Grant will pay for emergency opioid treatment in Alabama — but then what?

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First responders around the state will get a naloxone auto-injector aimed at stopping opioid overdoses under a grant announced Wednesday.

But after the three-year grant from drugmaker Kaleo runs out, it’s not clear how rescue squads will be able to acquire Evzio. The drugmaker, which says it distributes the injector free to first responders, has drawn attention for Evzio’s soaring prices, which at one point last year reached $4,500 per kit.

“What we’re doing three to four years from now, I can’t tell you that,” said Gerald Dial, a retiring state senator seeking the Republican nomination for Agriculture and Industries Commissioner at a news conference Wednesday. “We want to address that immediate problem of that individual. We want to save a life.”

The news conference — which had more than a few elements of a campaign appearance for Dial — focused on the opioid crisis, which state officials to this point have not developed a long-term plan to tackle.

In 2016, there were 1.2 opioid prescriptions for every man, woman and child in the state of Alabama. A report from the Alabama Opioid and Addiction Council delivered at the end of December noted Alabama’s data on opioid use and abuse is, at best, incomplete and recommended expanding access to state databases to allow researchers to better grasp the problem.

The council’s report also recommended better access to naloxone, particularly for first responders, though as with other recommendations in the report it identified a goal without spelling out specific steps on reaching it. Naloxone, first approved for use in opioid overdoses in 1971, can reverse the effects of an overdose and restore breathing.

Evzio, which hit the market in 2014, is a credit-card sized auto-injector that uses visual and audio cues to help the person administering the naloxone. Mark Herzog, the vice president of corporate communications for Kaleo Inc., which manufactures Evzio, said at the news conference Wednesday it has given out 300,000 auto-injectors to first responders since 2014. “It’s not a substitute for emergency medical care,” Herzog said. “The whole idea is something to keep someone breathing, dial 911 and then have the emergency responders come.”

Dial said the $12 million, three-year grant will put the devices in 872 rescue vehicles around the state. Emergency responders will also receive training on how to administer Evzio.

But after the grant runs out, it’s not clear how the state will maintain or renew its supply. Dial stressed most rescue squads suffer from lack of funding. The website goodrx.com Wednesday quoted prices for individual Evzio kits ranging from about $3,700 to $4,100 a dose on Wednesday. Narcan, which delivers naloxone via nasal spray, costs $132 to $141 per prescription.

Herzog said Wednesday that the listed price for Evzio was “not at all accurate” for first responders. He said the company provides it free to those agencies, or at a discounted rate of $360 per carton for first responders that must pay for the drug. (Adapt, which manufactures Narcan, also provides a discount to first responders.) Herzog says there was “no expectation” that the grant to Alabama would be a one-time donation by the company, though he stopped short of making a commitment to renew it.

Spencer Williamson, the CEO of Kaleo, was quoted in a Wired report last year saying the price increases would “support our enhance patient access program and . . . ensure that as many patients as possible have access to Evzio for $0.”

Naloxone prices have risen as the opioid crisis has worsened and demand for the drug has increased. The jump in prices drew the attention of members of the U.S. Senate last year, including Sen. Claire McCaskill, D-Mo., asked Kaleo and other companies for information on the price increases in letters sent last August.

“The rise in costs associated with acquiring naloxone has caused significant accessibility issues for those on the front lines of this epidemic,” McCaskill wrote. “Law enforcement departments in states without sufficient community resources, for example, could potentially pay between $22 and $60 per naloxone kit, depending on the specific form of naloxone used.”

In an attempt to bring naloxone prices down, some advocates have pushed to make the drug available over the counter or require opioid prescriptions to include naloxone.

The Alabama Opioid and Addiction Council’s recommended the state develop co-prescribing guidelines for “high-risk patients,” though it did not mention making naloxone available over the counter. Dial received praise from several speakers in attendance, one of whom presented him with an award at the end of his talk, giving the conference the feel of a campaign stop. The agriculture commissioner candidate stressed throughout the news conference he was looking for something that could ease the epidemic immediately.

“This is that immediate response to that individual out there today who overdoses, and we save a life,” he said.

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