California programs wait weeks to receive free Narcan
After losing her son Luke to an overdose, Sheila Scott tried to “revenge the death”, she said.
Scott founded the Lukelove Foundation and taught families how to use Narcan, a nasal spray containing naloxone that can reverse the deadly effects of opioids. If the drug had been present when her son overdosed, Scott said, things might have been different.
“It’s like creating an army,” Scott said of his workouts. Every time she hears from someone that they used Narcan to save a life, “I dance around the kitchen.”
But as the overdose crisis has deepened, demand for naloxone in California has deepened — and the pinch is being felt by community groups. Like many in California, Scott orders Narcan through a state program that provides lifesaving drugs free of charge to community groups, emergency responders, law enforcement and other eligible agencies.
Scott said his naloxone orders were processed in two weeks or less, but his last order took nine weeks to arrive in October. She had run out of Narcan from the state program at the end of August and worried about whether she would have to dip into her own personal funds.
As of this fall, the California Department of Health Care Services estimated wait times for medications averaged four to six weeks. By early October, the DHCS had received more than 2,000 requests for free naloxone this year, more than double what it had received in all of 2019.
State officials have attributed the growing demand to the rising rate of overdoses, which has increased calls for more Narcan to enter communities so it can be easily used to rescue people. The drug binds to the same receptors in the brain as opioids, reversing or blocking their effects.
Unsure of her supply of Narcan, Scott refrained from responding to further training requests. She ended up getting a donation from a company that makes Kloxxado — another nasal spray with a higher amount of naloxone — and also turned to another nonprofit, End Overdose, to get enough money. Narcan for do a training that was already planned in Thousand Oaks.
End Overdose, in turn, said it relies on donations to purchase additional doses to continue training thousands of people each month. The state limits the amount of free Narcan that can be ordered at one time, limiting each order to 2,100 units. The cap had been set at 2,400 units but was lowered in September 2021 due to growing demand, according to the Department of Health Services. Each unit contains two doses of Narcan Nasal Spray.
“What we really need right now is 4,200 units a month” in California, said Theo Krzywicki, chief executive of End Overdose. Because each order can take six weeks to arrive, End Overdose has to buy more naloxone itself each month — and that means delaying the launch of new programs and services, Krzywicki said.
If the association needs 1,000 additional boxes, “you have to pay $47,000,” he estimated. “It cuts into other areas of your program.”
More than 100,000 people die each year from drug overdoses in the United States, and about 80,000 of those deaths are opioid-related, according to the most recent data from the National Center for Health Statistics. Across the country, naloxone is increasingly seen as a crucial life-saving tool, with states passing laws to make it easier for ordinary citizens to access.
Among them, California “is one of the states at the forefront of naloxone access,” said Amy Judd Lieberman, senior counsel for the Network for Public Health Law’s Harm Reduction Legal Project. Its laws allow for the prescription and distribution of naloxone to people who are not at risk of an overdose, so that they can help others.
The California Department of Public Health has also issued a “standing order” to provide naloxone, which community groups can request to use, rather than having to turn to a health care provider. And its Department of Health Care Services has launched its project to provide the drugs free of charge to eligible groups.
The DHCS-led Naloxone Distribution Project had distributed more than 1.5 million units of naloxone by mid-October, which have been credited with reversing more than 100,000 overdoses. Harm-reduction organizations such as needle exchanges had obtained less than a third of boxes so far, but accounted for two-thirds of reported reversals, according to state figures.
“It’s a super valuable program,” Krzywicki said. “I don’t think the problem is with the program. I think they just need more support.
This budget year, the program had $52 million in funding, including state, federal and one-time funds for opioid settlement, according to the Department of Health Services. Prior to that, he had not received any money allocated in the state budget, but had received more than $100 million in federal grants since 2017, the department said.
The DHCS pointed out that the program is not California’s only source of naloxone and that the purchases have also been funded by grants and local opioid settlement funds.
Three years ago, California applicants requested more than 373,000 units of Narcan in a single year through the program, and the state sent nearly 202,000. This year, applicants had already requested more than 688,000 units by early October and had received around 530,000.
In some cases, DHCS said it had to reduce requested orders below the cap of 2,100 units to meet growing demand and ensure it does not exceed weekly program spending limits, which aim to ensure that it can always provide naloxone throughout the year.
In San Diego County, Nathan Smiddy distributes Narcan with the nonprofit organization Humanity Showers. He said his organization requested the maximum amount of Narcan allowed under the caps because “it goes as fast as you can give it.” He wants to give it freely, because “it is better to have it and not need it than to need it and not have it”.
But Smiddy said the state gave the group less Narcan than it requested, forcing it to ration supplies. He struggles with how much to give people, especially those who aren’t actively using drugs but want to have some on hand in case of an emergency. “I really have to think about it. Can they get by on less?” said Smiddy.
“It makes me feel like I’m not serving my people,” he said. “I’m always worried about ‘What if I don’t have enough?'”
In addition to growing demand for naloxone, production issues reduced available stocks early in the pandemic. Last year, Pfizer stopped production of its single-dose injectable version of naloxone, citing manufacturing issues. Pfizer had provided the discounted injectable drug to the Remedy Alliance, which links harm reduction programs across the country to affordable naloxone.
“There were other manufacturers making naloxone, but it was not available at an affordable price for harm reduction programs,” said Eliza Wheeler, co-director of Remedy Alliance. Prior to Pfizer’s shutdown, Wheeler said his organization provided between 100,000 and 200,000 doses a year to groups in California.
Pfizer has since resumed producing the injectable doses, and Remedy Alliance has also moved to begin supplying injectable naloxone to harm reduction groups through another manufacturer. But the earlier shortage had put more pressure on other sources of naloxone, like the California program.
In addition to the hundreds of thousands of units of Narcan distributed each year, the state program has also sent 37,000 doses since August of injectable naloxone, which is available to harm reduction groups with no caps. The injectable version of the drug is much cheaper — California pays $3 per vial vs. $47.50 for a two-dose Narcan kit, health services department says – and has been around longer than the nasal spray.
Wheeler said that in the early days of naloxone distribution, the main beneficiaries were people who had used the drug before and “there was very little discomfort with using an injection product.” But as the distribution of naloxone has spread to others who could step in to save a life, many are more comfortable with a nasal spray, although Wheeler argued that the injectable form is little different from other drugs. commonly injected such as insulin.
Smiddy, who does naloxone training in San Diego, said some people who use drugs prefer the injectable version because it’s less likely to put people into withdrawal abruptly. But “the laymen – they want the nasal,” he said. “It’s going to be a learning curve to involve a lot of people.”
Scott said for the bands she forms, the nasal spray needs to be on hand.
“You can’t be in the middle of this crisis and people are running out of Narcan,” she said.
Los Angeles Times