It started as an ordinary day last October when Joe Jones unexpectedly saved a life at his pharmacy in the Roebuck neighborhood of Birmingham.
A customer had just left Mills Pharmacy when she returned to let Jones know a person was unconscious on the curb outside his business. When he went outside, he found a man – his face white, lips blue – covered in sweat and not breathing. His wife was in a car by the curb, screaming at Jones that her husband might be having a heart attack.
Jones turned the man on the side and saw where he had just injected the inner part of his arm. Suspecting an overdose, Jones told his technician to call for help and ran back inside to grab Narcan, an emergency medication that blocks the effects of opioids and reverses an overdose.
“I drew up the dose in a syringe and aerated it as I ran back down the aisle,” Jones recalled. “I ran my knuckles across his breast bone very hard, and he still had no response. He was dying right in front of me, right in front of the store.”
The next part was like the famous scene from “Pulp Fiction,” when actress Uma Thurman’s character springs back to life after Vincent, played by John Travolta, drives a hypodermic needle into her heart following a drug overdose.
A dozen people stood around watching as Jones turned the man on his side again and injected a syringe of Narcan into his thigh. About 90 seconds later, the man began gasping for air all at once, just like Mia Wallace did in the 1994 cult classic.
“His respiratory rate was still very low, and he slowly came back to consciousness about a minute later exclaiming, ‘I’m fine, man! I’m fine,’ to which I replied, ‘Just relax man, I got ya,'” Jones said. “I held him until the paramedics got there, and then I went back inside while they took care of him.”
The man and his wife left soon after paramedics arrived. Jones had to sit still for a few minutes to process what had just happened.
The experience was harrowing for Jones, who had only been carrying Narcan – also known as naloxone – for a month when the dying man appeared outside his door last fall. Having just lost two longtime customers to heroin overdose, Jones thought it would be responsible to carry the lifesaving medication for friends and family members of addicts to purchase.
He never anticipated having to administer it to anyone himself.
“The stars aligned and it was just kind of a magical experience, like somebody up above sent him to my front door,” he said.
Alabama Department of Public Health State Pharmacy Director Nancy Bishop said all Alabama pharmacies now have access to a standing order to dispense naloxone without a prescription. The law expanding access to naloxone was enacted in 2016 to prevent opioid deaths throughout the state.
Although the health department does not track overdose reversal incidents in Alabama, Bishop said the standing order increases the possibility of getting naloxone to individuals who need it.
“It is important that the public become aware of the opioid epidemic and what can be done to save the lives of those who are addicted to opioids, including heroin and street fentanyl,” she said. “Increasing awareness of how naloxone can be used to save lives and that access is available through pharmacies is an essential part of educating the public.”
Opioids were involved in 33,091 deaths nationwide in 2015, and opioid overdoses have quadrupled since 1999. Alabama was among the top five states reporting opioid overdose death increases from 2014 to 2015.
AL.com reports more than 730 Alabama residents died in 2015 from drug overdoses, some caused by heroin, painkillers and other opioids. About 5.8 million prescriptions were written for opioids by Alabama physicians the same year.
Naloxone, approved by the Food and Drug Administration (FDA) to prevent overdose by opioids, may be administered through injection or by nasal spray, allowing the person to regain consciousness and breathe normally. The medication has no potential for abuse and poses no danger to individuals who encounter it.
Patty Sykstus, president of Not One More Alabama – an organization that supports families whose lives have been affected by addiction, said Narcan is a regular topic of conversation among NOMA board members.
Although the medication saves lives, Sykstus said it’s not without its faults.
“One of the issues is availability and accessibility and knowledge of what it is and how to get it,” she said. “I talk to a lot of people who have family members that have addiction issues with opiates and they do not carry around Narcan with them. In the South, we tend to be a little slower in getting on board with this.”
Sykstus said there are active campaigns in the U.S. to deliver “overdose kits” with naloxone in the form of nasal spray. In Alabama, it’s a little more challenging to find Narcan, despite the standing order allowing pharmacies to administer it without a doctor’s order.
Some pharmacies don’t stock the medication because it can be expensive. Sykstus said Narcan can also be unaffordable at the consumer level, ranging from $20 to $4,000 for a single dose.
Without a coupon or other mechanism to bring the price of Narcan down, some consumers may walk away without the lifesaving medication.
“We have a lot of work to do in the state of Alabama with making Narcan more accessible, more available to people,” she said.
Mills Pharmacy sells naloxone in vials for $49 for two doses at all nine stores in the Birmingham area. Propst Discount Drugs, another locally-owned pharmacy in Huntsville, also carries the medicine, but the price varies.
Mike Oddo, pharmacist at Propst, said they’ve seen a surge in the use of Evzio, the first and only naloxone auto-
Propst has been working with physicians in the Huntsville area to ensure patients who are on opioid management therapies receive naloxone devices.
“We do have some people who have dependency issues for whatever reason, and they are being encouraged by their physicians to get the Evzio or the Narcan,” Oddo said. “Pretty much everybody who is getting it is not just your average ‘addict.’ It’s somebody who is seeing a doctor under pain management.”
Although the medication is more widely available to patients and their loved ones, Oddo said there is still a stigma attached to naloxone.
The vast majority of Propst’s patients who use naloxone became dependent on opiates after a car accident, being diagnosed with cancer or some other experience out of their control.
“It’s not intentional; it’s an unfortunate side effect of whatever incident is happening in their life,” he said. “We keep an open mind. They need the help. It is a problem with people abusing (opioids), yes, but you can’t really assume first that people are abusing it when they have prescriptions.”
Jones agrees, saying he sees opioid users as young as 16 or 17 and as old as their late 60s. He called it a “shotgun effect,” because addiction doesn’t affect only a select few.
The government and pharmaceutical industry need to do a better job of providing support for patients and families dealing with addiction, he said.
“It’s a true disease,” Jones said. “It’s not anything that has favorites and there’s nobody out there that’s immune to the effects of it.”