Patients departing Seabrook House after treatment for opioid dependence are now being armed with some new tools for recovery: two doses of the overdose reversal drug naloxone, and instructions for a loved one on the signs of—and necessary responses to—an overdose. Having the drug dispensed directly from Seabrook's in-house pharmacy, rather than via a prescription written in the community, helps to ensure that the medication will get into the hands of those who eventually might benefit from it in a life-or-death situation, says the medical director of the New Jersey addiction treatment facility.
“If the drug was dispensed from another pharmacy, even with no copay, my estimate is only 30% of the prescriptions would ever be filled,” says Joseph Ranieri, DO, FASAM.
The maker of the Evzio naloxone auto-injector has been largely responsible for allowing Seabrook House's effort to launch; Seabrook began distributing naloxone kits to departing patients last month. The pharmaceutical company, Kaléo Pharma, has offered a savings program to commercially insured and cash-paying patients, with some insurance patients eligible to receive naloxone with no copayment. That makes a big difference in whether a patient ultimately will obtain the drug, says Ranieri.
“Any little amount that someone has to pay for, they often won't get it filled,” he says. The intranasal formulation of naloxone does not have a similar zero-copay arrangement, he adds.
Only Seabrook patients with a history of opioid addiction are receiving the doses of naloxone. State law requires Seabrook also to distribute to these patients information on essential steps for a first responder, such as a loved one, in: calling for help, checking for signs of an overdose, supporting the individual's breathing, administering naloxone, and monitoring the person's response.
“What good is it if you give it to the patient and it ends up in their sock drawer?” says Ranieri.
Loved ones of the patient are also receiving training injectors that they can use to practice on without actually administering the drug.
Can't treat a fatality
Ranieri says he's heard all the arguments that to some degree reflect skepticism about naloxone: that it's not treatment, that it needs to be coupled with mandated treatment and recovery programming, and so forth. While he says they all have merit, he does not hesitate to suggest that the drug should be accessible under all circumstances to anyone at risk of overdose, including someone who has just successfully completed a treatment stay.
“This is a disease so severe that it will always have patients on that range of despair,” Ranieri says. The time when a person has to be saved with use of naloxone “may be their time for recovery,” he says.
“I can't help anybody if they're six feet under,” he adds.