With thousands of Americans dying each year due to opioid overdoses, health professionals and a Colorado Congresswoman are working to change federal law so that more hospitals are reimbursed for giving people an antidote — naloxone.
Naloxone, commonly referred to as Narcan, is a medicine that reverses an opioid overdose, according to the National Institute on Drug Abuse.
It is the most powerful tool to prevent opioid overdose deaths, said Don Stader, an emergency and addiction medicine physician at Swedish Medical Center in Englewood and the executive director of The Naloxone Project.
For too long, many people struggling with addiction have had to go to a pharmacy to get naloxone, he said.
“We have a miraculous drug that should be in everyone’s hands,” Stader said. “But what we’ve done for too long is we’ve said, ‘Let’s hide it in a place further away.’”
Only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions, according to the CDC.
Stader said less than 2% of people fill a prescription for naloxone after an overdose.
Hoping to increase access to naloxone, Democratic Rep. Brittany Pettersen, of Colorado’s District 7, introduced the Hospitals As Naloxone Distribution Sites (HANDS) Act on National Overdose Awareness Day, which was Aug. 31.
The bill aims to require Medicare, Medicaid and TRICARE to cover hospital providers physically handing naloxone to patients upon discharge if they are identified as at-risk of an opioid overdose.
“We’re taking this work at the national level to make sure that, across the country, that people who are the most vulnerable for an overdose actually have this life-saving medication,” Pettersen said.
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Bringing Colorado’s work to a national level
Stader has been working on expanding access to naloxone for years.
In 2021, he created The Naloxone Project with the goal of getting all hospitals, labor and delivery units, and emergency departments to distribute naloxone to at-risk patients.
As reported by The Colorado Sun in December 2022, all 108 hospital emergency departments in Colorado agreed to offer take-home doses of naloxone to any patient treated for an overdose, and 14 out of 48 labor and delivery units in Colorado committed to do so as well.
Stader also helped lead an effort to change state laws surrounding insurance reimbursement and regulation, per The Colorado Sun.
Passed in 2020, House Bill 1065 mandated coverage by private insurers in Colorado for dispensed naloxone from hospitals, according to The Naloxone Project.
In 2022, the passage of House Bill 1326 mandated coverage by Colorado Medicaid for dispensed naloxone from hospitals. It also made it so that hospitals may dispense naloxone with “less regulation or threat of penalty for not complying with board of pharmacy regulations,” per the project. [cqmedia layout=”panel” content=”eyJwaG90byI6W3sibWVkaWFfdHlwZSI6InBob3RvIiwicGhvdG9faWQiOiIzMzcxNTkiLCJwaG90b19jYXB0aW9uIjoiRG9uIFN0YWRlciwgYW4gZW1lcmdlbmN5IGFuZCBhZGRpY3Rpb24gbWVkaWNpbmUgcGh5c2ljaWFuIGFuZCB0aGUgZXhlY3V0aXZlIGRpcmVjdG9yIG9mIFRoZSBOYWxveG9uZSBQcm9qZWN0LCBzcGVha2luZyBBdWcuIDMxLCAyMDIzLCBhdCB0aGUgU3dlZGlzaCBNZWRpY2FsIENlbnRlciBpbiBFbmdsZXdvb2QuIiwicGhvdG9fY3JlZGl0IjoiQnkgVGF5bGVyIFNoYXcifV0sInZpZGVvIjpbXSwiZmlsZSI6W119″]
Stader said Colorado had to change its rules to provide better care to patients, and now, the rules need to be changed across the country.
“We have to create the payment mechanism to actually send people home with the drug, so that we’re not asking hospitals to just do this for free,” Stader said. “While hospitals are charitable, they’re not charities, right? They’re businesses, and we should be reimbursing them to provide high level care.”
On top of creating the payment mechanism, Stader said the HANDS Act asks the U.S. Food and Drug Administration, or FDA,mto strip away some regulations he says have “made it impossible to do this in many communities.”
Across the country, medicine is regulated by the board of medicine, the board of pharmacy and hospital regulations, and too many of them say hospital providers cannot give out naloxone, Stader said.
He said a lot of the obstacles make sense when it comes to other drugs. For example, hospital providers should not give antibiotics to everyone because it will lead to resistant bugs to antibiotics. Other drugs like chemotherapy drugs should also be tightly regulated, he said.
“Naloxone has only one purpose and has very little side effects. This is not a drug that we should shackle,” Stader said. “This is a drug that we should free and make sure that there’s no regulation standing in front of what would be great policy, great action that will save the lives of thousands of Americans.”
More than 100,000 drug overdose deaths in 2022
Drug overdose continues to be a major public health issue in the U.S., the FDA said in July.
The predicted number of drug overdose deaths in the U.S. in 2022 was 109,680, according to the Centers for Disease Control and Prevention. Nearly 83,000 were predicted opioid-involved drug overdose deaths.
Like many people, Congresswoman Pettersen has been impacted by the opioid epidemic.
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When Pettersen was around 6 years old, her mom was prescribed opioids after a back injury. Her mom became addicted and she eventually started using heroin, Pettersen said.
As fentanyl came into the drug supply chain, Pettersen’s mom, who has now been in recovery for about six years, started overdosing “at a very high rate,” Pettersen said.
“I had been to the hospital so many times with my mom, and we were never talked to about our options for naloxone,” Pettersen said. “I didn’t even know that this was an option.”
For a long time, naloxone was a prescription drug, said Robert Valuck, the executive director of the Colorado Consortium for Prescription Drug Abuse Prevention.
Now, it is an over-the-counter drug, he said.
The FDA approved two nonprescription naloxone products, both of which are nasal sprays, earlier this year.
“It’s not a new drug,” Valuck said. “We’ve just been hiding it for too long.”
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Ricky Dhaliwal, an emergency medicine physician representing the American College of Emergency Physicians, said there is no question that naloxone saves lives.
“The data is clear — providing naloxone to patients when they leave the hospital is much more effective than providing prescriptions,” Dhaliwal said.
The American College of Emergency Physicians issued a letter of support for Pettersen’s proposed legislation, saying that preemptively providing naloxone to patients who are at risk of an opioid overdose helps reduce overdose deaths.
“Your legislation will ensure that naloxone or other overdose reversal agents are covered under Medicare, Medicaid, or TRICARE at no cost to patients at risk of overdose,” the letter stated. “By eliminating financial barriers to this lifesaving drug, we can provide our patients who have overdosed or who are at risk of overdose with the opportunity to continue on their path to recovery — an opportunity they may not otherwise have had.”
Pettersen said she hopes the legislation will be bipartisan.
“It is very important to me that this is a bipartisan bill,” Pettersen said. “This is something that we have to come together on. Whether you’re Republican or a Democrat, this impacts every community across the country.”