(this article can be read by searching for the title on http://twitter.com/, then opening the link in a private window)
> Two doses of an injectable form of naloxone, Evzio, cost $4,500, up from $690 in 2014. The price of other forms of the drug, including the nasally administered Narcan, typically range from $70 to $150 per dose, officials say.
The cost of naloxone [1] is an insignificant part of the cost of reviving an addict. The rest of the costs mentioned in this article are pure profiteering.
If you buy 5 grams from Sigma Aldrich, a 2mg dose costs $0.588. Add a few more cents for salt, water and packaging brings the cost per dose to $2. An EMS supplier sells a single "kit" with an intranasal atomizer for <$48 [2]...
Someone on Reddit sent me 4 vials of naloxone. I sent them <$20 to cover postage. [Edit: these vials have .4mg naloxone. Needles were also included. I think the standard intranasal dose is 2mg.)
Naltrexone is very similar to Naloxone. It is used to keep people from getting high on opiates. Big Pharma has found a way to jack the price of this generic drug too. 15 days ago I posted about the Naltrexone rip-off: https://news.ycombinator.com/item?id=14672338
After struggling with alcoholism for decades I used Naltrexone to stop drinking five or six years ago. It wasn't a simple taper but when I had my last drink it was easier to walk away from than anything I could have ever imagined before I did it.
Furthermore, I'd imagine the cost of the naloxone alone is a small percentage of the total cost of the emergency responders + acute care given in life-threatening overdose. The article doesn't discuss a recurring theme in medicine: acute care is really, really expensive. It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose.
I don't know how long this country can survive with this rampant corruption and profiteering. When do we hit a breaking point, and what does that look like?
I mean I read your response and think, "wow, that's horrible." Then realize absolutely nothing is going to be done about it.
If you totally discount the good manufacturing practices and traceability that pharmaceuticals have to follow, sure you can hack together a cheap substitute that might not work when the chips are down
Except for biologics, many drugs are not that expensive to manufacture. The cost is in proving they will do what they say they do on the package.
Big Pharma has found a way to jack the price of this generic drug too.
Take a look at what companies make these generic drugs. It's not big Pharma at all. It's small companies. Most big pharma give up on a drug once it goes generic.
How can it be acceptable that you would declare people too expensive to save, rather than challenge the prices of a profit-making company that is bringing those costs in the first place? Shouldn't you be able to detect the sheer amount of corporate worship in such a statement before it leaves your mouth?
It breaks my heart to keep reading about this epidemic, with such a consistent reaction of hatred from so many people. This state of vulnerability should be met with support, but because opiates are nominally pleasurable, everything surrounding them must be a failure of personal responsibility - of people getting in over their heads.
Naloxone is already generic and basically free, government officials just like buying the branded version so they can get kickbacks while complaining about the cost.
Epidemic:
"a widespread occurrence of an infectious disease in a community at a particular time."
I can't see how drug addiction can fit in this definition.
If one of them sneezes I don't immediately feel the urge to put some shit in my veins.
I think that if someone doesn't want to be saved then maybe after a while it doesn't make much sense to try to save him.
For a less dire example, when people stop making progress in physical therapy, insurance stops paying for it. Not because there is no chance they will benefit from further therapy, but to control costs.
In the UK, naloxone with an injector costs £20.58, plus £4.16 VAT and £4.95 shipping, in quantity 1. Total is about US$38. The price goes down if you order in bulk. The supplier notes "You may be able to get naloxone free of charge from your local drug service, or GP."
Note that this, like ephedrine, is an old drug, out of patent decades ago.
There's an opportunity here for a startup. The startup doesn't even have to make the drug; there are contract pharmaceutical manufacturers who can do that.[3] The startup just has to handle marketing, distribution, and FDA approvals. Here's a list of makers worldwide.[4] Auto-injectors are available from various suppliers.[5][6]
This project could be put together by a small team and would get very favorable publicity.
Why is ibogaine [1] still a fringe treatment for opiod addiction? It seems like a heroin -> methadone -> ibogaine treatment could get the vast majority of addicts cured. Instead, on one end of our medical system's pipeline we get people addicted to opiods, and on the other end we've created so many addicts we have to save them from overdosing. In this domain our "medical" pipeline is actually a disease-creating pipeline that's clogging itself up at the end... Research is still ongoing, but it seems likely that even the majority of opioid painkiller prescriptions can be replaced with cannabis.
It seems then, that we can empty the pipeline by adding less opiod addicts in, by prescribing cannabis when possible instead of opiods, and clear out the end by actually effectively treating addicts.
