SEATTLE — As nationwide rates of fentanyl overdoses have grown into a public health crisis, experts have pointed to naloxone as a way to save lives. But years after Washington doubled down on efforts to get the medication into communities, the hunt for the drug remains often burdened with obstacles.
The state is determined to ensure the medicine that reverses opioid overdoses is as accessible as possible, and those who study addiction and drugs agree community efforts have made a difference in availability in pharmacies, local clinics and by mail. Still, naloxone remains expensive for many with and without insurance, and distributors like pharmacies often place strict limits on how many doses they hand out — in some cases, despite being shown a state policy meant to improve access.
Meanwhile, last year marked King County’s deadliest year ever for fatal overdoses, including more than 700 involving fentanyl. As of last week, the county had already tallied more than 400 fentanyl deaths for 2023.
Statewide trends are similar: Last year, about 65% of all drug deaths involved synthetic opioids, mainly fentanyl, totaling more than 1,700 overall, according to the University of Washington’s Addictions, Drug & Alcohol Institute.
“A lot of naloxone has been used to reverse overdoses, which is fantastic, and if we didn’t have it, we’d be in a much worse situation,” said Alison Newman, a community drug-education specialist with UW Medicine who works with the institute. “And I still think at this point, it’s not enough.”
The state issued a standing order in 2019 that allows all pharmacists to dispense naloxone without a prescription. However, a mix of more than 15 pharmacy locations in the Puget Sound region — including Walgreens, Bartell Drugs, Safeway, QFC, Fred Meyer and others — reported a range of distribution policies and copays when Seattle Times journalists stopped by this month.
Under the order, anyone at risk of experiencing an opioid overdose or anyone who might need to help someone overdosing can ask for naloxone at a pharmacy. Proof of eligibility isn’t required.
At a CVS and Walgreens in Renton, pharmacists wouldn’t provide anything unless customers were patients on file and could provide a name, identification and insurance information. A QFC and Walgreens in Everett required customers to fill out prescription forms. At a Rite Aid on Mercer Island, a pharmacy technician wasn’t sure how to bill the kits.
A pharmacy staffer at a Seattle Bartell’s on Rainier Avenue said they could only run one kit through insurance per person per day, even though the standing order allows those eligible to receive up to five kits.
The state’s Apple Health insurance, or Medicaid, covers the drug for free, and some insurance plans include copays ranging from around $15 to $25, Times journalists found. But for those without insurance or with plans that don’t pay for the full cost of a naloxone kit, charges can be as much as $130 per kit, said David Green, Seattle’s director of pharmacy operations for Safeway/Albertsons.
“The copays certainly can be an economic barrier,” Green said. “It’s very difficult to get this to the homeless community or some people who are on the streets. It’s still a public health issue we have to figure out.”
Naloxone was approved by the U.S. Food and Drug Administration in 1971, and is still the only medication on the market effective in reversing opioid-related overdoses, which can be caused by prescription pill, heroin and fentanyl use.
The drug was originally only administered as an injection, but the easier-to-use Narcan nasal spray was approved as a prescription drug by the FDA in 2015. In March, the FDA took another major step in addressing the national public health crisis and greenlit over-the-counter Narcan nasal spray for nonprescription use.
Last week, the FDA also endorsed Opvee, a new version of another medication that reverses overdoses called nalmefene. The prescription drug achieved similar recover results to Narcan in studies, but some medical experts have shared concerns about cost and potential side effects, according to The Associated Press.
Public health advocates have celebrated the decision to further expand access to naloxone, but over-the-counter Narcan likely won’t be available until this summer, while Opvee will likely launch in October at the earliest. It’s not clear exactly when either will hit shelves, and questions also remain over cost and which insurance plans will cover it, Newman said.
According to Emergent BioSolutions, Narcan’s manufacturer, kits will likely be available for about $50 each. However, Newman said additional store fees will likely be tacked on in retail markups.
“We don’t know exactly how that will work,” she said.
According to the state’s standing order, which will remain in effect even after over-the-counter Narcan becomes available in pharmacies, those eligible can receive up to five kits. The kits include either two single-dose vials of naloxone hydrochloride injection solution with syringes, or two single-doses of naloxone hydrochloride nasal spray.
No time frame is specified for how long someone has to wait before getting a refill.
Despite barriers such as high copays and conflicting pharmacy policies, pharmacies throughout the state have reported a rise in naloxone’s popularity since the statewide order went into effect, Green said. At the region’s Safeway pharmacies, staffers are “actively dispensing” naloxone every week, he added.
There’s also been a “steady increase in demand” at QFC stores in the last few years, said Marci J. Reynolds, pharmacy practice coordinator of the statewide grocery store chain. Pharmacists have found a “need to educate patients who use opioids for pain management and having naloxone on hand in case of emergency,” Reynolds wrote in an email.
While there isn’t a federal standing order that authorizes access to naloxone, all 50 states have laws that allow individuals to obtain access, often through similar standing orders, according to SAFE Project, a nationwide nonprofit that promotes education and support around fatal drug overdoses.
For those who can’t afford a naloxone copay at a pharmacy, there are free and discounted options in Washington.
For example, the state’s ArrayRx card, formerly the Washington Prescription Drug Program, helps lower the price of naloxone at pharmacies in Washington, Nevada and Oregon for people without prescription drug coverage, Emalie Huriaux, a health programs manager with the state Department of Health, wrote in an email.
According to ArrayRx, card users can save up to 80% on medications without having to qualify under age or income restrictions.
The state also provides free naloxone to certain organizations such as syringe, street outreach, jail release and housing programs, Huriaux said.
In addition, Washingtonians can request free naloxone through the state’s mail-order program, though residents are asked to only put in one order per person per month.
The program’s supply is limited and “intended to serve people who have no other way” to access the drug, Huriaux added. In 2022, the state distributed about 30,000 kits to residents through the mail.
Washington’s naloxone finder at StopOverdose.org, which Newman helps run, includes a map of sites throughout the state that offer free naloxone, including community organizations and hospital clinics with walk-in options.
Dozens of locations, like the People’s Harm Reduction Alliance and Kelly-Ross Pharmacy at The Polyclinic, provide helpful options, Newman said, but work remains around other forms of treatment and destigmatizing substance-use disorder in general.
“Naloxone is just this tiny piece — it only saves someone for the 30 to 90 minutes it’s in effect,” Newman said. “There’s a lot more that we need to do to be helping support people who are at risk of overdosing.”