In Maine and across the United States, prescriptions for a life-saving opioid antidote have escalated since 2016, according to federal and state statistics. Meanwhile, after climbing for years, drug overdose deaths started declining for the first time in 2018.
Experts say there’s a strong correlation between the two trends, as the use of the antidote naloxone helps substance use disorder patients stay alive until they can get into treatment. Naloxone is most commonly used as a nasal spray to revive patients who have overdosed on opioids.
“The trend is good, but we are really still just at the beginning,” Gordon Smith, Maine’s director of opioid response for the Mills administration, said in an interview Wednesday. “Naloxone indisputably saves lives.”
The U.S. Centers for Disease Control and Prevention released retail pharmacy data for 2018 this week showing that Maine had prescribing rates that vary substantially by county, with Washington County having the highest rates and Sagadahoc the lowest. A report that accompanied the data did not analyze state-level figures, but found substantial regional variations in dispensing.
In the Northeast, the average number of naloxone prescriptions was 172.5 for every 100,000 people. In Maine, 12 of the state’s 16 counties had rates below that level and four counties had higher rates: Washington, Piscataquis, Penobscot and Kennebec.
Nationally, dispensing rates were lowest in the Midwest and in rural counties, and highest in the South and among micropolitan counties, or those that include cities with populations of 10,000 to 50,000.
In 2016, 134,109 naloxone prescriptions were sold from retail pharmacies, according to the U.S. CDC statistics. That number had expanded to 556,847 naloxone prescriptions in 2018. U.S. CDC officials said despite the increase, naloxone prescriptions were still far too low compared to the need.
Drug overdose deaths declined from 70,000 in 2017 to 68,000 in 2018 nationally, a 3 percent decrease, according to the U.S. CDC. Maine saw a more significant dropoff in overdose deaths, going from 417 in 2017 to 354 in 2018, a 15 percent decrease.
While the U.S. CDC didn’t release state-by-state numbers for naloxone prescriptions before 2018, data from Medicaid and research indicate that Maine has experienced a similar trend in recent years as the state Legislature has approved laws that expanded the availability of naloxone.
In the Medicaid program, Maine went from 351 naloxone prescriptions in 2017 to 735 in 2018. And according to research conducted by the University of New England, among private insurers naloxone prescriptions increased from 250 in the first quarter of 2017 to 1,000 in the first quarter of 2019.
“We’ve seen a dramatic increase in Narcan (naloxone brand) in Maine and nationally,” said Kenneth McCall, past president of the Maine Pharmacy Association and a pharmacy professor at the University of New England. “Just a few years ago, the product was only available in the hospital or ambulance as an injectable.”
Now it’s predominantly sold as a nasal spray that – starting last year – can be purchased without a doctor’s prescription at pharmacies across Maine. Not counted in the data is the wide distribution of naloxone to police and fire departments, a program operated by the Maine Attorney General’s Office.
While former Republican Gov. Paul LePage was reluctant to increase the availability of naloxone, the administration of current Democratic Gov. Janet Mills is rolling out new programs to expand access.
Smith said the plan is to give 35,000 naloxone prescriptions to nonprofit agencies across the state, who will give them free to those who need it. He said another plan will set up about 20 distribution boxes throughout the state where patients can get naloxone for free.
“We really want anybody that’s able to and wants to use Narcan to be able to have access to it,” Smith said.
Smith said the Mills administration also is considering making it a standard practice or a requirement that for every high-dose opioid prescription sold in Maine, a naloxone prescription would automatically come with it. Arizona and Virginia require naloxone prescriptions with high-dose opioid prescriptions.
The naloxone prescription – which contains two doses – costs about $150 if paid for out-of-pocket at the pharmacy.
The difference in prescribing rates by county can vary substantially. For instance, in Maine in 2018, there were 294 naloxone prescriptions per 100,000 population in Washington County, the highest in the state. The lowest in the state was a rate of 26 naloxone prescriptions per 100,000 in Sagadahoc County.
Smith said he doesn’t know why there were such regional differences in Maine. He said perhaps awareness among medical professionals of the severity of the opioid epidemic in Washington County and Kennebec County, which had the second-highest rate in Maine at 262 prescriptions per 100,000 population, led to greater prescribing.
Dr. Mary Dowd, who treats substance use disorder at Milestone Recovery detox center, said she is seeing more patients with Narcan, and now it’s much easier to get patients into treatment programs.
“Naloxone keeps them alive until we can get them help,” Dowd said. “You can’t treat dead people.”
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