Johnson County EMS medical director Ryan Jacobsen envisions a day soon when any Kansan will be able to walk into a drug store without a prescription and walk out with a nasal spray that can save a life by stopping an opioid overdose.
Most other states allow that. Kansas has been slow to follow suit, even as the dual threats of the urban heroin problem and the rural and suburban prescription opioid epidemic creep into the state.
That’s about to change, thanks to a lobbying effort led by Jacobsen and a coalition of law enforcement and medical groups. A bill expanding access to the emergency medicine, naloxone, passed the Kansas Senate unanimously Tuesday and is now on the desk of Gov. Sam Brownback, who is expected to sign it.
Once the Kansas Board of Pharmacy finishes writing regulations for dispensing and tracking it, naloxone will be available to every Kansan concerned about opioids, including police officers who are first on the scene of an overdose, the mother who knows her son is addicted to heroin and the grandma whose husband is on prescription painkillers.
“Think of it like an Epi-pen or any epinephrine auto-injector,” Jacobsen said. “If you have a family member who has a severe peanut allergy, grandma carries one, mom carries one, dad carries one, baby sitter carries one, school has them. Well it’s the same kind of concept. If you knew you had a family member or somebody who was addicted to opioids or had overdosed already once, it would be nice if you had a potentially life-saving thing that had zero downside.”
Naloxone, sometimes referred to by the brand name Narcan, works by blocking opioid receptors, so if it’s given by mistake to someone who isn’t on opioids it has no effect. The only potential medical downside to using the drug is sending someone into opioid withdrawal if they’re heavily addicted.
Hospitals and licensed paramedics have been using it for decades in Kansas and elsewhere.
But others had to seek a prescription from their personal doctors, who were only authorized to prescribe it to the person who was going to take it, not a third party.
Over the last several years states hit hard by the opioid epidemic have changed their laws to make it easier for lesser-trained emergency medical personnel, police officers and even private citizens to get it and use it on others as needed.
As of December, Walgreens was selling naloxone without a prescription in 33 states and Washington, D.C.
Missouri and Arizona passed expanded access laws last year, leaving Kansas, Wyoming and Montana as the last states without them.
Jacobsen said Kansas was behind the other states largely because the opioid crisis has been less acute there. A Kaiser Family Foundation analysis of data from the Centers for Disease Control determined there were 150 opioid overdose deaths in Kansas in 2015, compared with almost 700 in Missouri and almost 2,700 in Ohio.
But Jacobsen said Kansas law enforcement agencies have been showing more interest in accessing naloxone, both for rescuing others and potentially rescuing each other.
Law enforcement access
Jacobsen said the push for expanded access in Kansas actually began with a call to him from the Johnson County crime lab. The employees there were working with increasingly concentrated and dangerous seized opioids that, when in powder form, had the potential for unintentional ingestion.
Could they have some naloxone to keep in the lab?
“My answer was, I don’t know; you’re not a medical provider, you’re a government employee that works in the crime lab,” Jacobsen said.
After consulting with numerous state agencies, Jacobsen found there was no legal framework to allow that in Kansas, as there was in other states.
The Kansas Legislature, more focused on patching annual budget holes, had yet to really consider the opioid issue. But once a naloxone bill was introduced it quickly found traction with a new-look House Health and Human Services Committee that includes several freshman legislators who are also medical professionals.
Law enforcement also lined up behind it. Ed Klumpp, a retired Topeka police chief who lobbies on behalf of associations for sheriffs, police chiefs and rank-and-file officers, said it became a top legislative priority.
Officers are concerned about accidental exposure to seized drugs, but Klumpp said they’re also eager to be able to help when they’re the first on the scene of an overdose. Kansas may not have the opioid problem that other states have yet, but Klumpp said it’s getting worse. There were nine heroin overdoses in Shawnee County over a one-week period last Christmas, Klumpp said.
“There are definitely some agencies that are really wanting to get moving on this,” Klumpp said.
The Grandview Police Department was the first in the Kansas City metro area to start distributing naloxone to its officers after Missouri changed its law last year.
“We started talking about it last summer just cause we started seeing more overdoses,” Grandview Police Department Capt. Ryan Sharp said.
Sharp said the department hasn’t had to use it yet, because so far the fire department or EMS have been first on the scene to every overdose since then. But he believes the day will come. He said he knew of at least three car crashes in his jurisdiction just since the beginning of the year that were caused by opiate use.
“They’re not necessarily alcohol anymore,” Sharp said. “A lot of people are high on their pills.”
Throughout the country more than 1,200 police forces already carry naloxone, according to an advocacy group in North Carolina, another state with an outsized number of opiate-related deaths.
The Baltimore City Police Department was one of the first, and Baltimore City Health Department spokesman Sean Naron said officers have saved 70 lives with naloxone since 2015.
Jacobsen said there will be training and medical oversight requirements for police officers in the new Kansas law, but the greatest obstacle to widespread adoption of naloxone is likely to be cost. The nasal spray can be purchased for as little as $150, while auto-injector devices that deliver naloxone in a syringe can run into the thousands.
It’s already becoming an issue in Baltimore.
“Cost is a serious factor,” Naron said. “It has increased significantly over time.”
Sharp said Grandview Police purchased its first set of naloxone with its general fund, but is planning to use asset forfeiture proceeds to purchase replacements as needed.
Klumpp said that once the Kansas bill becomes law and the rules are written, the last step in expanded access to naloxone will be for each jurisdiction to decide if the benefits outweigh the costs.
“Every agency is going to have to decide how they’re going to do this because it’s not cheap,” Klumpp said. “To buy one of those for every officer, you’re looking at some big bucks.”