Heroin antidote may become more accessible in Michigan

James David Dickson
The Detroit News

A state drug task force is recommending a tweak in Michigan law to allow over-the-counter sales of an injectable drug that can prevent overdose deaths.

The Prescription Drug and Opioid Abuse Task Force, named by Gov. Rick Snyder in June to address an alarming spike in overdoses, wants to make the antidote naloxone readily available for heroin emergencies. The governor will discuss the task force’s recommendations at a press conference Monday at the Detroit Medical Center.

State health officials say 99 opioid-related deaths were reported in 1999 and 840 in 2013, the last year for which numbers were available. Naloxone, also known as Narcan, is considered a critical tool in tamping down those statistics: It can reverse the effects of heroin and prescription pain-killing drug overdoses within seconds, returning blacked-out or unresponsive users to consciousness.

State and drug industry experts say Michigan law does not prevent the drug from being sold over-the-counter, but neither does it specifically permit it. Drug stores want the law to clearly permit over-the-counter naloxone before they stick their necks out in Michigan.

Mike DeAngelis, spokesman for CVS, said the chain will sell the antidote drug over-the-counter in 20 states by next year.

“The states in which we’ve implemented naloxone without a prescription have regulations that specifically permit standing orders or collaborative practice agreements for this medication,” DeAngelis said in an email.

Spokesman Phil Caruso said Walgreen’s “supports efforts that would make naloxone more accessible,” but as of now does not sell it over-the-counter. Rite-Aid only dispenses naloxone with a prescription here, but said it “continue(s) to explore opportunities to expand this service.” Walmart, through a public relations firm, said it sells naloxone to prescription holders in Michigan but would not comment beyond that.

If companies need specific permission to offer the heroin antidote without a prescription, state Rep. Anthony Forlini, R-Harrison Township, hopes to lead the charge. A legislative leader on opiate-related issues and a member of the opioid abuse task force, Forlini said he will introduce legislation allowing naloxone sales in Michigan without a prescription.

Forlini believes opiate-related deaths are vastly underreported in Michigan, likely because families don’t want to be bear the shame.

“This is in every neighborhood. It’s in every family,” he said.

Pharmacist requirements

Last year, California established protocols requiring pharmacists to screen for the recipient’s opioid history and possible hypersensitivity to naloxone, and the training of customers, by a pharmacist, in overdose prevention, recognition and response — including how to administer naloxone. Customers are not allowed to waive consultation with a pharmacist before buying the drug.

That’s a policy Snyder’s task force recommended, said Judge Linda Davis, chief judge of the 41-B District Court in Macomb County and a longtime advocate for efforts to address the heroin problem in Michigan.

“This is bigger than crack (cocaine) ever thought of being,” Davis said.

Andrew Fortunato, executive director of the Macomb County-based Families Against Narcotics, and a former addict, said the group would “100 percent” support legislation specifically allowing naloxone sales via collaborative practice agreements, if users are educated about the treatment and its limitations.

At a town hall meeting in West Virginia this week, President Barack Obama advocated for increased law enforcement use of naloxone.

In January, it became legal in Michigan for police agencies to carry and administer naloxone to counter suspected heroin overdoses, as paramedics have done for years. Not all have signed on, however. While deputies in Oakland and Macomb counties reportedly have saved more than two dozen lives as a result, Wayne County deputies, state police troopers and Detroit police officers do not carry naloxone, officials say.

Families Against Narcotics has worked with law enforcement agencies in Macomb County to identify grants for auto-injectors for naloxone, and leads training sessions when those injectors come in, he said.

Fortunato called the idea that wide availability of the antidote would enable drug users “ridiculous.”

“That completely contradicts what addicts are about when they’re getting high,” which is staying high, Fortunato said.

Experts say naloxone is unpleasant. When it stops the brain’s receptors from accepting opiates, it throws the user into immediate withdrawal. People die of heroin overdoses because when opiates overtake their brain receptors, they forget to breathe.

Naloxone wears off after 30-90 minutes, experts say, and if there are enough drugs in the user’s system when the antidote fades, the overdose can resume, Fortunato said.

Eric Roath, director of professional practice at the Michigan Pharmacists Association, said the professional group is “supportive of pharmacists — operating within a legal framework — being able to improve access to life-saving medications like naloxone.”

Margaret Farenger, a public health consultant in southeast Michigan, said increased access to the heroin antidote would be a good thing.

“As it stands, some people in Michigan have access to naloxone while others do not,” Farenger said. “Community programs are working, but not available everywhere. Over-the-counter access is efficient, will save lives, and also has the potential to reduce disparities.”