Nov 03 2017

Bell Peppers

You don’t live to be 120+ years old (mid 30s in 1926, do the math) without being extremely fortunate which is a word we will return to.

While it is easy to claim good genetics (Richard and Emily are still kicking too and more ornery than ever) the truth is that my health is not perfect as any of my many physicians would be happy to tell you at length and in excruciating detail.

Among my minor complaints is a life threatening food allergy. I am not kidding. I don’t react well to Bell Peppers with the trivial effects being headaches, hives, and shortness of breath and the potential consequence of not needing to breathe at all and acquiring a new hobby as plant food. It is so bad I can smell the house salad across the restaurant and while I don’t want to detract from your enjoyment of a colorful and spicy addition to your diet I find I frequently have to return plates to which the chef has appended this trendy garnish.

Honest to goodness I feel bad every time. My fault actually for forgetting to inform the server of my sensitivity.

My doctors, alarmed as they always are by my callous disregard of unhealthy habits like the daily carton of Kools and gallon of Graves’ (the only reason ever to go to Lewiston, Maine), have prescribed me an EpiPen, that infamous bundle of 20 cents of medicine in a $600 dispenser. I suppose in relation to my $200 a week Therapy bill it’s not an extravagance, I have 2 (in case 1 is not quite enough) and my major objection is that they’re rather awkward to carry in your front trouser pocket so I usually put them in my coat which I leave in the car. A medical friend I frequently dine with who knows my condition often asks me, “So, do you have your EpiPens?”

Of course I do, they’re in the car.

“We had to park a 5 minute walk from here. That’s hardly any good, is it?”

I’ll get them the next time I go out for a smoke. And there damn well better be another shot of Graves’ when I get back!

Am I funny like a clown? Rip your arm off and drag you into the gutter I will.

This is not really about EpiPens (though that is a scandal) it’s about naloxone which is an emergency anti-opioid that can provide temporary relief of potentially fatal overdoses. I want to emphasize the temporary nature of this treatment since too many people show up at Emergency Rooms and because they feel instantly better check themselves out against medical advice to die on the street later.

While great progress has been made making this drug commonly available it still suffers the stigma of being associated with Opium addiction. The attitude of many is that if you use, you deserve to die. Survival of the fittest baby.

Of course that ignores the fact that many of the most potent opioids are pills pushed like Chicklets by Big Pharma for big bucks. Naloxone on the other hand is finally free of patent monopoly protection and is available by the pail for about $20, unless of course you live in the United States.

If You Can’t Afford $4,500 for a Dose of Medicine, You Don’t Get to Live
By Amy Faith Ho, Truthout
Monday, October 23, 2017

More than 40 states responded (to the opioid addiction epidemic) by making naloxone available without a prescription for the express purpose of enabling family members to revive their loved ones in case of overdose. Other local initiatives have involved the push to make naloxone available to all first responders, including the police and even their K9s who may be exposed to lethal levels of opioids at crime scenes.

While these initial strides have helped to combat deaths from opioid overdose, the financial burden is becoming exhausting. Naloxone has been on the market since 1971 and became generic in 1985. The drug itself is cheap, with current wholesale price cited as $0.33 for a 2ml vial or $11.70 for 10 2ml vials by the International Medical Product Guide. Comparatively, in the US, a simple vial of naloxone is 40 times that price. Price-gauging poster child Mylan of the now infamous EpiPen scandal sells naloxone at $23.72/ml, Hospira sells it at $14.25/ml, Amphastar at $19.8/ml and West-Ward at $20.40/ml.

These prices are for the drug naloxone only, and do not include any of the delivery devices like auto-injectors or nasal injectors. As a result, they are only helpful to medically-trained persons like paramedics, often funded by state and local taxpayer dollars. Citing cost concerns, communities have begun to propose “one and done” or “three strikes” rules where people are limited on the number of overdose responses they get from city ambulance services — so the next time they call, the city will just let them die. Middletown, Ohio, was one of those cities — a town that is on track to spend over $2 million this year responding to opioid addiction problems, with $100,000 on Narcan alone.

With government capabilities already limited by cost, the burden of life-saving shifts to private (usually lay, non-medically trained) consumers of naloxone, almost always family members of an opiate user. These loved ones need a naloxone option that is easy to deliver in a crisis, without the training required for syringes and measurements needed to use simple vials of naloxone. This is where the price gouging becomes more appalling. For a drug that costs as low as $0.16/ml, current naloxone options for the lay consumer are exorbitantly cost prohibitive. The naloxone auto-injector by Kaleo Pharma costs $4,500, and the naloxone nasal spray by Adapt Pharma, a simple plastic nasal sprayer that could be manufactured for pennies, now costs $110. This is the price to save a life now, with a generic drug that has been on the market for nearly 50 years.

This is concerning, especially for people living in poverty who are disproportionately affected by addiction. Concerned by the public health ramifications of this, earlier this year, 31 US Senators sent a letter to Kaleo, maker of Evzio, demanding an explanation for not only the cost of the drug, but also the 600 percent price hike in the drug. Like Mylan during the EpiPen scandal, Kaleo responded by citing donations of its product to various agencies, as well as a complicated web of rebates and discounts. These do make the drug more affordable for some patients, usually those with insurance, but more often than not, this results in increased market share as consumers are swayed to use the product and not enough impact from a population health perspective. Already, Kaleo has maxed its donations of product, but many that received those devices now rely on it. Meanwhile, Kaleo is enjoying a 20 percent overall market share on the retail naloxone dispensed. For the 40-64-year-olds that most often need naloxone, Kaleo holds an even more solid 50 percent of the market share.

Pharmaceutical price gouging has created a situation where access to life-saving medicines is limited by profit margins. As government agencies are already struggling with costs, the burden gets shifted to the private consumer. In that market, the message is clear: If you can’t afford $4,500 for a dose of medicine, you don’t get to live. In a way, haven’t these pharmaceutical companies now become the “death panels” in the “rationing of health care” that we once so feared during the initial Affordable Care Act debates?