Unfortunately, our federal government is so out of touch with reality that it classifies both ibogaine and cannabis as Schedule I drugs, substances with "high potential for abuse", "no accepted medical use", and "lack of accepted safety for use under medical supervision". The irony is devastating, and it's ruining countless lives.
There is a big controversy about this in the area of Ohio I am from (overdose capital of
the U.S., Coincidentally). A sheriff who presides over a country near my home is loudly deriding the use of Narcan, saying it will not be used by his deputies, due to moral and financial concerns.
Needless to say, I have lost 8 high school classmates to the epidemic at last count, and of those, 5 had been revived multiple times. So I can see both sides. There is no easy answer, and this problem will not go away on it's own.
While we are dealing with this severe public health crisis, Republicans in Congress are about to pass a healthcare bill that will, according to the non-partisan CBO, result in millions of people losing their health insurance.
There is really no word that adequately describes how disgusting it is.
Threaten to nationalize manufacturing of Naloxone, then do it if prices aren't brought down.
If there's an epidemic and private manufacturers can't respond to the demand without raising prices by a factor of 10, something needs to be done.
Annual overdose deaths have doubled over the last ten years. To bring a certain brand of hyperbole to the table, 2016 saw a loss of life equivalent to about thirty times that of 9/11.
Some see that as national crisis, others see it as an opportunity to gouge our people, towns and country.
The Naloxone patent expired in the 80s. There is not some grand complication to its production - there are plenty of generic drug manufacturers who could be making Naloxone for $5 a bottle.
It seems obvious this is more a case of regulations mandating the use of brand name Naloxone by a specific company, thus eliminating any free market competition in the prices since only one entity can provide Naloxone to EMTs by law.
And, naturally, the politicians that signed such a law to mandate one singular company provide all of a specific drug probably got sizable benefits from said drug company for doing so.
Compare it to the money US spent on Afghanistan invasion and the explosion in opium production there. Where do you think the production goes and who is running the operations? Wouldn't it be fair to divert part of those budgets to help civilians in US to cope with the results?
The bitter thing is that even Trump will boost military budgets, not much change here from the previous regime.
I agree about the costs of war (though I think Iraq was a war of choice, to the detriment of the campaign in Afghanistan) but "nearly all of the heroin available in the United States comes from Mexico and South America." [0]
This problem was also started with prescription meds, due to deception by pharma companies and lack of attention and mismanagement by the medical professions and government.
This sheriff is an asshole. He says he doesn't want his deputies carrying Narcan playing paramedic, does he also not want them trained in administering CPR or basic first aid?
Why is the price increasing as volume has gone up? Is it FDA-type regulation that's preventing new market entrants or patents? Or something else artificially preventing new market entry like legal risk?
I think we could add this to Jeff Bezos' ideas for philanthropic endeavors. Hell, it doesn't even need to be philanthropic. Amazon seems to have no problem with razor-thin profit margins: Why not create a company which has no problem making and selling generic-only drugs at razor-thin margins? There would seem to be a lot of room to undercut a business who sells for $4500 what might be produced for $20.
I think our capitalism may actually suffer from too much profit taking and not enough competition. I want the market to serve me (the consumer) not the other way around. I'm sure the producer see things differently... There doesn't seem to be a lot of appetite for companies to go after profitable businesses that don't have big margins.
There would be a Jeff Bezos if the drug market was as unregulated as the book market. Because of the regulations, instead there will be a Martin Shkreli.
Generally curious what the efficacy rates of opioid rehabilitation are. How many times does it take for someone to kick heroin? For how long? What's the cost breakdown for a turn in rehab?
"In recent weeks, Butler County Sheriff Richard K. Jones has drawn national attention for vowing that his deputies will never carry Narcan because he doesn’t want them playing the role of paramedic."
This is one of the sickest, most disgusting, most disturbing, most inhumane things I have ever heard. I guess police are not satisfied with just shooting unarmed people, now they have to let sick addicts die. So they can save $50, an amount that would be even less if it could be negotiated by a program like Medicaid or Medicare. At least it finally confirms the fact that a lot of police, like Jones, would rather stand around, do nothing, and let the people they are supposed to serve and protect die while they watch. What a sick, disgusting mother fucker. No, there's isn't a word in the English language that even begins to describe this lowlife. And the give this piece of shit a fucking gun? I wonder how many he's murdered so far without impunity?
