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New Maryland law allows for blanket prescription for heroin overdose drug

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An internasal atomizer of Naloxone.

Thousands of people have been trained to use a drug that prevents heroin overdoses, but many have faced a hurdle to obtaining naloxone — a doctor's prescription.

Under a Maryland law that takes effect Thursday, doctors at local health departments around the state can write a blanket prescription that covers anyone who is trained on how to administer the drug, also known as Narcan. They simply need to present a card at the pharmacy showing they had been taught by a state-certified trainer.


Baltimore Health Commissioner Dr. Leana Wen lauded the law Wednesday as a way to more widely distribute the lifesaving drug and curb the number of overdose deaths. Last year, 303 people in Baltimore died from overdoses, and most had taken opioids. Statewide, 578 deaths were attributed to heroin last year, compared with 464 the previous year.

"Until now policy has tied our hands," Wen said. "People should not have to go to a doctor and justify why they need the ability to save a loved one or a friend. Nobody has to go to a doctor to explain why they need to use a defibrillator if somebody's heart has stopped beating and they need to save them in that moment. So why should we treat overdose any differently from something else that is killing our citizens?"


Wen, trained as an emergency room physician, planned to issue a "standing order" Thursday, to become the first jurisdiction in the state to take advantage of the new law.

About 4,000 Baltimore residents have received training this year to administer Narcan, which blocks the effects of opioids and stops respiratory depression during an overdose.

State lawmakers passed legislation in 2013 allowing nonmedical personnel to be trained to administer the drug and receive a prescription for it, and then last year approved the measure allowing for blanket prescriptions.

Also under the new law, doctors don't need to be present at training sessions in the use of Narcan. The chief medical director for Health Care for the Homeless said that will enable the nonprofit to have training sessions in the streets and shelters — where their clients live — rather than at its downtown headquarters.

Naloxone "really puts power in people's hands to save those around them," said Dr. Nilesh Kalyanaraman. "It allows the community to take care of themselves. And with the standing order it makes it that much easier."

While the new laws remove some barriers, Wen said cost remains an obstacle. The price of naloxone has skyrocketed just as cities like Baltimore have made it a key component of their drug prevention strategy.

Rep. Elijah E. Cummings, a Baltimore Democrat, along with Sen. Bernie Sanders of Vermont, who is seeking the Democratic presidential nomination, recently urged cities and states to push drug companies to charge less for the drug.

Officials in New York and Ohio have reached agreements with California-based Amphastar Pharmaceuticals to allow public agencies to purchase naloxone at a lower price. Maryland made a similar request, and negotiations are continuing.


Richmond-based pharmaceutical company Kaleo also has given injector kits with naloxone to the Baltimore and state health departments, which has offset costs.

But Wen said prices still are too high. The city paid about $20 a dose for the drug in February, and that price jumped to $40 by July. Officials expect another price increase this week, Wen said.

"This very much hurts our ability to hand out or to be able to distribute this life-saving medication," Wen said.

Baltimore residents on Medicaid in the city pay $1 for a dose of naloxone, and the city health department distributes the drug to the most vulnerable populations.

Drug companies have declined to talk specifically about their pricing strategies, but some said manufacturing costs have risen.

Policymakers are trying to encourage both addicts and friends and family members of drug users to have naloxone on hand.


Local pharmacists said they regularly see people who could benefit from the drug, but they can't help them immediately without a prescription.

"This allows your pharmacies who support your communities to have a tremendous impact," said Steve Wienner, a pharmacist and owner of Mount Vernon Pharmacy in Baltimore.

A representative with Walgreens — which has 21 pharmacies in the Baltimore metro area and 73 statewide — also praised the new law.

"Working together we can help combat the growing problem and trend of opiate overdoses by creating better access to naloxone," said Steve Bouyoukas, the health care supervisor for Walgreens' retail and pharmacy operations in the Baltimore region.

Mayor Stephanie Rawlings-Blake has declared heroin use a public health emergency. The city became the first jurisdiction in the state this summer to begin giving naloxone in drug treatment court.

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But some health care workers warn about an over-reliance on naloxone.


Mike Gimbel, a former drug user who served as director of Baltimore County's substance abuse office, called Narcan an "amazing drug," but said that without immediate drug treatment many addicts will use again. He believes that Narcan should only be used by paramedics and police who ensure that an addict is hospitalized or gets treatment.

"We are giving the public a false sense that Narcan will solve our heroin epidemic, and it won't," Gimbel said. "We have tens of thousands of heroin addicts in Maryland who are spreading diseases and committing crimes every day, and most of them will not overdose. We need to have more long-term treatment for all addicts."

Wen also agrees that treatment is part of the solution but emphasized the need to address overdose deaths.

"Naloxone has already prevented hundreds of deaths across Baltimore," Wen said. "If we don't save lives today, there is no chance for a better tomorrow."