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Grassroots Effort Aims to Make Overdose Drug Narcan Easier to Get

The overdose reversal drug naloxone, better known as Narcan, has been available to anyone who wants it since June. But that doesn’t mean it’s easy to get.

John Burns runs a substance abuse support group for families in Dover. He says since the law passed, none of the nearly 30 people in his group has been able to get a prescription.

“Parents that were trying to get them through their primary care providers, they couldn’t get them. The doctors were saying no, that’s not legal, they didn’t know about it or they didn’t want to," Burns says. "The second group was the pharmacies. They just weren’t prepared, they didn’t know how to fill it, they didn’t know how to order it even if they knew what we were trying to do.”

Burns offered to show me just how tough it can be to get a prescription filled. So we headed to a Rite Aid in Somersworth. 

When Burns handed the pharmacist the script, she gave it a double look and then went back into the stacks of medication. When she returned, she spoke to her supervisor, who said he'd have to phone the board of pharmacy to figure out how to order the medication.

Credit Paige Sutherland/NHPR
Here are the two doses of Narcan and nose applicator that came with John Burns' prescription.

We then proceeded to another Rite Aid three miles down the road in Dover. This looked more promising – there was a sign on the counter that read, “Narcan available here.”

And within 10 minutes Burns had two doses of Narcan in hand.

Since Gov. Maggie Hassan signed a law to expand access to Narcan in June, state officials have been meeting with various departments to work out the details of the state’s rollout. They’ve created fact sheets for pharmacies and doctors, which can be found online, and earlier this month they made available more than 4,500 Narcan kits at community health centers across the state.

Michael Dupuis, executive director of the state’s Board of Pharmacy, says this type of campaign takes time.

“It’s something that we have not done before, so getting the word out, doing the education about what the law is -- it’s a new practice and any new practice that you roll out tends to have some lag time involved,” Dupois says.

"You know the downsides of prescribing naloxone are very few and the upsides are that it keeps someone alive," said Jason Lucey, a nurse practitioner in Dover.

But Burns thinks there’s no time to spare. “I felt like once the law was passed, I felt like day one it should be available to families,” he says.

And for Burns, this is personal. Last year his 18-year-old daughter was saved by Narcan after overdosing on heroin. 

So far this year, 247 people in New Hampshire have died from drug overdose, including eight in Strafford County since June. Another handful of cases in the county are pending toxicology reports.

During the summer, Burns teamed up with a local nurse practitioner, Jason Lucey, to get prescriptions out faster.  Lucey says he was initially hesitant to prescribe naloxone. 

“As a prescriber this whole law is such a different way of prescribing to people than we are accustomed to because what the law allows us to do is now prescribe to somebody that we don’t really have a relationship with," Lucey said. "You would never prescribe practically any medicine, even if it was an aspirin."

Credit Sara Plourde/NHPR
Since the law passed in June 2, 2015 there have been eight drug-related deaths in Strafford County.

Lucey was also worried he could be sued if something went wrong. But once he read up on the law and realized 39 other states were already prescribing Narcan this way, he said it was a no brainer. 

“You know the downsides of prescribing naloxone are very few and the upsides are that it keeps someone alive, who otherwise would likely die if they overdose on an opioid,” Lucey says.

Related: Here's the prescription that Jason Lucey wrote up.

Narcan, which only works on opioids, is non-addictive and is not harmful if given in error. The medication costs roughly $30 to $40 with insurance and around $80 out of pocket. But that cost is projected to rise as demand increases, as it did in Massachusetts and Rhode Island.

Credit Paige Sutherland/NHPR
John Burns demonstrates to members of his family support group in Dover how to administer Narcan.

So far Lucey has written roughly 100 Narcan prescriptions to family support groups throughout Strafford County.

Before John Burns hands them out at his weekly meetings, he sets aside time to train family members on how to use Narcan. So far he has trained dozens of people.

First they watch a short 10 minute video that explains what to do before, during and after giving the medication – breaking it up into five steps. That's followed by a hands-on demonstration of how to administer it.

But Burns and Lucey say the biggest hurdle remains getting the word out to prescribers and pharmacists. 

That’s where Melissa Silvey of the Strafford County Drug Task Force comes in.

Silvey and her team have provided information to all 23 pharmacies in the county detailing who can get Narcan and how to train people in its use, along with a standing order written by a doctor or nurse practitioner allowing anyone to walk in and get Narcan without a prescription.

Related: Here's the standing order that was dropped off at the 23 pharmacies.

Credit Sara Plourde/NHPR
More than 4,500 Narcan kits are available at no cost at community health centers statewide, including 30 at a center in Strafford County.

The task force also handed out packets for EMS and police to distribute on the job. Next on Silvey's list are the dozens of health care providers in the county.

“Our providers are not getting this information in real time," she says. "So the only way that I know how to get the message out is by going one by one. It’s not through a mass email saying here is your scripts, here is your educational material, please print. So we have to go practice by practice.”

Credit Paige Sutherland/NHPR
Stacks of these contact cards were handed out to EMS and police departments in Strafford County as well as all 23 pharmacies.

 And it's paying off, according to Chuck Mancuso of Dover, who is a member of Burns' family support group.  Just a few weeks ago he was able to get Narcan easily for his three sons who battle addiction.

"I don't think anyone was in a position at that time anyway to make it happen for us, so I think John's [Burns] involvement really paved the way for us to be able  to get our hands on some of this," Mancuso said. "Which is a godsend for us because we want to make sure we are not in a situation where one of them died." 

Burns said there’s still a lot that needs to be done before everything runs smoothly. But he hopes by next month everyone who wants it can easily get Narcan in Strafford County.

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