Does Profit Trump Lives?

As a Behavior Analyst, I always told my supervisees not to listen to what people said, but to watch what they did. I find myself amazed about what is being done, or not being done, about the steep rise in the price of Naloxone since the beginning of the year.

Estimates are that there is one Opioid-related death every half-hour [in the United States]. The World Health Organization says that increasing the availability of Naloxone could prevent more than 20,000 deaths in the United States annually. Naloxone is a "lifesaving antidote" to opioid overdoses and increasingly, first responders, including the police, are carrying Naloxone kits and are being trained to administer it to people who, without it, would die of a overdose. "Everyone" agrees that this is an important measure in the State's fight against the growing opioid addiction problem, which includes the surprising and troubling rise of heroin addiction and overdose deaths. But guess what! What appears to be an excellent solution to a pressing problem is being hampered by a sharp increase in the cost of the life-saving drug.

The Baltimore Business Journal (1/30/15) reported that the cost of Naloxone doubled in the past year. The cost of a kit needed to administer the medication rose 111%, from $19.56 to $41.95 in a six-month period, meaning that the grant monies used to purchase the kits, which would have purchased 3,600 kits, can now only purchase 2,000. 

According to Dr. Leana Wen, Baltimore's Health Commissioner, cited in July, 2015, since the spring, the price of a 10-dose kit needed to administer the medication, went from $97 to $370.

If the price of a life-saving medication is allowed to rise with market forces, ought we to enquire whether we think profit trumps lives? Should we be writing our legislators, urging them to increase the grant funding for this medication? Would that reinforce the price rise by giving in to Big Pharma’s demands for more money?

It’s easy to say it’s all greed, and that is certainly something that can be hypothesized. The easily-administered nasal spray dose that is being used to train non-EMTs uses a much higher dose of the Naloxone than the injectable dose. Nasal Naloxone from the one company that makes it, uses 1-mg/ml in each dose, compared to 0.4/ml for the injectable dose (MedPage Today, The Gupta Guide, Psychiatry, 11/26/14).  However, I do have difficulty understanding how an increase of 0.6 mg of a generic drug that has been around for many years can account for a doubling of the price of the medication depending on the delivery system. There are issues with the drug in its injectable form, mostly having to do with the delivery system. Because of issues with needles, blood transfer with patients who may have HIV/AIDS, and liability, the relatively risk-free nasal delivery is preferred.

The nasal form of the drug and its delivery system are made by one company; when one source controls the market, prices tend to rise. Recently, a self-injectable form of the medication was given the go-ahead by the FDA. Evzio works much like an EpiPen used by allergy sufferers.  The delivery system appears quite complex and the prices on-line, even with a “manufacturer’s coupon” range from $594.85 to $636.41 for a two-dose pack.

If this is a “commodity” needed to save lives, oughtn’t there be some regulation? People may not be too excited about saving the lives of heroin addicts (“after all, they brought it on themselves”), but this could be your grandmother, who took an overdose of pain medication because she didn’t remember when she took her last dose. It could be the new-born, to whom it was administered to counteract the effects of narcotic pain medication given to the mother during labor. If we say that this is important, ought we not to ensure that it is available in quantities necessary to save more than 20,000 lives in the United States every year?