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Overdose drug on sale online in Texas

Naloxone, used to stop opioid deaths, now available by personal order

Mary Huber
mhuber@statesman.com
A patient navigator with Austin Harm Reduction Coalition packs Naloxone into baggies on May 30, 2018. Naloxone is used to pull people out of an opioid overdose. [ANA RAMIREZ / AMERICAN-STATESMAN]

As deaths from opioid overdoses continue to climb across the country, state agencies have focused on getting the life-saving medication naloxone, which reverses the effects of an opioid overdose, into the hands of police and emergency workers.

But addiction experts say the drug should go first to drug users and the people close to them, since they are usually the first to respond to an overdose. On Tuesday, one company made that goal much easier by selling naloxone online in Texas.

The Chicago-based company, Fiduscript, is now selling two doses of the medication at a cost between $116 and $178. Customers only have to watch a short training video on how to use the drug before they place an order through the Naloxone Exchange online marketplace, then wait for the drug to be discreetly delivered to their door.

Fiduscript Founder James Lott says the first-of-its-kind service is launching in Texas because of the state's willingness to approve its business model.

"The board of pharmacy in Texas was surprisingly very open to the innovative ways to solve this problem," Lott said.

Naloxone, also known by its brand name Narcan, is a medication that can be injected or inhaled to restore normal breathing in the event of an opioid overdose. The drug has been on the market for many years, and it is commonly used by emergency medics and police. The drug is also available in pharmacies through what is known as a "standing order," a prescription that can be accessed by anyone who needs it.

Many states have a true statewide standing order, meaning that the secretary of health has signed a prescription that any pharmacist can use to dispense naloxone. Texas, on the other hand, has a more limited standing order, which requires pharmacists to submit an application to the Texas Pharmacy Association, then complete training on how to administer the medication — sometimes at a small cost. Lott says these barriers have created problems for smaller pharmacies in rural areas that might not know the requirements.

Lott said selling the medication online will expand access to people in those areas who really need it. The delivery service also will cater to people who might be too scared or embarrassed to walk into a pharmacy to buy it, he said.

"This protects their autonomy, reduces stigma and increases access," he said. "Naloxone is a life saver. In the process of recovery, whether you just overdosed yesterday or are 10 years sober, you should have naloxone handy."

While Texas still has some hurdles in place for pharmacists to dispense naloxone, Lott said the state's pharmacy board quickly approved their proposal.

"They were just excited about it, versus some other states where they did not have the exemplary standing order. Those states were not willing to be open to the idea yet. They were saying it would require legislation," he said. "Some of these states are top five states dealing with the opioid crisis, and you would think they would be motivated, but they are not."

Texas's opioid problem isn't quite as significant as other states like Pennsylvania, where pharmacies will dispense naloxone to anyone who wants it. Still, nearly 3,000 people in Texas died from drug overdoses in 2017, an increase of 4% from the year before. Officials have largely attributed the increase to the rise of synthetic fentanyl, a substance about 50 times stronger than heroin that is imported from China.

Law enforcement and policymakers have been pushing to expand access to naloxone across Texas in recent years due to the rise in deaths, but also out of concern about police officers’ potential exposure to fentanyl. Police agencies worry that their officers could be hurt during drug raids or other operations when they come into contact with the powerful drug.

The Texas Department of Public Safety, Travis County sheriff's office and the Houston Police Department are just a few of the departments that now outfit their officers with naloxone. Legislation being considered by state lawmakers this session would establish new grant opportunities for police departments that want the expensive drug.

But harm reduction experts say the frenzy to get naloxone to police because of fears of passive fentanyl exposure is not justified. They say that what's most important is to get the medication to drug users, their friends and family members.

“My bias is always toward diverting as much medication as possible to those individuals,” said University of Texas pharmacy professor Lucas Hill, who manages the school's Operation Naloxone program, which has been expanding access to the drug since 2016.

Allison Benz, executive director of the state pharmacy board, said nothing in Texas law prohibits organizations or businesses that have a prescription from selling naloxone online.

"If they have a standing order, they can do it however they want to do it," she said.

Fiduscript said it plans to expand into other states after launching its pilot program in Texas, and it hopes to offer other harm-reduction medications in the future.

How to order naloxone online

  • Visit naloxoneexchange.com.
  • Watch a training video on how to administer the medication.
  • Submit basic personal information for yourself or the person for whom you are ordering, including name, date of birth, address and any allergies.
  • Pay with a credit card, flexible spending account or health savings account card.
  • No insurance is accepted.
  • No prescription is required.