Fentanyl ODs kill eight this summer

MUNCIE — Six hundred opioid overdose reversal kits are being sent to Delaware County, where opioid overdoses have claimed 65 lives in 2015-16.

While the kits also have become available without a prescription at participating pharmacies and other locations across the state, local health officials are calling their price "crazy" and "absurd."

Delaware County has seen a surge this summer of cases in which fentanyl — said to be 50 to 100 times more potent than morphine — caused or contributed to deaths, including those of an 18-year-old man, a 22-year-old woman, a 23-year-old man, a 24-year-old man and four other people, said Coroner Scott Hahn.

"Fentanyl is good for cancer patients who are in a lot of pain, but they usually use it like a time-released patch," Hahn said. "We're finding people who chewed or injected those patches. We have found them still in a person's mouth where they had been chewing on them."

It was an accidental overdose of fentanyl that killed Prince, according to toxicology tests.

Other pain-relieving opioid drugs that have caused or contributed to 42 fatal overdoses in Delaware County last year and 23 so far this year include morphine, oxycodone (e.g., OxyContin, Percocet), hydrocodone (e.g., Vicodin) and heroin.

The state health department has awarded nearly $150,000 worth of opioid overdose rescue kits containing naloxone hydrochloride, aka Narcan, to health departments in 20 counties, including Delaware (600 kits), Henry (100 kits) and Randolph (30 kits).

The goals of the program include expanding the distribution of naloxone rescue kits and increasing education about the state law that provides immunity for lay responders  to carry and administer the life-saving medication.

Naloxone can be injected into a muscle or sprayed into the nose.

"These people are dying when we get to them," Hahn said. "It shuts down their breathing, which causes respiratory arrest and then cardiac arrest. Narcan reverses that. I talked to one paramedic who responded to an overdose in the parking lot at Meijer. The guy overdosed and was going to die. After he was given Narcan intravenously, he wakes up and says, 'What's going on?' They told him, 'You are OD'ing.' He said, 'No I'm not.' Those paramedics are really good at waking these people up."

The Delaware County Health Department sees the rescue kits as an opportunity to save lives, not as evidence that it condones the abuse of prescription or illegal drugs, Administrator Jammie Bane told The Star Press.

"Drug overdoses not only result in the death and loss of an individual, there is also an enormous fallout for family and friends, not to mention the  burden on taxpayers," Bane said. "Where this program is allowing us to get naloxone into the community for free, an overdose death can result in tens of thousands of dollars in cost ultimately borne by the family, medical system and taxpayers."

The coroner says an autopsy and toxicology screen for an opioid death costs the county about $2,000.

Bane has seen price quotes of $70 to $90 per opioid rescue kit when purchased over the counter. "This is for a drug that is so cheap that we have seen its production cost compared to sterile sodium chloride — essentially salt water," Bane said. "Recently in the  news, we've seen daily coverage of … the cost of EpiPens now versus in years past. Naloxone is also seeing a significant rise in cost, which overall hasn't seen much in the way of press coverage."

His department will notify the public after it finalizes details of how and to whom the rescue kits will be distributed. Any agency or person interested in signing up for a kit should email Bane at jbane@co.delaware.in.us.

Max Barnhart, director of the IU Health Retail Pharmacy network, calls the cost of naloxone "really crazy."

"We carry the Narcan kit, which has two nasal dispensers pre-filled, has great usage instructions including a good YouTube video, and is very easy to use …," he told The Star Press. "It runs about $135 for the kit. There are also individual pre-filled syringes that you can purchase with a nasal aspirator. Two syringes and the aspirator will run around $80  or so. There is also an auto-injector product like EpiPen, but it is so incredibly expensive, we will not stock it right now. It runs around $4,000."

The Henry County Health Department plans to host quarterly rescue kit education/distribution discussions at the public library, the hospital, township fire departments, police departments, NA meetings and mental health centers.

"We believe that our communication through the jail population will really stimulate discussion among our high-risk groups throughout the county," Henry County Health Officer John Miller and county nursing director Deb Miller wrote in their rescue kit grant application to the state department of health. "Shortly after the Scott County (opioid-sparked HIV) outbreak, we were testing more people in a month than we would previously test in a year. Among these sub-groups, word can travel quickly."

The Madison County Health Department, which also is receiving rescue kits, plans to distribute them to syringe exchange participants.

"Because of the overdoses and the cases of hepatitis, we are wanting to help the community and make sure we don't have any more overdoses," said Melynda Donham, coordinator of the Randolph County Health Department.

Meanwhile, Delaware County is also one of a dozen counties to share $519,117 in Centers for Disease Control and Prevention funding to provide education and training in naloxone use for first responders and lay providers, along with technical assistance to local coalitions to increase awareness of opioid prescribing habits. Blackford County was among six other Indiana counties that received help through another grant.

Contact Seth Slabaugh at (765) 213-5834.