Nov. 30--Deena Porter's 26-year-old daughter has been addicted to pain pills and heroin for half her life, and she can't be forced into treatment.
But Porter, 54, of McConnelsville in Morgan County, at least had some peace of mind knowing they could afford a lifesaving drug that can reverse an opioid overdose.
That is until recently when, she said, the cost of the naloxone her daughter had been buying went up to almost $50.
"We're being priced out of the market, and I'm losing my mind," she said, crying uncontrollably. "If I can't keep her alive, I can't eventually get her into recovery."
Naloxone, which also is sold under the brand name Narcan, works by blocking the effect that painkillers and heroin have in the brain and reversing the slowed breathing and unconsciousness that come in an overdose. It can be given by an injection or nasal spray.
Until the late 1990s, naloxone, which has been around for more than four decades, could be bought for as little as a dollar a dose. Now the drug runs from a little less than $40 for a single generic dose to $3,800 for two auto-injectors that give people administering the drug voice instructions, according to an analysis of Ohio prices by HealthPlan Data Solutions.
The average wholesale cost of a dose of injectable naloxone has more than doubled since 2013, according to data by Truven Health Analytics. This is even as generic versions of naloxone still cost pennies in other countries.
"It's not cheap. A Narcan spray kit can easily cost $135," said Dr. Brad Lander, a psychologist and clinical director of addiction medicine at Ohio State University's Wexner Medical Center. People might need to buy multiple kits over time. And kits have a shelf life of only 18 months to 24 months before they have to be replaced.
"I don't know if the price increases are legitimate or not," Lander said. "But I know people will pay whatever they have to to save their loved ones, and I wouldn't be surprised if the drug companies are taking advantage of that."
Drug overdoses killed a record 3,050 people in Ohio last year, more than a third of them from fentanyl, a super-potent opiate often mixed with heroin.
"Ohio loses about eight people a day to this terrible epidemic, and it would be dramatically higher if not for naloxone," Ohio Attorney General Mike DeWine said.
Though naloxone can reverse an overdose from drugs laced with fentanyl and carfentanil, a sedative used on elephants and other large animals, higher or multiple doses of naloxone are often needed to revive patients because of the drugs' higher potency, DeWine said.
"Tragically, there is no sign that this epidemic is going to drop any time soon," DeWine said, which is why it is so important to make naloxone more accessible and affordable.
To that end, the state recently reached a deal with Adapt Pharm to freeze the price of its naloxone spray at $75 for two, 4-milligram doses next year to agencies serving the public interest. That's a 40 percent discount from the business' wholesale cost of $125.
Ohio also receives a rebate for Amphastar Pharmaceuticals of $6 for each naloxone syringe purchased through early March 2017 through an agreement reached almost two years ago.
The discounts apply to law enforcement; state, county and local government agencies; and Project Dawn community programs that provide naloxone kits and education to the public free of charge.
So far, the agreement has saved Ohioans nearly $392,000, DeWine said.
Ohio Gov. John Kasich signed a bill into law in February 2015 that allows pharmacists to dispense naloxone without a prescription.
Nearly 1,400 pharmacies in 84 of 88 counties offer the drug without a prescription, said Cameron McNamee, spokesman for the Ohio Board of Pharmacy. That's about two-thirds of all retail pharmacies in the state, up from less than half in August.
To make naloxone more available in all 88 counties, the most recent state budget also included $500,000 to be distributed among the county health departments in fiscal 2016 and 2017. Cuyahoga County received the largest amount ($46,669 annually), followed by Franklin ($44,789) and Hamilton ($29,724).
In 2016, 8,190 kits were distributed and 2,311 lives were saved through overdose reversals, thanks to the investment, according to Eric Wandersleben, spokesman for the Ohio Department of Mental Health and Addiction Services.
The state also set aside another $200,000 for emergency naloxone needs in 2017, he said.
Since April, the Mount Carmel Health System has distributed more than 100 naloxone kits free of charge through its mobile medical coach and at forums held throughout Franklin County to raise awareness about the growing heroin problem, said Brian Pierson, Mount Carmel's regional director of outreach population.
"If I had a child at home or someone close to me who was addicted, I can say with 100 percent certainty that I would have a kit," Pierson said.
In September, Columbus Public Health and the Columbus City Council teamed up with Equitas Health to buy naloxone for people who don't have insurance or can't afford it. The $20,000 grants will buy about 400 doses of the drug, which officials say probably won't even last a year.
"If I had a crystal ball, I would say we haven't even hit the peak of the epidemic yet," said Peggy Anderson, chief operating officer at Equitas Health. "I don't know what we'll do once those doses are gone."
To find a list of Ohio pharmacies carrying naloxone or Project Dawn sites, go to stopoverdoses.ohio.gov. Because retail prices vary greatly, people should call around before making their purchase.