On September 16, 2014, 25-year-old Matthew Comfort walked into his mother’s bathroom in the working-class Philadelphia suburb of Bensalem, shot up heroin, and died from an overdose. His mother, Liz Fox, was working at home that day to keep an eye on her son, who had struggled with addiction for three years, including spending time homeless on the streets of Kensington, once the heart of the city’s manufacturing industry and today its epicenter for injection-drug use. He had recently been released from jail, where he had served time for thefts he had committed to supply his habit. At his mom’s house, the two had searched for an inpatient rehab slot, with no success. Before he left jail, Fox had asked that her son be sent directly to rehab. She received no response.
In jail, Matt had been forced to detox. As a result, his tolerance was low when he was released, putting him at a higher risk of overdose. Nonetheless, the Bucks County jail had not supplied him with naloxone, a drug that can reverse overdoses and that might have saved his life. And his mother didn’t really know much about naloxone, or that it was something that she might want to keep on hand. Shockingly, the emergency crew that responded wasn’t carrying it either, she said.
“I think everyone should have it and everyone should be trained and ready because we’re losing a whole generation,” said Fox, who now volunteers with Angels in Motion, which, armed with naloxone, distributes food, clothing, and other resources to users on the Philly streets.
Yet, for all naloxone’s life-saving promise, the drug remains out of reach for thousands of people who need it. From cities like Philadelphia and New York to southwestern Ohio, family members and first responders are struggling to pay for enough doses to treat the need. And that is partly because the high price of the drug is limiting its distribution, even as an opioid crisis tears through the United States.
Between the beginning of February 2015 and the end of January 2016, an estimated 52,898 Americans died from a drug overdose, many from opioids like OxyContin, heroin and, most alarmingly, from the extremely potent synthetic opioid fentanyl. In the year that followed, the number of fatal overdoses recorded rose to 64,070. Many of these deaths should have been preventable: Naloxone can reverse an overdose before it fatally depresses a user’s respiratory and central nervous system. But as overdose deaths spike and government moves to respond, companies have seized the opportunity to profit from the crisis by exploiting skyrocketing demand.
Amphastar Pharmaceuticals, for instance, raised the average wholesale price of its naloxone, which can be injected or outfitted off-label with an atomizer for intranasal use, from $20.34 to $39.60, according to a December 2016 paper in The New England Journal of Medicine. The price of the popular Narcan nasal spray, manufactured by Adapt Pharma and approved in 2015, has not been raised, but it came on the market in 2015 at a high average wholesale price of $150. The largest price hike was for Evzio, an auto-injector device designed for easy use by laypersons. In 2014, a two-dose package of Evzio, manufactured by kaléo, cost $690. As of 2016, it cost $4,500. That’s more than a 500 percent increase.