Frustrated and out of patience with bureaucratic stalling in the midst of the opioid crisis, Dr. Noah Nesin, medical director at Bangor-based Penobscot Community Health Care, recently announced he will personally write a prescription for the life-saving drug naloxone for any adult in Maine who asks for one.
No office visit is required.
“All it takes is a phone call,” Nesin said Monday.
He hopes other health care providers will follow suit.
Naloxone, also known by the brand name Narcan, reverses the effects of opioid drugs and can save the life of someone who has overdosed on heroin, fentanyl, prescription painkillers or other opioids.
Maine’s crisis in opiate use and addiction claimed 418 lives last year, an increase of 11 percent over the year before. Since 2016, the rules needed to make Narcan available over the counter have been stalled in Augusta, first with the Board of Pharmacy and then on the desk of Gov. Paul LePage.
LePage vetoed the initial legislation, writing in his veto message that, “Naloxone does not truly save lives; it merely extends them until the next overdose.” Since lawmakers overrode his veto, LePage has made little effort to speed the law’s enactment and successfully pressured the state’s pharmacy board to impose an age limit of 21 on the ability to purchase the drug, a move critics said lacked any medical or scientific rationale.
Other regulations and rulemaking required by the law have yet to be submitted to the governor’s office by his Department of Health and Human Services. LePage has argued that increasing access to Narcan discourages opioid users from getting the treatment they need to overcome their addiction.
Nesin said the “really incomprehensible delay” in making Narcan available without a prescription motivated him to approach the PCHC board with the idea of at least making those prescriptions easier to come by.
“Our leadership team totally endorsed it,” Nesin said.
That means any adult in Maine, even without being a PCHC patient, can pick up the phone and ask for a prescription that can be filled at the pharmacy of their choice. Nesin doesn’t know of any other medical practice in Maine or elsewhere that has adopted such a policy, but he said at least one other practice in Maine has contacted him to express interest in following his lead.
Nesin says prescribing for someone he’s never met is unusual, but not unprecedented, and he doesn’t anticipate any challenge to his medical license.
“For example, if a patient comes to me with a sexually transmitted disease, I can treat that person’s sexual contacts [with an antibiotic] without seeing them,” he said.
Some insurers will cover the cost of Narcan, Nesin said, but many people will have to pay out of pocket — about $75 for a single dose delivered as a nasal spray. Still, he said, for those who can afford it, the low-barrier prescription provides access to an essential tool.
In clinical guidelines adopted in 2015, the American Society of Addiction Medicine recommends that patients being treated for opioid use disorder, along with their family members and significant others, be given prescriptions for Narcan and trained in how to administer the drug.
At an event last week announcing PCHC’s action, a spokesperson read a statement from Sen. Angus King, who has conducted meetings about the opiate crisis across the state in recent months, including one in Bangor last month.
“These meetings have shown me time and time again that the scope of this scourge is massive, and that the depth of the anguish it causes is endless,” King said in the statement.
King, who has advocated for prescription-free Narcan distribution since 2016, commended PCHC on its leadership in making the drug more available.
As Mainers wait for Narcan to be available over the counter, some groups who work directly with the drug-using population have been able to obtain it. Since June of 2016, the office of Maine Attorney General Janet Mills has provided Narcan to law enforcement groups, including state and local police. And, despite the absence of rules governing its distribution, the Maine Health Equity Alliance, known as HEAL, has used private funds to provide free Narcan kits and training directly to drug users and their associates.
“We gave out about 200 Narcan kits last year and have heard back about 100 overdose reversals,” said HEAL spokeswoman Andrea Littlefield.
She called PCHC’s announcement “a step in the right direction” to get Narcan into the hands of parents and allies of drug users. “If I were the parent of someone who was using drugs, I would want to have it,” she said.
Littlefield said the group will switch from the nasal spray to an injectable form of Narcan in order to save money and provide more kits to more people.
Both Nesin and Littlefield said social stigma and political considerations underlie the stalled effort to make Narcan available in Maine without a prescription.
“Some people find it very difficult to see [addiction] as a disease,” Littlefield said. “They see it as a choice people make to use drugs and they think, ‘Why should I have the same compassion toward you as I would have toward someone with cancer?’”
But in the meanwhile, she said, people are dying from overdoses in Maine at the rate of one every 21 hours.
As long as the effort to make Narcan available over the counter remains tabled in Augusta, Nesin said his goal is to help get the drug into as many hands as he can, as easily as possible. He especially hopes that friends, neighbors and family members of people who use opioids will take advantage of the new PCHC policy — even those who have trouble thinking of addiction as a disease.
“More access means more ability to save lives,” he said. “No one would walk by someone who was dying of a drug overdose if they had this tool in their pocket.”
A request for comment from the Maine Board of Pharmacy on Monday went unanswered.
Mainers who want to request a prescription for Narcan can call PCHC at 207-404-8000, ext. 2232 or 1157.
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