Ontario County emergency response agencies talk about importance of naloxone and their concerns over rising costs.
If it wasn’t for naloxone, chances are Evan Wagner wouldn’t be alive today.
During the height of his addiction to heroin, the 31-year-old Newark resident said his habit at times demanded up to $200 a day to support.
“It’s an incredibly difficult lifestyle to keep up with,” Wagner said.
And the bleak life he took on because of his dependency wasn’t the life he envisioned for himself.
When he was younger, Wagner recalls imagining an addict as a vagrant covered in dirt, begging for change on a street corner. As heroin dug deeper into his life, Wagner said he wasn’t too far from becoming what his child-like mind pictured an addict to be.
These days, however, life is different for Wagner. For the last 15 months he’s been drug free and involved in a supported-living program. At the end of the month, he will be successfully discharged, and he plans to go back to school and get on top of a career.
Wagner battled to reach the point where he is today, which aside from his thirst for recovery, was brought on by being handed another chance at life.
That chance came in early 2015, when Wagner had his first experience with naloxone. Naloxone, also sold under the brand name Narcan, is an opioid antagonist that reverses an opioid overdose.
Wagner pointed out that living the life of an addict, he ran into many other addicts who owed their lives to the medication.
Naloxone is being used more than ever because the number of opioid-related overdoses is escalating nationwide.
Drug overdoses hit the highest number on record in 2014, with 47,000 deaths reported, mostly due to opioid pain relievers and heroin, according to The Centers for Disease Control.
The cataclysmic number of deaths has reached the political stage, as Congress passed legislation that includes $1 billion in prevention and treatment for what has been deemed a national epidemic. This funding has helped provide many emergency response agencies nationwide with the lifesaving drug.
But as the demand for the overdose antidote spikes, so does its cost — and the concern of having it readily available to the public.
Wagner has used some form of drug or alcohol since he was in his early teens. As he reached the end of his high school days, he tried opiate-based pills and even had one experience with heroin.
“For a few more years, my drug use was steady but at the same time, my opiate use was not consistent,” Wagner recalled. “It was more about using whatever drug I could get my hands on.”
As his pill habit became harder to keep up with due to a growing dependency, he eventually began injecting heroin, as it was cheaper and more readily available.
Physical withdrawal, the sickness that comes with the physical dependency associated with chronic use, became a regular experience for Wagner. He said that when he did end up sleeping, he’d wake up sick.
“Then the day starts all over again,” Wagner said. “It’s a terrible and vicious cycle and that cycle starts a few hours after the last time you get high, so it’s never enough. You’re always trying to figure out the next way you’re going to get money and how you’re going to get high.”
Wagner funded his addiction by borrowing money from people — manipulating them into getting them to lend him funds with no intention to pay them back. He stole, shoplifted and resorted to "selling any item that wasn’t bolted down," he said.
In early 2015, he was using heroin at a person's house and the next thing he remembers is coming to in an ambulance. He later learned that naloxone — typically administered through an injection or a nasal spray that block the receptors in the brain used by the opiate — had brought him back from an overdose.
“I remember being strapped down, and being angry and confused,” Wagner said. “I was not really understanding what was going on.”
Over the next five months, he had two more experiences with naloxone. The final time, he again came to in an ambulance, and it ended with him being charged with a violation of probation.
“Since then, I was in jail for a few months and then I went through Cayuga Addiction Recovery Services or CARS and completed that program successfully," he said.
When Wagner was freed from his time behind bars, he moved to Wayne County and became involved with the Finger Lakes Addiction Counseling and Referral Agency, also known as FLACRA.
Wagner has been clean since his arrest in August 2015. He is working and considering a career in social work, or even applying what he learned during the dark stage of his life to a career in chemical dependency counseling.
“I understand that there are mixed feelings on naloxone in general from the public," Wagner said. "Some people feel that, ‘Well, if you make the choice to put heroin in your body, and poison yourself, then you deserve to die.’ It seems to me that’s a little harsh. The people who say things like that are people whose lives have not been affected by addiction.”
Brought to the table
Naloxone has become a regular tool for law enforcement and other emergency response agencies and hospitals across the U.S. The medication has also become available in pharmacies across the state without a prescription.
