BURLINGTON — After a rash of opiate overdoses in central Vermont, the state Health Department has signed an order allowing every Vermont pharmacist to sell the overdose reversal drug naloxone without a prescription.
Officials said it’s more important than ever for drug users and the people close to them to have naloxone, commonly referred to by the brand name Narcan, because a powerful opioid known as fentanyl is becoming increasingly prevalent in the illicit drug supply.
Naloxone, which is administered as a nasal spray, is highly effective in reversing opiate overdoses. Currently, two doses retail for $75, but several social service nonprofits make the drug available for free at clinics across the state.
Health Commissioner Dr. Harry Chen said Thursday the order he signed will make it so Medicaid and private health insurance can cover the cost of naloxone.
“The aim of making naloxone easy to get and available at the moment it’s needed is really to keep people from dying,” Chen said. “In my view as health commissioner, this is what we call risk reduction.”
CVS pharmacies already make the drug available over the counter through standing orders with physicians in Vermont.
Walgreens plans to follow suit in September, Chen said. The state order will allow any pharmacy to do the same, he said.
“Naloxone doesn’t encourage use. It simply saves lives, and it’s needed now more than ever,” Chen said. “Unknowingly or knowingly, heroin users are facing an even deadlier mix.”
The ascendance of fentanyl in the drug trade has created a deadly dynamic for drug users, who are often unaware that what they’re getting from dealers isn’t heroin, officials say.
Fentanyl is up to 50 times stronger than heroin. Dealers may cut it into heroin to increase potency or to stretch profits, but increasingly they are selling it to users by itself as heroin, according to law enforcement.
Chen said that, as of June, fentanyl was involved in 14 of the 44 opiate overdose deaths that had occurred in 2016. It was present in 29 of 76 opiate overdose deaths in 2015, according to Health Department figures.
“Fentanyl is much stronger than heroin and can cause even experienced users to overdose,” according to a Drug Enforcement Administration report from June. “Between 2013 and 2014, there was a 79 percent increase in deaths related to synthetic opioids, the category under which fentanyl falls.”
Most fentanyl overdoses are concentrated in the eastern U.S. where white powder heroin is prevalent, according to the DEA report. That’s because fentanyl can be easily cut with or disguised as white powder heroin, the report states.
Chen warned that an even more powerful synthetic opiate known as carfentanil, which is 100 times stronger than fentanyl, is circulating in the heroin supply.
Carfentanil is the most powerful synthetic opiate approved for commercial use, but it is not approved for human use. It’s used as a general anesthetic for large animals.
However, fentanyl and other synthetic opiates that are increasingly common aren’t being diverted from pharmaceutical use, according to the DEA. Instead, drug traffickers are smuggling or manufacturing the drugs in clandestine labs.
With the increasing danger of using heroin, Chen encouraged drug users to take precautions. He advised users to do the following:
- Don’t use alone. Have someone there who can provide naloxone and call 911. (Vermont has “good Samaritan” laws that shield people who report an overdose from prosecution.)
- Use only one drug at a time. Don’t mix heroin with cocaine, benzodiazepine or other drugs.
- Test the strength of the drug before using the whole amount. Cut the amount used at one time, and inject less if it’s too strong.
