(UPDATED 6 p.m.) Legislators and health officials have spent a lot of time in recent weeks patting themselves on the back, claiming that Connecticut just passed the most forward-thinking, far-reaching legislation in the country to combat the state’s growing opioid epidemic.
But there’s a new problem facing those who fight substance abuse for a living — getting their hands on the life-saving drugs to reverse the effects of opioid and heroin overdoses.
The Department of Mental Health & Addiction Services Alcohol and Drug Policy Council heard firsthand about that emerging problem at its meeting this week.
The bill recently signed into law by Gov. Dannel P. Malloy, places a 7-day cap on opioid prescriptions in an effort to rein in what many called the “over-prescribing” of painkillers. The legislation also requires first responders to be trained in the use of Naloxone, or Narcan, and to carry and dispense it. The drug is injected into patients to counter the effects of opioid and heroin overdoses.
But, there isn’t enough Naloxone, commonly referred to as Narcan, to go around.
Dr. Raul Pino, commissioner of the Department of Public Health, told the policy council that “supplies are real short.”
In New Haven, the Drug Enforcement Administration and New Haven Police Department are investigating the drug overdoses of 17 individuals that occurred in New Haven on June 23.
Three of the victims died, and four victims remain hospitalized.
The investigation has revealed that many or all of the victims believed the substance they were consuming was cocaine.
However, based in part on DEA laboratory testing, it appears that the substance was pure fentanyl, a powerful opioid that can be at least 50 times more powerful than heroin.
Narcan was effective in treating at least some of the victims, which indicates that the ingested substance was an opioid and not cocaine.
Pino said, “under orders from the governor,” 700 doses of Narcan were sent immediately to New Haven, followed by 2,000 more.
The problem in New Haven, Pino said, “is some of these individuals required multiple doses which is not normal. It usually takes just one dose per user.”
Shawn M. Lang, deputy director of AIDS Connecticut and a longtime advocate for greater access to Narcan, said there needs to be a much broader system to acquire Nalaxone.
Jim Siemianowski, director of quality at the Department of Mental Health and Addiction Services gave his fellow panelists some sobering statistics to mull over.
Looking over Mental Health and Addiction Service statistics from the past five years, Siemianowski said there has been a 40 percent increase in admissions to methadone maintenance clinics and 50 percent of the admissions, overall, are related to opioid use. He said opioids have replaced alcohol as the most frequently used substance.
Part of the reason for the policy council met this week was to come up with an action plan to present to legislators as to how to combat Connecticut’s drug epidemic going forward.
Many on the council said much more needs to be done to educate parents, school officials, pharmacists, and doctors on the dangers of opioids and the drugs that can counter their effects.
Rep. Melissa Ziobron, R-East Haddam, said she is troubled that legislators believe they have been so proactive by supporting the recently passed anti-opioid legislation.
“I was shocked to find out the number of CVS and Walgreen pharmacists who aren’t even enrolled in the program we passed to distribute Narcan,” Ziobron said.
She suggested the $50 fee the state is charging to enroll as a certified Narcan dispenser is holding these pharmacies back.
“It should be free,” Ziobron said.
Rep. Theresa Conroy, D-Seymour, said one of the things she’d like to see is a better tracking system in place “on how many times we are giving Narcan out.”
“It seems like we have better information on deaths than we have on tracking reversals,” Conroy said.
Department of Children and Families Commissioner Joette Katz agreed. She said it was like “closing the barn door after the horses are out.”
Siemianowski said one of the things the state needs to — and will — do, is to be very aggressive in going after any and all federal grant money to purchase Narcan.
“We’ve applied recently for four or five federal grants,” he said. “We’ll be following up and looking for all the money we can.”
Also, according to the state’s Connecticut Open Data website, there are at least 89 pharmacies in Connecticut that sell Naloxone.
The list is available at: http://bit.ly/naloxone-pharmacies-list
According to Karen Hekeler, a consultant with the Northeast Pharmacy Service Corporation who also is a member Statewide Overdose Prevention Workgroup, legislation passed last year allows any pharmacist who completes the state Naloxone training program to write and dispense prescriptions for Naloxone. It is not free but it is covered by insurance, including 100 percent by Medicaid without a co-pay.
Hekeler said the shortage described above is related to the state’s supply of Naloxone for first responders.
“That means any of us can walk into any one of those pharmacies and ask for Naloxone,” Hekeler said. “It does not have to be for us but if we had a friend, family member, or loved one we thought was at risk, we can get the script without visiting a doctor.”
She added that pharmacists also are required to train the patient or purchaser on how to use the product.