You mean like poppy plants? This addiction wasn't created by drugs - drugs are merely a coping mechanism for a world that people can't fucking deal with.
The root causes aren't opioid manufacturing it's whole slew of things from poor physical and mental health care in this country, worsening job prospects for people, a culture that ties worth and value to working hard and monetary prosperity, etc...
Regardless of whether or not you regard opioid addiction as a disease, please please consider the slippery slope you're sledding down if you buy into this. Who's going to deny insulin to people whose credit card statements show more than 3 Dairy Queen visits this month? Who's going to deny chemo to people who smoked too many Pall Malls, in your opinion? This reeks from top to bottom, and yes, narcan isn't nearly as expensive as chemo, so yes, the slippery slope is pretty much guaranteed to go there. Proceed with caution.
That's why I think Kratom could be of huge benefit to a lot of people struggling with opioid addiction. It's cheap, otc, and a ton of people have had success with it.
[+] [-] tcj_phx|8 years ago|reply
> Two doses of an injectable form of naloxone, Evzio, cost $4,500, up from $690 in 2014. The price of other forms of the drug, including the nasally administered Narcan, typically range from $70 to $150 per dose, officials say.
The cost of naloxone [1] is an insignificant part of the cost of reviving an addict. The rest of the costs mentioned in this article are pure profiteering.
[1] http://www.sigmaaldrich.com/catalog/product/sigma/n7758?lang....
If you buy 5 grams from Sigma Aldrich, a 2mg dose costs $0.588. Add a few more cents for salt, water and packaging brings the cost per dose to $2. An EMS supplier sells a single "kit" with an intranasal atomizer for <$48 [2]...
Someone on Reddit sent me 4 vials of naloxone. I sent them <$20 to cover postage. [Edit: these vials have .4mg naloxone. Needles were also included. I think the standard intranasal dose is 2mg.)
[2] http://www.dixieems.com/Economy-Naloxone-Kit.asp?pid=2086
Naltrexone is very similar to Naloxone. It is used to keep people from getting high on opiates. Big Pharma has found a way to jack the price of this generic drug too. 15 days ago I posted about the Naltrexone rip-off: https://news.ycombinator.com/item?id=14672338
[+] [-] Quequau|8 years ago|reply
[+] [-] dwelch|8 years ago|reply
[+] [-] Clubber|8 years ago|reply
I mean I read your response and think, "wow, that's horrible." Then realize absolutely nothing is going to be done about it.
[+] [-] nimish|8 years ago|reply
Except for biologics, many drugs are not that expensive to manufacture. The cost is in proving they will do what they say they do on the package.
[+] [-] dredmorbius|8 years ago|reply
NB: I have no association with outline.com, nor do I even know who's running this, though if anyone has information on that, I'd like to know.
It is ... staggeringly useful.
[+] [-] refurb|8 years ago|reply
Take a look at what companies make these generic drugs. It's not big Pharma at all. It's small companies. Most big pharma give up on a drug once it goes generic.
[+] [-] ivanbakel|8 years ago|reply
It breaks my heart to keep reading about this epidemic, with such a consistent reaction of hatred from so many people. This state of vulnerability should be met with support, but because opiates are nominally pleasurable, everything surrounding them must be a failure of personal responsibility - of people getting in over their heads.
[+] [-] Alex3917|8 years ago|reply
[+] [-] tigershark|8 years ago|reply
[+] [-] maxerickson|8 years ago|reply
For a less dire example, when people stop making progress in physical therapy, insurance stops paying for it. Not because there is no chance they will benefit from further therapy, but to control costs.
[+] [-] creaghpatr|8 years ago|reply
Not a common or planned outcome, but an unfortunate byproduct of nationalized healthcare.
http://www.bbc.com/news/uk-england-40423371
[+] [-] Animats|8 years ago|reply
Note that this, like ephedrine, is an old drug, out of patent decades ago.
There's an opportunity here for a startup. The startup doesn't even have to make the drug; there are contract pharmaceutical manufacturers who can do that.[3] The startup just has to handle marketing, distribution, and FDA approvals. Here's a list of makers worldwide.[4] Auto-injectors are available from various suppliers.[5][6]
This project could be put together by a small team and would get very favorable publicity.
Then, on to replacing the Epi-Pen.
[1] http://www.exchangesupplies.org/shopdisp_prenoxad_naloxone_p... [2] https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454757.pdf [3] http://www.contractpharma.com/csd/categories [4] http://naloxoneinfo.org/get-started/where-to-get-naloxone [5] http://www.medicalplasticsnews.com/news/autoinjector-landsca... [6] http://www.shl-group.com/products/shl-medical/
[+] [-] laser|8 years ago|reply
It seems then, that we can empty the pipeline by adding less opiod addicts in, by prescribing cannabis when possible instead of opiods, and clear out the end by actually effectively treating addicts.
