The administration of Maine Gov. Paul LePage (R) has come up with a new reason to oppose expanding access to a lifesaving medication that reverses heroin overdoses: cost.
A parade of overdose victims' relatives, doctors and sheriffs spoke during a Wednesday hearing in support of a bill that would expand distribution of the drug, naloxone, to first responders and the family members of addicts. But an official from Maine's Department of Health and Human Services who spoke afterward said he was worried about the bill's potential effect on the state budget.
"The administration is committed to the prevention of drug abuse in this state, and to reduce the number of deaths as a result of drug overdoses," Nicholas Adolphsen, the department's director of legislative affairs, said at the hearing, held by the state's Joint Standing Committee on Health and Human Services. "We cannot, however, determine what the fiscal impact would be ... additional costs cannot simply be absorbed in our existing resources."
Last year, LePage vetoed a bill expanding access to naloxone because he claimed it would give drug users a feeling of invincibility. Scientists say there is no evidence to support that assertion.
"Do you think having a fire extinguisher in your home makes you more dangerous?" asked Dr. Phillip Coffin, a leading researcher on naloxone at the San Francisco Department of Public Health. "Personally, I think it makes you less dangerous, because you always have fire on your mind."
The LePage administration's new reason for opposing greater naloxone distribution appears to be undermined by medical research as well. A January 2013 study in the Annals of Internal Medicine found that naloxone is a highly cost-effective medication that saved one life for every 227 kits distributed.
"Among public health interventions, it's definitely among the top in terms of efficient use of resources," said Coffin, who co-authored that research. "It is most likely an extremely cost effective way to prevent heroin overdose mortality."
Depending on whether it is delivered as an injection or a nasal spray, a dose of naloxone can cost between roughly $20 and $50. Adolphsen expressed concerns about having the state's budget-crunched Medicaid program cover prescriptions for drug users' family members. The current version of the naloxone bill in Maine, sponsored by Rep. Sara Gideon (D), also calls for the state's health department to make grants for naloxone distribution from existing funds, which could cut into the budget for other projects. The department is currently looking at an $89 million budget shortfall.
"Twenty-two bucks?" asked Jay Nutting, the Maine lobbyist for the Drug Policy Alliance. "You take a couple hundred bucks out of your drug forfeiture budget and you can put a kit in every [police] cruiser. That really should not be the aspect that creates opposition. It's kind of a sad argument."
"Given the finances at DHHS and the pressure they're under, I get that they need to highlight that issue, but I don't think it elevates to the point where we should not pass this law that saves lives because of these $22 kits," he added.
Another state official, Jay Bradshaw of Maine Emergency Services, expressed concern that overdose victims brought back to consciousness by the medication "can be angry and physically violent. Vomiting is not unusual." Bradshaw also wondered if members of the public could be properly trained to deliver naloxone, as Gideon's bill envisions.
But experts disagree with his assessment. The American Medical Association wrote a letter last week in support of the naloxone bill in Maine, and White House drug czar Gil Kerlikowske on Tuesday called for greater naloxone access across the country.
"As a health care provider, if I see somebody who's unconscious on the street, the only medicine that I could safely give them by itself is naloxone," said Coffin. As far as first responders and family members' safety, he said, "we in San Francisco have had no reports of physical violence after a reversal, with around 1,200 reversals reported."
He acknowledged that making a heroin user who has overdosed breathe properly is "complex," but he said that was no reason not to administer naloxone in the first place.
Critics have sometimes questioned whether administering the drug will make those observing overdoses less likely to call 911, because they believe they have the problem under control by themselves. But Coffin said research he conducted in Seattle showed that people who have administered naloxone are no less likely to call emergency services than anyone else witnessing an overdose.
Nutting was underwhelmed by the administration's objections that naloxone would cost too much, and that it might not be safe for wider use.
"We'll take an angry, violent, throwing up person all over me if they live. I'll take that trade any day of the week," he said. "If the alternative is someone who is about to die, it really seems like a minuscule tradeoff."
CORRECTION: After publication, Coffin contacted HuffPost to say he misspoke, and that the number of reversals in San Francisco was not 1,500, as initially reported, but was 1,200.