Frederick police Officer Kristen Kowalsky still remembers the first time she used an opioid overdose reversal drug to revive a man who had lost consciousness after shooting up heroin.
The man’s friend called 911 after watching the man inject himself in Baker Park one night last year, Kowalsky said. By the time she arrived, the man was slumped over in a portable bathroom, a hypodermic needle lying next to him on the floor, Kowalsky said. As Kowalsky opened her nasal spray kit of naloxone, marketed as Narcan, she noticed that the man had turned blue.
“It’s amazing how quickly it reacts to a person, within a couple seconds, this guy who was turning blue and well on his way to becoming completely unresponsive, was conscious and talking with us,” she said. “He opened his eyes, his color came back and then, within a couple of minutes, he was talking to us.”
Frederick officers and county sheriff’s deputies made a combined 29 naloxone saves in 2015. In the first six months of 2016 alone, naloxone saves already are at 32 for both agencies, according to records. That pace, if it holds, would be more than double the rate of last year.
Since 2014, Maryland State Troopers have administered naloxone 56 times statewide.
“In the very beginning, when we first got this stuff, we were doing life-saving awards for it,” said Capt. Michael Fluharty, commander of the Maryland State Police’s western region. “Now? It’s just kind of passé. Everybody’s like, ‘Okay, you saved someone with Narcan? Good for you. Welcome to the club.’”
In addition to law enforcement agencies, emergency medical technicians and paramedics with the Frederick County Division of Fire and Rescue Service have administered naloxone 204 times from Jan. 1 through Thursday, said Michael Cole, the battalion chief overseeing emergency medical services.
The effectiveness of naloxone is so staggering that some first responders and health officials are beginning to worry. Now that almost every patrol officer and all emergency medical teams carry some version of the drug, addicts could begin to see it as a safety net for their continued abuse of opioids.
But, as miraculous as naloxone may appear to be, 14 people have died from heroin overdoses so far this year, putting the county on course to surpass the 19 fatalities recorded all of last year. The most fatal heroin overdoses recorded in a single year in Frederick County was 32 in 2014, according to sheriff’s office’s data.
“There were two incidents this year in the city where we used Narcan but they didn’t survive,” said Lt. Dennis Dudley, who oversees the training of officers in naloxone and the distribution of kits to Frederick police officers. “Narcan’s not magic, you have to get it to them in time.”
In terms of heroin overdoses, both fatal and nonfatal, there have already been 153 in the first six months of 2016. By comparison, law enforcement agencies responded to 135 overdoses in the entirety of last year.
Perhaps as startling as the increase in naloxone saves recorded by first responders has been the concurrent increase in price per dose of the life-saving drug.
When the Frederick Police Department began training officers and equipping them with Narcan, the department was paying about $22 per dose, Dudley said. The price as of June was approximately $44 a dose, the lieutenant said.
The department paid for its last batch of the drug using funds from a federal High Intensity Drug Trafficking Area (HIDTA) grant, but the money has since been exhausted.
Dudley was eyeing leftover funds from the department’s last fiscal year — which ended Thursday — to purchase more, but other divisions in the department were also vying for the use of such funds; for example, the money was also being considered to buy new vehicles, he said.
“We’ll look for grants but if we have to, we’ll just budget for it,” Dudley said of future Narcan purchases. “In the next budget cycle I’ll be submitting a budget line item to purchase it.”
The sheriff’s office was a little better off, said Maj. Tim Clarke, who oversees that agency’s training and distribution of naloxone kits. The sheriff’s office recently bought 60 new doses and funds still remain in the agency’s Drug Unit Partnership with Homeland Security Investigations, as well as its own HIDTA fund.
“The problem with that is Narcan has a shelf life and rather than [have] it waste on a shelf, we purchase as needed now to restock our deputies, giving us a dose with the longest shelf life,” Clarke said. “We have a large purchase to make in February of 2017 and may use HIDTA funds if they are available.”
Still the price hike is taking its toll on agencies that have come to rely on the drug, according to Cole. The division of fire and rescue services currently purchases naloxone kits through the Frederick Memorial Hospital, but prices have tripled in the past four years, Cole said.
“Our current price for one vial costs about $30, so for me to buy 10 vials of Narcan, it costs me $308,” the EMS chief said. “We burn through a ton of money when it comes to Narcan for a year. It’s definitely an issue. You’re talking just over $6,000 in just six months [this year].”
Nonprofits like the Maryland State Medical Society — MedChi — are calling for studies by the Maryland Health Care Commission into the pricing of such drugs, said Gene M. Ransom III, MedChi’s chief executive officer.
In spite of this, the real issue often arises when first responders purchase doses through distributors, said Thom Duddy, a spokesman for Adapt Pharma, a company that manufactures NARCAN nasal spray kits.
Adapt Pharma launched its NARCAN brand in 2015 at a price for first responders of $75 for a kit that contains two doses, Duddy said. Non-first responders pay more, $125 per kit, but the company’s launch prices haven’t increased, Duddy said.
“A lot of times [first responders] don’t buy it direct, they buy it through a special distributor who is probably marking up the price,” Duddy said. “That’s why we sell direct, or, when we do sell through distributors, we control the price.”