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As opioid epidemic worsens, the cost of waking up from an overdose soars

Taylor Kay was driving on Interstate 290, heading east near Chicago, when a car veered across lanes of traffic into the highway median.

"I thought, 'Something is wrong,'" the 26-year-old said. "So I get out of my car, and I see he's overdosing, with a needle still in his arm."

Kay recognized what was happening to the driver because it could have happened to her. She had used heroin for six years, until she was 24, and she herself has overdosed. She knew what to do.

"I go to my car and I get my Narcan, because I always have it with me," Kay said, referring to the brand name of the drug naloxone, which quickly reverses opioid overdoses. "Once I put the Narcan in him, it took about 20 seconds. … I was so scared that this kid was going to die."

He didn't; he woke up, Kay said. She called 911, and the paramedics who arrived later told her the driver had taken fentanyl — a synthetic opioid up to 100 times more potent than morphine.

"Any longer," Kay said, "he would have died."

It's an epidemic playing out across America as prescription painkillers lead to addiction, and their price on the street often causes people to turn to heroin. In 2015, for the first time, the number of deaths from heroin overdoses in the U.S. surpassed those from gun homicides, according to the Centers for Disease Control and Prevention. In total, more than 33,000 people in the U.S. died from opioid overdoses.

As the number of opioid overdoses has skyrocketed in the U.S., so has the price of the drug that can wake someone up from a situation like Kay described. And in some cases, the rising prices make it hard for first responders and others to carry naloxone, which public health experts say threatens their ability to save lives.

"I've seen the price of Narcan as well as epinephrine just skyrocket," said Brandon Heard, a fire department captain in Farmington, New Mexico. While he referred to the brand name Narcan, Farmington Fire uses a generic form of the medicine. "It makes it difficult for us as a municipality to purchase the same medications and provide the same treatment and abilities that we have in years past."

Farmington Fire is switching away from the EpiPen, the lifesaving auto-injector for allergy attacks, in favor of vials of generic epinephrine and syringes, in order to save money. The department already uses a makeshift system for naloxone, with a preloaded syringe and a nasal spray attachment.

Public health experts say having naloxone in the hands of first responders — from firefighters to police officers — is vital; it can provide precious minutes before more medical help can arrive.

When someone takes too much of an opioid drug like heroin or prescription painkillers, which bind to opioid receptors in the brain, it can cause the body to stop breathing. Naloxone acts as an opioid antagonist, knocking opioids off those receptors in the brain and restoring breathing. Administration can bring someone back in seconds.

Naloxone has been available since 1971, originally under the brand name Narcan, and now in several generic forms, as well as formulations with new delivery systems. Both categories have their own cost stories; a generic form made by Hospira, now owned by Pfizer, rose in price from less than $1 per milliliter vial in 2005 to more than $15 in 2014. The newer delivery systems range in price from $125 for two doses to as much as $3,750.

It's a pricing story not unique to naloxone. Prices have risen for certain generic drugs across the pharmaceutical industry, most recently garnering headlines with EpiPen, which is owned by Mylan. In many ways, aspects of the naloxone story are similar: While the prices of some older generic drugs rise, new delivery systems carry higher and higher price tags.

Taylor Kay was carrying the Evzio auto-injector that day on the highway. Made by Richmond, Virginia-based drug developer Kaleo Pharma, the device is about the size of a deck of cards, and actually talks to users while they administer it.

"I love that it talks to you," Kay said. "With the syringe, it's like: You have to go get the syringe, get the vial, and put the medicine in … with the auto-injector, you just take the cap off, and it speaks to you, and then it talks you through how to use it. So it is a lot faster."

The Evzio has a list price of $3,750 for two auto-injectors, up more than 550 percent since it was introduced in 2014, according to data from Truven Health Analytics.

"We call it the Courvoisier of the overdose...