Unfortunately, our federal government is so out of touch with reality that it classifies both ibogaine and cannabis as Schedule I drugs, substances with "high potential for abuse", "no accepted medical use", and "lack of accepted safety for use under medical supervision". The irony is devastating, and it's ruining countless lives.
[1] http://ww.iceers.org/docs/science/iboga/Alper%20et%20al_1999...
[2] https://www.theatlantic.com/health/archive/2016/11/a-new-tes...
[+] [-] altotrees|8 years ago|reply
Needless to say, I have lost 8 high school classmates to the epidemic at last count, and of those, 5 had been revived multiple times. So I can see both sides. There is no easy answer, and this problem will not go away on it's own.
[+] [-] enraged_camel|8 years ago|reply
There is really no word that adequately describes how disgusting it is.
[+] [-] darpa_escapee|8 years ago|reply
If there's an epidemic and private manufacturers can't respond to the demand without raising prices by a factor of 10, something needs to be done.
Annual overdose deaths have doubled over the last ten years. To bring a certain brand of hyperbole to the table, 2016 saw a loss of life equivalent to about thirty times that of 9/11.
Some see that as national crisis, others see it as an opportunity to gouge our people, towns and country.
[+] [-] zanny|8 years ago|reply
It seems obvious this is more a case of regulations mandating the use of brand name Naloxone by a specific company, thus eliminating any free market competition in the prices since only one entity can provide Naloxone to EMTs by law.
And, naturally, the politicians that signed such a law to mandate one singular company provide all of a specific drug probably got sizable benefits from said drug company for doing so.
[+] [-] refurb|8 years ago|reply
That should do wonders for R&D investment in the US!!
[+] [-] flatfilefan|8 years ago|reply
The bitter thing is that even Trump will boost military budgets, not much change here from the previous regime.
[+] [-] extra88|8 years ago|reply
This problem was also started with prescription meds, due to deception by pharma companies and lack of attention and mismanagement by the medical professions and government.
This sheriff is an asshole. He says he doesn't want his deputies carrying Narcan playing paramedic, does he also not want them trained in administering CPR or basic first aid?
[0] http://www.politifact.com/truth-o-meter/statements/2016/sep/...
[+] [-] robk|8 years ago|reply
[+] [-] torpfactory|8 years ago|reply
I think our capitalism may actually suffer from too much profit taking and not enough competition. I want the market to serve me (the consumer) not the other way around. I'm sure the producer see things differently... There doesn't seem to be a lot of appetite for companies to go after profitable businesses that don't have big margins.
[+] [-] Noumenon72|8 years ago|reply
[+] [-] scurvy|8 years ago|reply
[+] [-] mnm1|8 years ago|reply
This is one of the sickest, most disgusting, most disturbing, most inhumane things I have ever heard. I guess police are not satisfied with just shooting unarmed people, now they have to let sick addicts die. So they can save $50, an amount that would be even less if it could be negotiated by a program like Medicaid or Medicare. At least it finally confirms the fact that a lot of police, like Jones, would rather stand around, do nothing, and let the people they are supposed to serve and protect die while they watch. What a sick, disgusting mother fucker. No, there's isn't a word in the English language that even begins to describe this lowlife. And the give this piece of shit a fucking gun? I wonder how many he's murdered so far without impunity?
[+] [-] thesz|8 years ago|reply
[1] https://en.wikipedia.org/wiki/The_Final_Circle_of_Paradise
Situation in US is quite close to one described there.
[+] [-] dredmorbius|8 years ago|reply
[+] [-] jtmcmc|8 years ago|reply
The root causes aren't opioid manufacturing it's whole slew of things from poor physical and mental health care in this country, worsening job prospects for people, a culture that ties worth and value to working hard and monetary prosperity, etc...
[+] [-] criddell|8 years ago|reply
Consumers can't buy direct, can they? There's always a middleman. Why not blame pharmacies or better yet, doctors?
[+] [-] mnm1|8 years ago|reply
[+] [-] justanother|8 years ago|reply
[+] [-] berzerk5|8 years ago|reply
[+] [-] valuearb|8 years ago|reply
[+] [-] eagletusk|8 years ago|reply
[+] [-] ninguem2|8 years ago|reply