Where to get overdose reversal drugs in Wyoming?

When it comes to the role of overdose-reversal drugs like naloxone and Narcan in the opioid crisis, a common mantra is that it’s better to have and not need than need and not have — especially as an increasing number of young people are dying from overdoses nationwide. 

Top federal officials recommended more Americans start carrying the drugs as far back as 2018. 

It’s not always easy for Wyoming residents to access or afford these potentially life-saving tools, however. Things are changing, but significant challenges remain.

Why have naloxone?

Illicit drugs have become more dangerous, often mixed with the potent synthetic opioid fentanyl and other nefarious additives. That means everyone from a curious teen to someone who’s used drugs for a long time can lose their life after taking only one pill.

As WyoFile reporting found, several trends in the state — ranging from EMS suspected overdoses to drugs seized by law enforcement — show that the risks of overdosing are increasing in Wyoming.

However, it’s not just people using illicit drugs who benefit from naloxone: chronic pain patients and elderly individuals who’re prescribed several opioid medications may also be prescribed naloxone. Their family members and caretakers could benefit from having the drug, too.

“There’s concern in the older age group,” said Jennifer Miranda, a pharmacy case management supervisor in Montana working with Mountain-Pacific Quality Health. “We do forget about the elderly population and we have to remember: they’re more likely to get an opioid for a hip fracture or for a cancer diagnosis.”

Miranda was speaking at a recent Drug Information Opportunity Symposium in Cheyenne. Older residents can be prescribed a mix of prescription drugs and may have dementia or Alzheimer’s, she said, which can increase the risks of an accidental overdose.

Naloxone has been used to save many lives in Wyoming this year. Between Jan. 1 and June 1, there were 741 suspected overdoses, 57 suspected overdose deaths and 116 naloxone administrations, according to ODMAP data presented by Cheyenne Fire Rescue’s Brice Jacobson at the same summit. 

“We know these numbers are underreported,” he added, noting that he’s talked to his own kids about naloxone in case they have to use it.

Where can I get naloxone now?

Wyoming statute says pharmacists can prescribe the medication directly to most people. That includes those at risk of an opioid overdose, those who could help someone at risk of overdosing or someone who “in the course of their official duties or business” may encounter a person overdosing.

At five pharmacies in Laramie, the reception to a request for naloxone was mixed. Staff at some stated they give prescriptions to almost anyone who asks, while others said they didn’t get many requests or seemed more reluctant, initially telling a WyoFile reporter she would need a prescription.  

Insurance will often pay for naloxone prescriptions, but costs range for the uninsured — a group that is expected to grow as thousands of Wyomingites lose access to Medicaid. Amongst Laramie pharmacies visited, the cost for a two-pack of nasal spray generic naloxone ranged from $60 to $99. Brand name Narcan two-packs cost anywhere from $120 to $150. 

A Narcan employee working for a consumer helpline stated that by late July, the company’s product is expected to be available over-the-counter. That’s thanks to a March FDA approval of an over-the-counter naloxone nasal spray. There won’t be a need to ask a pharmacist for it, unless someone wants insurance to help pay for it. 

It’s taking a while to reach stores because each manufacturer has to get further approvals from the FDA and new labeling, according to Wyoming Pharmacy Association President Matthew Meyer.

“So right now, even though the FDA has approved that Narcan can be moved to over-the-counter, I have not seen any of the wholesalers currently carrying the ‘over-the-counter’ Narcan,” said Meyer, who also owns and works at Hospital Pharmacy West in Sheridan.

Wholesalers are the companies that pharmacies, stores and even vending machines could buy the product from once it makes it through manufacturing.

The cost for over-the-counter spray is rumored to be around $50 for two doses, but Meyer doesn’t want to speculate just yet. 

For those who don’t have insurance or much cash to spare, things get trickier. 

Where to look? 

Businesses and organizations can apply to get free naloxone through the Wyoming Department of Health, which has a federal grant to disseminate it through September 2024.

Participation requires a business to follow state rules, including having a policy that includes training for how to use naloxone, making sure anyone who has overdosed gets further medical care and reporting naloxone administrations to the WDH via an electronic form. 

Since August 2022, the WDH program has given out nearly 1,800 2-packs of naloxone nasal spray to 90 entities, according to Erica Mathews with the WDH. Though any kind of business can apply, common requesters include law enforcement, schools, treatment providers and those serving vulnerable populations. 

“Any certified physician or pharmacist in Wyoming is authorized to provide a prescription or standing order for NARCAN,” Mathews stated in an email. “Because of this flexibility, it really has never been a barrier.”

That said, if an organization has trouble securing a prescription or order, she stated, the WDH can help. 

There’s one big caveat: the program was originally only intended for organizations to have naloxone on hand, not give it out.

Federal rule changes could prompt a change in that policy, Mathews said, but “it’s just too soon to say right now.”

That said, more opportunities to distribute naloxone may be on the horizon. 

Dr. Angela Vaughn is a community health project director at the Wyoming Institute of Population Health. Working through the Cheyenne Regional Medical Center, Vaughn is helping start something called the Wyoming Naloxone Project, which aims “for all hospitals, labor and delivery units and emergency departments to distribute naloxone to at-risk patients.” 

That means giving patients naloxone before they leave the building and potentially offering help — including medications — to those who want to seek further treatment for a substance-use disorder.

Several harm-reduction groups in Wyoming have also secured naloxone via other avenues to hand out to those in need. That includes the Wyoming Harm Reduction Collective, which recently accepted a grant that will be used in part to get more of the life-saving drug. 

While WDH’s free naloxone could still be helpful for WHRC to have on hand, volunteer Kota Babcock said, the grant-funded naloxone can be given out without restrictions. That would enable the collective to provide naloxone to law enforcement agencies that don’t have it yet or didn’t know about the WDH program, Babcock said. 

“I’ve distributed quite a bit to highway patrol [and] local law enforcement just because they didn’t know that the Department of Health would do it,” Babcock said. “And they were under the impression that the department would have to pay for it themselves, which is obviously not ideal when you live in a small town and have limited resources.”

There is also a Wyoming Medication Donation Program via WDH, which is free but involves a fair amount of paperwork, according to Lander Free Medical Clinic Executive Director Kevin Wilson. However, even though that program has many kinds of medications on hand, there were only six naloxone packs on June 20, Wilson found. 

There are national groups that mail naloxone directly to those in need, too, including NEXT Distro. Some substance abuse treatment centers and health care providers can also provide individuals with naloxone, but there’s no clear map of which places offer that.

WDH has a map that shows some locations offering naloxone, but portions of it appear to be out of date. Part of the site that includes overdose death data was last updated in 2018.

More recent overdose data is on their opioid dashboard, but as WyoFile has reported, timely local information on overdoses is limited.

For assistance in getting naloxone or other harm reduction tools in Wyoming, feel free to message the Wyoming Harm Reduction Collective on Instagram at @wyoharmreduction, reach out to Recover Wyoming in Cheyenne, check out WDH’s Narcan program or talk with local health care/pharmaceutical providers. You can also contact Dr. Angela Vaughn directly for help setting up in-person naloxone training at angela.vaughn@crmcwy.org or 307-773-8241.

If you or someone you know is having suicidal thoughts, you can call or text the Suicide Prevention Lifeline at 988.