Pharmacists in West Virginia soon could provide naloxone — the opioid-reversing drug — over the counter if the West Virginia Legislature passes a bipartisan bill supported by Gov. Earl Ray Tomblin.
The legislation (HB 4035) would change pharmacy and medical rules to allow trained pharmacists to sell the overdose antidote at pharmacies throughout the state without a prescription, which is currently required under West Virginia law.
If the bill passes, the Mountain State would join many neighboring states, including Kentucky, Ohio and Pennsylvania, which have legalized over-the-counter dispersement of the life-saving drug in the past year, either through executive orders or similar legislation.
The law is expected to increase people's access to naloxone — also known by its brand name Narcan — to reduce the number of overdose deaths caused by heroin and prescription pills, like morphine, Percocet and OxyContin. The drug can cost $100 to $3,700, depending on the manufacturer and the way it is administered to overdose victims.
West Virginia has the highest drug overdose death rate in the nation, with nearly 34 deaths per 100,000 people, more than double the national average.
The push to have naloxone, known as an opioid antagonist, sold over the counter at drug stores is one of the biggest steps being taken to combat West Virginia's problem with opioid addiction and death, which President Barack Obama spoke about in Charleston last year.
Many pharmacy chains in Ohio, Kentucky and Pennsylvania already have agreed to sell naloxone, including numerous Kroger stores. At least one pharmacy executive in West Virginia plans to allow the over-the-counter sales if the law is passed in the Mountain State.
As the debate over naloxone distribution has moved forward, Lynne Fruth, the president of Fruth Pharmacy, said she and her staff have had lengthy discussions about whether the Point Pleasant-based company would sell the emergency medication without a prescription or not.
In the end, the pharmacy chain, with more than 20 locations in West Virginia and Ohio, decided that it couldn't ignore the public need for the drug. Fruth said Tim Webber, the company's vice president of pharmacy, explained during meetings that he became a pharmacist to help people and that it shouldn't be up to him to decide who lives and who dies as a result of access to this drug.
“We will be participating in the naloxone programs in both states, but we are not up and running yet,” Fruth said, adding that the company's stores in Ohio would begin selling the drug as early as April.
For those concerned about the use of the drug without a prescription, Fruth has a simple message: Someone who dies from an overdose will never receive a second chance to defeat their addiction.
“If you live to fight another day, you have another chance at recovery,” Fruth said. “I think we should give them that tool, to live long enough to seek recovery.”
In January, Tomblin called for the Legislature to allow pharmacies to sell the drug without a prescription and, on Monday, the Governor's Office reiterated his support for the bill.
“The governor strongly supports expanding access to this life-saving drug that gives people a chance to survive a potential overdose and get their lives back on track,” wrote Chris Stadelman, Tomblin's communication director. “He appreciates the support of Fruth Pharmacy and others who agree it would be one way to combat heroin abuse in West Virginia.”
Fruth said the widespread harm of heroin and prescription pill addiction in West Virginia and across the country made the choice rather easy.
“If you don't know somebody who has felt the heartbreak of drug abuse in their family,” she said, “just wait, you will.”
The lawmakers supporting the bill, which passed the House's Health and Human Resources Committee in late January, say one of the primary reasons for the bill is to get the drug into the hands of more people. Currently, only emergency responders and people with a prescription have access to the drug.
Chris Stansbury, the lead sponsor of the bill, said the need for a prescription from a doctor has limited the number of people who obtain naloxone. Records and conversations with medical professionals, he said, have shown that many physicians don't prescribe the drug because of legal concerns or out of fear of being the only doctor in the region who will approve the scripts for patients.
Many West Virginians living in rural parts of the state, he said, might not even have access to a physician to get a prescription for the drug, and even more might be too afraid to ask a doctor for a script because of the continuing stigma that surrounds drug abuse.
By putting the drug into more people's hands, said Stansbury, R-Kanawha, more lives could be saved. Instead of waiting on emergency responders to administer the antidote, family members or friends could counteract a heroin or pill overdose in a shorter amount of time, which can be a difference between life and death.
The law does not come without some restrictions. Every person who buys the drug at a pharmacy must be trained by a pharmacist on how to recognize an overdose, when to administer the antidote and how to use the drug, which can either be injected through a syringe or inhaled through the nose.
Fruth said she and her staff have met with the Governor's Office and voiced their support for those training requirements.
“I want to make sure, if a mother, brother or spouse comes in to get naloxone, they get the amount of instruction that is required,” she said. “This is not something you pick up in the drive-through and go use in the parking lot.”
About seven pharmacists with the company are being trained on how to properly administer naloxone and will then train the rest of the company's staff.
The law also requires pharmacies to provide educational material to the person buying the drug that will tell them how and where to access treatment programs. The pharmacy company is designing brochures and posters that highlight treatment programs in the region, and Fruth said every person who buys the drug in Fruth stores will receive a brochure on treatment opportunities.
Like the needle exchanges that have been started in parts of the state, the setup is expected to bring people suffering from addiction one step closer to treatment opportunities, while reducing the societal costs of drug addiction.
“Naloxone itself doesn't do anything for addiction,” Stansbury said, “and that is where the pharmacists are really critical to this.”
Reach Andrew Brown at andrew.brown@wvgazette.com, 304-348-4814 or follow @Andy_Ed_Brown on Twitter.