Naloxone’s presence in Ontario County is rampant, and the numbers explain why.
According to Sheriff Phil Povero, in 2015, eight deaths were associated with drug overdoses. So far in 2016, that total has more than tripled, with 27 deaths being reported to date.
“The heroin issue remains a significant public safety and public health concern,” Povero said.
According to Povero, three lives a week are being saved on average through the use of naloxone in Ontario County of late.
The sheriff said that, within his department alone, it has been deployed 13 times this year, with the majority of those situations resulting in a life saved.
Geneva Police Lt. Eric Heieck said naloxone has been used at an alarming rate in the community, including being deployed successfully nine times over a recent seven-day period.
“Every dose used by a GPD member has saved a life of an opioid overdose victim, sometimes more than once,” Heieck said.
Ben Cramer, the emergency medical services coordinator for the Canandaigua Fire Department, said first responders with the department have used the drug 12 times since it has been put into practice in May 2015. That includes its deployment by department personnel three times during a recent three-week period.
The Canandaigua Police Department began using naloxone in early 2015 and the frequency of use has gone up drastically, according to Chief Stephen Hedworth.
So far in 2016, Hedworth pointed out that officers have revived seven people experiencing an overdose, twice in early November. The antidote was employed only once in 2015.
“If you watch the news or read the papers, everyone is struggling with it,” Hedworth said. “It’s a terrible situation that we’re trying to get under control.”
According to Canandaigua Emergency Squad Chief Ken Beers, unlike the local law enforcement departments and smaller emergency response agencies across the county, his department has been carrying naloxone for many years.
The department purchases it directly from one of its vendors and its cost is included in the squad’s annual supply budget.
“With the more widespread use, particularly with law enforcement carrying it, there have been times that it has been on backorder,” Beers said. “To compensate for this, we have increased our stock.”
Also, the street practice of mixing heroin with other potent drugs has created issues with naloxone’s effectiveness.
“For years, heroin was largely cut with inert material and had no impact on the effect of administering naloxone,” Beers said. “What we see today is heroin being cut with other medications such as fentanyl, a strong narcotic, and it is taking several doses of naloxone to counter the effects of an overdose.”
Spike in cost
One dose of naloxone costs the Canandaigua Emergency Squad $37.50. It is taking two and sometimes as much as three doses of the antidote to counter an overdose on some patients, according to Beers.
With an average of one patient per week at two and a half doses, the estimated budget for naloxone in 2017 is expected to be $4,875.
Five years ago, Beers pointed out that you could buy a multiple-dose vial of naloxone for around $25. That cost today has increased nearly 600 percent, with a multiple-dose vial costing now around $148, Beers said.
Also adding to the concern associated with the cost is the fact that naloxone has an expiration date.
“We are concerned on how we can continue to provide this lifesaving medication without having had an increase in Medicare or Medicaid reimbursement in many years,” Beers said. “The last increase in Medicaid reimbursement for ambulance service in Ontario County was more than 15 years ago.”
Povero pointed out that the Sheriff's Office, which has 130 doses on hand, receives naloxone through the Ontario County Public Health Department. The funding is made available through a state grant. He doesn’t anticipate that funding to end, though there are concerns regarding the increase in cost for the medication.
The Sheriff's Office currently has a backup plan to reach out to a vendor to purchase naloxone at a price just short of $100 a dose, if in fact state funding becomes unavailable.
Meanwhile, Hedworth pointed out that his department recently received a shipment to replace expiring naloxone kits. It’s the second shipment the city has received since the program began.
According to Hedworth, it costs $1,500 to equip all the road patrol and special services within the department with naloxone — a cost that also is covered through state funding.
“As long as I’m chief of police, I will always push for it even if there was no funding available to pay for this drug,” Hedworth added. “The money is never going to be an issue. The value of a human life is of the utmost importance."
Nobody is born an addict — it’s a process in a person’s growth and development, Hedworth stressed, adding that his "heart goes out to those who are addicts."
“How did this person get to this point in their life?” he said. “That’s what it boils down to — we are dealing with the results. If we are really going to get out in front of this, we have to address where the problem starts. That comes through education, awareness and intervention services. It’s going to take a mass effort from the entire community.”