CINCINNATI — Even though it's now legal for heroin addicts and their families to buy Naloxone in Ohio without a prescription, many customers are hard-pressed to find pharmacies equipped to sell it. But there are signs that could change soon.
“I probably talk to two families a month that haven’t been able to find it, or they call me and tell me that they had to go to seven different pharmacies before they finally found it,” said Libby Harrison, who offers help to heroin addicts at the Cincinnati Exchange Project.
The life-saving drug, also called Narcan, can reverse an opiate drug overdose by helping an addict breathe again. It’s usually given as a nasal spay and costs between $80 to $100 for a standard dose, experts said.
Only 25 of the 2,132 retail pharmacies in Ohio sell the the antidote over the counter, according to an Ohio Board of Pharmacy list, which includes eight participating pharmacies in Southwest Ohio. National pharmacy chains, like Walgreens, Kroger and CVS, do not sell Naloxone over the counter in Ohio at this time, but a local doctor is working to change that.
“You can’t treat people that are dead. (Naloxone) is the most efficient use of funds currently available to keep people alive while we’re trying to build the capacity to treatment,” said Dr. Shawn Ryan, who has spent months working with some of the county's largest pharmacies to make Narcan widely available in Ohio as a state law intended. “(Twenty-five pharmacies) is not nearly enough.”
It’s been seven months since Gov. John Kasich signed House Bill 4, the law that expanded access to the drug by allowing heroin addicts and people who know them to buy it without a prescription. The law’s passage was a major win for those fighting to end the state’s heroin crisis, but its also brought on more responsibility and red tape for pharmacies deciding to sell it as an over-the-counter drug.
“This is kind of a new method of providing drugs,” said Cameron McNamee, director of policy and communications at the Ohio State Board of Pharmacy.
Most Ohio pharmacies haven’t met the Ohio Board of Pharmacy standards required to opt in. Some pharmacists don’t yet realize that the law allows them to sell the drug without a prescription, experts said. Others are fearful that handing out Naloxone will enable an addict to keep using.
“Some pharmacists were really glad they could do this, that they would have this opportunity to save people’s lives. Some were skeptical that they would be able to put this into practice,” said Ann Barnum, who manages the community strategies team at Interact for Health. “Some pharmacists know a lot about what’s going on with the (heroin) epidemic and some don’t understand the disease of addiction."
“It’s a shame that we didn’t have this ready to go when we passed the law,” Barnum added.
Why More Pharmacies Don't Sell It
Even though House Bill 4 was designed to expand access to Naloxone, it doesn't force pharmacies to offer the drug without a prescription. It just gives them the option.
But before a pharmacy can sell the antidote over the counter, pharmacy leaders must create specific protocol and training instructions for pharmacists handing out the drug, and then a doctor must sign off on that protocol.
Pharmacists must receive training so they can train the customers seeking Naloxone. Before a person can take a dose home, the pharmacist must teach a 15-minute lesson about recognizing an opiate overdose, calling 911 and using the drug on another person.
“You don’t just give it folks and say ‘Just go out and use it,’" Barnum said. “If you give someone a dose and they’re still not reviving, you still need to know what to do. You have to know to do CPR, to do rescue breathing.”
That compliance process can take a lot of time — especially for the pharmacy chains that have hundreds of properties and people to train across the state.
“When they passed (House Bill 4) last summer, it’s like, ‘Oh great. Everything is fixed.' There’s a lot more to it," Ryan said. "It’s never been done before. Not only is it the size of their organizations and there’s no way for them to move that quickly, but this is a relatively new legislative change and allowance by the State Board of Pharmacy."
That’s one reason why it’s the small and independent pharmacies that have jumped on board first, McNamee said.
“There are obviously fewer hoops to jump through and fewer policies,” he said. "I'm actually pretty pleased with the number of places that have stepped up and started offering it.”
Ryan, who heads an outpatient addiction recovery center, has signed off on the protocols for two of the major pharmacy chains. He’s on track to sign off on a third this year, he said. That means Ohioans are one step closer to having more options to purchase the drug.
“For a family member to make a decision to go into a place and ask for help at a critical time is pretty tough, so it’s disheartening that they would go to a place looking for help and find that doesn’t exist,” Ryan said.
“I think by the end of 2016, we’ll have a pretty wide distribution and utilization of House Bill 4’s intended program,” he added.
'You Can't Get Anyone Into Treatment If They're In A Coffin'
Just like communities are divided over needle exchange programs that swap dirty syringes for clean ones, widening access to Narcan makes some people uneasy.
“People have said you’re enabling a person because you’re creating a safety net,” said Judi Moseley, a public health consultant at the Ohio Department of Health.
Moseley said that’s not true because people are more likely to seek treatment after they’ve experienced an overdose.
“Experiencing an overdose is a very unpleasant experience. From what addicted people who have gone through an overdose have said, you’re very sick, you may vomit and it’s a very traumatic, stressful unpleasant experience. They’re not likely to want to repeat that experience,” she said.
Ryan said Narcan is not the answer to ending the heroin crisis, but it’s a step toward it.
“It’s a part of the puzzle. It’s part of the process. You can’t get anyone into treatment if they’re in a coffin. Nobody is that good,” said Ryan.
If you can’t find Naloxone over the counter at one of these Ohio pharmacies, you’re not completely out of luck. Many pharmacies, including some of the major chains in Ohio and Kentucky, sell the antidote with a doctor’s prescription.
Also, local health departments, treatment programs and some hospitals have a Naloxone supply to give out free of charge at one of these Ohio locations through Project Dawn, which stands for Deaths Avoided with Naloxone.