 to help equip more Philadelphia police officers with naloxone kits in April.
But most patrol officers still don’t carry the drug. As of this year, naloxone kits had only been distributed to about 15 percent of Philadelphia police officers, mostly in high-risk districts.
Philadelphia Police Commissioner Richard Ross said the money came just in time, as his department had nearly exhausted its existing naloxone funds.
However, city officials say pricing remains a concern.
“We want to make sure that this important drug is available to help people to need it,” said Cameron Kline, a spokesperson for the Philadelphia District Attorney’s Office, which facilitated the newest round of naloxone funding for the PPD. “If there are ways we can make that easier for police to get their hands on naloxone we will do that, but if the market is bearing higher prices that means that means the funds we pass on will buy less of this medication, and that’s something we are concerned about.”
Thomas Nestel, Chief of the SEPTA Transit Police, said despite his department’s strong presence at two of Philadelphia’s most drug-ridden Elevated transit stations—Huntingdon and Somerset—his agency has so far been shut out of the city’s naloxone funding. SEPTA Transit cops on duty in suburban Delaware County, Pennsylvania, however, are fully outfitted with naloxone courtesy of the Delaware County prosecutor.
Delaware County has used a mixture of federal grant dollars, and money seized during drug investigations under asset forfeiture laws to support its program. Last year it forged a discount agreement with Pennsylvania-based Adapt Pharma to debut the company’s recently approved nasal-delivered naloxone kits.
That version of the drug has an average wholesale price of $150 for two 4-milligram doses; the Upper Darby Police Department secured its kits for $75.
But naloxone doesn’t last long. In May, the county had to destroy half of its remaining naloxone stores—about 200 of the 900 kits it originally purchased in 2014 from Amphastar—because they had expired. District Attorney Jack Whelan said the naloxone cost $22 per dose when he acquired it, but today would cost more than double that price.
In the absence of more traditional funding channels, officials are forced to get creative to secure the money to save lives.
Rhode Island tapped $40 million out of a nearly $230 million settlement it reached with Google in 2012 for facilitating the illegal online exchange of prescription drugs from Canada.
A number of other police departments rely on money seized during drug investigations to fund their naloxone programs. And in July, a judge in Pittsburgh took the unusual step of requiring two convicted drug dealers to shell over nearly $4,000 to pay for naloxone.
Luongo applauds the creativity of these municipalities, but says they are little more than half measures.
“These are hardly stable streams of funding,” he said. “Unless somebody starts someone pumping money in there I don’t see this being sustainable.”