PORTLAND — New rules from the State Board of Pharmacy for distribution of the overdose-reversing drug naloxone are being welcomed in the city and regionally.
Pharmacists can fill prescriptions for naloxone, also known by its Narcan tradename, but cannot write them. Rule 40 would allow licensed pharmacists to prescribe naloxone directly to people 21 years and older. The pharmacists must complete two hours of training, and counsel customers on proper use of the drug.
“The biggest impact is the friends and families of people who are using, it breaks a possible stigma for families who would not approach a doctor,” Oliver Bradeen said Feb. 2.
For the last two years, Bradeen has worked with Portland police as a liaison with overdose victims, meeting overdose victims and trying to get them any help he can. He said he has had 178 meetings with clients who “met with me face to face and wanted help,” he said.
He has also had another 96 referrals in that time, when suspected opioid use has led to almost 450 overdose calls, according to his and police data.
Naloxone revives victims of overdoses by directly blocking the effects of the opioids. With less than a full dose, it stabilizes a victim. With a full dose, a revived victim can become disoriented, physically ill, violent or go into withdrawal.
Bradeen and city Substance Use Prevention Program Coordinator Bridget Rauscher said people should call 911 first when there is an overdose, but Bradeen is less concerned about how much is administered by someone trying to help a victim after making the call.
“If someone is getting too much Narcan, it is better than no Narcan,” Oliver Bradeen said Feb. 2.
Pharmacy board President Joe Bruno emphasized Monday there are still limits to distributing naloxone. The new rules would expand naloxone prescribing authority to include pharmacists, but some form of prescription will still be required.
“It is not an over the counter drug,” Bruno said. “This just gives pharmacists prescriptive authority.”
Rule 40 is not in effect yet. The required public comment period and reviews by the pharmacy board, attorney general’s office and secretary of state could legally extend about 10 months.
Bruno hopes the reviews can move quickly and that the new rules can be in place by May 1.
Rauscher and Bradeen also hope the rules will be enacted quickly.
“This is a step forward to reducing barriers to access, which we wanted for years,” Rauscher said.
Narcan is carried by city police officers, who have used it 96 times in 76 calls in the last 15 months, Bradeen said. Emergency medical crews also carry it, and it is available at the city Needle Exchange.
The city has also hosted quarterly training programs on using Narcan and the chest compression techniques to save overdose victims. Narcan is not viewed as a cure for addiction, but it keeps people alive so they can start on the road to recovery.
“I’ve been narcanned once, and I used for four months after that,” Niki Curtis said Monday.
She said she barely recalls being revived after her overdose, it was mostly just a sense the responders were upset with her.
“There were these red faces in my view,” she said.
Curtis has been active in recovery for six years and runs a Portland sober house. She and Bradeen said they know people who have administered Narcan on multiple occasions.
Curtis has also led peer recovery efforts at the Portland Recovery Community Center, where executive director Leslie Clark said Monday the public needs to understand addiction as a disease in order to understand why some people have been revived with Narcan more than once.
“Once you apply a meritocracy approach, it is the wrong thinking. The thinking has to be this life is sacred, there is hope for the person for recovery,” Clark said.
The hope can become reality, Bradeen said.
“I have people in recovery who would be dead if not for naloxone,” Bradeen said.
In moving Rule 40 forward, the Board unanimously agreed to limit pharmacist prescriptions to people age 21 or older. Doctors can prescribe naloxone to people younger than 21, though.
Rule 40 was first sent to Gov. Paul LePage and the Department of Professional and Financial Regulation and approved by senior officials there, according to a Feb. 2 email from LePage’s press secretary, Julie Rabinowitz.
Rabinowitz said LePage directed the Department of Financial and Professional Regulation to sign off on Rule 40 once he was assured “the age to buy naloxone over the counter without a prescription had been raised in the rules to 21 to be consistent with other recent law changes raising the age of majority to purchase cigarettes to age 21.”
She did not respond to a question asking why the consistency was necessary to LePage.
Bruno said that the pharmacy board had previously agreed on 18 as the age requirement earlier in the rulemaking process, but that the minimum age “was the only sticking point” with LePage.
According to Bruno, the board’s action to raise the minimum age to 21 was pragmatic. Rule 40 had been stalled since August 2017.
“It was my way of getting the rule out of the Governor’s office and moving it along,” Bruno said. “It was all about compromise and it was all about pragmatism.”
The logic of raising the minimum age eluded Curtis, Clark, Rauscher and Bradeen.
“Beer and tobacco actually harm you, they don’t save your life, it is a false comparison. There is no rationale,” Clark said.
Lakes Region Weekly staff writer Matt Junker contributed to this story.
Bridget Rauscher and Oliver Bradeen work to prevent opioid use and overdoses in Portland, and said Feb. 2 that increasing the access to naloxone is needed to save lives.
Niki Curtis has been active in recovery for six years and was saved from an overdose by Narcan. She has lead peer recovery groups and operates a sober house where Narcan is considered essential but not a cure for addiction.
Moira Hoff receives an inhaler of Narcan from Needle Exchange volunteer Hilary Esslinger last June in Portland as part of city efforts to prevent overdoses. Officials urge calling 911 first if an overdose occurs.