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Extreme drug, extreme measures

More than 70 health experts — including dozens in Southern Oregon — are calling on the U.S. Food and Drug Administration to make a common drug overdose antidote available without a prescription.

The health experts submitted a petition this month, triggering an FDA review of whether naloxone nasal spray, sold under the brand name Narcan, can be sold safely on store shelves rather through a pharmacy.

Naloxone quickly reverses overdoses caused by opioid drugs, including heroin and prescription pain medications such as oxycodone.

Oregon is among the states that allow people to get a prescription of naloxone directly from a pharmacist, without having to visit a doctor first.

But stigma and the hit-and-miss availability of naloxone at pharmacies is stopping some people from getting the life-saving antidote, said Julia Pinsky, co-founder of Max’s Mission, a naloxone education and distribution nonprofit.

A Jacksonville resident whose 25-year-old son, Max, died of a heroin overdose in 2013, Pinsky said people are afraid to talk to their health care providers for fear they’ll be labeled as having an opioid use disorder.

“They know their pharmacist and they don’t want their pharmacist to know they or someone they love has this problem,” Pinsky said.

When people do go to a pharmacy to get naloxone, it’s sometimes not available — especially if a substitute pharmacist not authorized to prescribe the drug is working that day, she said.

Being able to pick up naloxone off a store shelf likely would cause more people to buy it, Pinsky said.

“People don’t want to have to explain why they want it,” she said.

Mark Kantor, pharmacist for Grants Pass-headquartered AllCare Health, has joined with Pinsky and more than 40 other Southern Oregon pharmacists, doctors, hospital officials and others to petition the FDA.

Health experts from across Oregon and the nation also have joined the petition effort.

Kantor said the move by health experts is unusual because pharmaceutical manufacturers are usually the ones to petition the FDA for approval to sell a medication over the counter.

“Naloxone meets the requirements for an over-the-counter product,” Kantor said. “It’s safe and easy to use. You really don’t have to have a health care professional involved to be successful in using the medication.”

Narcan is sold as a nasal spray similar to decongestant or allergy sprays already used by the public.

A study showed people had similar results in being able to administer naloxone, whether or not they had been trained, Kantor said.

It has a low risk of misuse or abuse — another criteria for whether a medication should be available over the counter.

Kantor said making the overdose antidote more widely available could also lower the price.

Flonase, a nasal spray for allergies, dropped from up to $100 to less than $20 once it became available on store shelves, Kantor said.

Narcan costs about $120 for a prescription with two spray containers — even though the dispenser device and medication together cost less than $2 for the manufacturer, he said.

The antidote is sold in sets of two because one might not be enough to reverse an overdose and restore a person’s breathing.

Kantor said naloxone’s price could potentially drop to $10 or $12.

The nonprofit pharmaceutical company Harm Reduction Therapeutics is separately advocating for naloxone to be available over the counter. The company wants to lower the overdose antidote’s cost and increase its availability, according to its website.

Kantor said most insurance providers, including AllCare Health, cover naloxone.

Increasingly, doctors are advised to prescribe naloxone to patients who have prescriptions for opioid medications. Doctors are also being asked to rethink whether opioids are necessary — or if other pain treatment strategies would work better for certain patients.

“Since the 1990s, there has been a lot of misinformation about opioids, especially from drug companies,” Kantor said. “These medications are actually very dangerous and need to be used cautiously.”

In 2013, the nation recorded almost 44,000 overdose deaths. Deaths rose to 64,000 in 2016, and climbed to 72,000 in 2017, according to health experts.

Dr. Jim Shames, Jackson County’s health officer, said data shows a lack of availability of naloxone in Oregon communities. Making the overdose antidote available over the counter would help address that problem.

“This is a simple step that could save thousands of people a year,” he said.

For more information about naloxone, including how to recognize the signs of an overdose, see www.maxsmission.org.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

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