New state program mails free opioid overdose-reversal kits to Iowans

A new initiative launched by the state public health department aims to increase access to the opioid overdose-reversal drug naloxone, but local advocates say the project may present more barriers than state officials hope.

The Tele-Naloxone Project was launched statewide earlier this month by the Iowa Department of Public Health in partnership with the University of Iowa Hospitals and Clinics.

Through the program, Iowans can have a naloxone kit - containing Narcan, a nasal spray that can be used to reverse an overdose on opioids - mailed to their address for free.

'The intent we want to make clear is that the Tele-Naloxone Project is to prepare an individual in case they encounter someone or they themselves experience an opioid overdose,” said Kevin Gabbert, opioids initiatives director at the Iowa Department of Public Health.

The project is funded through the State Opioid Response grant, the $4.4 million federal grant given to Iowa earlier this year from the Substance Abuse and Mental Health Services Administration. The agency, which is within the U.S. Department of Health and Human Services, distributed $932 million in State Opioid Response grants nationwide to address the opioid crisis.

Each naloxone kit costs approximately $150.

State officials have not set aside a certain dollar amount from the grant for this initiative, but Gabbert said they envision funding the program 'as long as we have funding available.”

The Tele-Naloxone Project is modeled after Iowa's TelePrEP program, another partnership with the University of Iowa Hospitals and Clinics that offers HIV pre-exposure prophylaxis (PrEP).

Iowans seeking naloxone kits from the state must either call or fill out a form on the project's website, www.naloxoneiowa.org/telenaloxone. Then, once they participate in a consultation with a UIHC pharmacist through a video call, the kit will be mailed to their address.

Higher than expected demand

Since the project's launch on Dec. 12, officials have seen unexpected high level of demand for the kits. As of Dec. 20, there were 168 requests for consultations submitted through the website since the launch of the program the week before.

'Early data reviews indicate that phone requests are on par with digital requests, which would put our current estimated total at 336,” Gabbert said.

State public health officials initially anticipated about 75 consultation requests per week, on average. Gabbert said he expects the high demand to eventually level off.

'Pharmacy staff are working diligently to meet the needs of the public at this time,” Gabbert said. 'They currently expect to be caught up and resume one-day response times as we move into the new year.”

But the delay in obtaining naloxone kits has raised some concerns from the Iowa Harm Reduction Coalition, an Eastern Iowa advocacy organization that provides services to those who use drugs, including opioids. In the past two years, the organization has distributed more than 30,000 doses of naloxone.

Sarah Ziegenhorn, executive director of the Iowa Harm Reduction Coalition, said distributing naloxone should be treated as an emergency, as people at risk for an overdose may not actively seek it out.

'It's an emergency for us to get naloxone to people, but for people who use drugs on a day-to-day basis, it's not,” Ziegenhorn said. 'When you get in your car in the morning, you're never like ‘today could be the day I die in a car accident.' For a lot of opioid users, it's just something you do. It becomes mundane, and you don't perceive the risk as greatly.”

Gabbert, however, stated the program is not meant to provide urgent access to the opioid overdose reversal drug. Instead, it is meant to prepare individuals, especially those who have loved ones that use drugs, in case they ever come across someone experiencing an overdose.

'In any of those urgent situations, emergency medical situations need to be pursued,” Gabbert said.

Consultation required by state policy

According to a 2018 report from the Centers for Disease Control and Prevention (CDC), more than 80 percent of overdose reversals with naloxone in the U.S. are carried out by individuals who use drugs. Therefore, naloxone distribution is most effective when provided to people at risk themselves for an overdose, the report states.

That is a population the Tele-Naloxone Project is hoping to reach, state officials said.

However, Ziegenhorn said the requirement to give full names and birth dates may deter those individuals who use drugs, as they could be fearful of prosecution from law enforcement, or of facing stigma from the medical community.

She also added that those without smartphones or access to technology face barriers to this program.

State rules require individuals to consult with a pharmacist in order to obtain naloxone, since it's considered to be a prescription. The rules also allow individuals to receive the drug from their physician, such as their primary care provider.

The required consultation with a UIHC pharmacist not only follows state policy, but it also ensures Iowans receiving the opioid overdose reversal drug have the appropriate training in the signs and symptoms of an overdose, Gabbert said.

In addition, Gabbert said it emphasizes the fact that naloxone administration is just a temporary reprieve from an overdose.

'It's not meant to be the solution to a person's overdose,” he said.

Overall, more naloxone access is always a good thing, Ziegenhorn said.

In 2017, drug overdose became the leading cause of injury-related deaths in the United States, according to the CDC. Opioids were involved in 47,600 overdose deaths in 2017, or nearly 70 percent of all drug overdose deaths in the U.S. that year, according to the CDC.

According to the National Institute on Drug Abuse, there were 206 overdose deaths­­­ involving opioids in Iowa in 2017.

Linn County saw 34 fatal opioid overdoses between 2016 and 2017, according to data from the county public health department.

'It's always extremely important to make naloxone more accessible and to find new routes and new avenues to get naloxone to people, because no one route is going to work for everyone,” Ziegenhorn said. 'The nice thing about this program is that it allows people to get it for free.”

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