Last week, the Alaska State Legislature took its first steps towards adding a new drug to its list of Schedule IA controlled substances. The list, detailed in A.S.11.71.140, codifies the illegality of drugs that represent the “highest probable degree of danger or probable danger to a person or the public” and define penalties.
The bill was first heard last week in the House Judiciary Committee.
“House Bill 24 addresses one of the issues that we’re facing statewide and nationally, which is the opioid crisis,” HB24‘s sponsor, Rep. Charisse Millett (R-Anchorage), said in her introduction. “Folks from around the state are losing their lives. Opioids don’t care what race, color, creed, or political affiliation you are. Once you get addicted to opioids it is one of the most dangerous drugs to manage. It’s one of the hardest drugs to get off.”
Opioids are scary. As an example, take the case of Jamie Roberts, a resident of Quinhagak. Alaska Dispatch News’s Lisa Demer recounted her tragic tale last year:
They were inhaling smoke from cooked heroin — once, twice, then each did a bit more, “three little tiny specks” in all, said Shane Church, 20. Soon he and his girlfriend closed their eyes, relaxing, lying together close.
She never woke up.
A lot of people never wake up.
“Every day, 120 people die as a result of drug overdose, and another 6,748 are treated in emergency departments (ED) for the misuse or abuse of drugs,” the Centers for Disease Control (CDC) notes. “Nearly 9 out of 10 poisoning deaths are caused by drugs.”
The CDC updated that in December of last year to note that 33,000 Americans were killed by effects of opioids in 2015 — more than any other year on record.
That sounds like it should be a suspense movie featuring Denzel Washington in a submarine, but it’s not.
U-47700 — more commonly known by it’s street name “Pink” — is a synthetic opioid that serves as an additive to other opioids, like heroin and other prescription medications.
“U-47700 has been found in combination with other powerful drugs such as heroin and fentanyl,” the CSAC wrote in its report to Gov. Bill Walker (I-Alaska) last month. “The substance is recognized unregulated and poses a serious risk to overdose. In short, it is highly dangerous and an imminent hazard to public health and safety.”
The drug was originally developed by the UpJohn Company — a pharmaceutical manufacturer based in Michigan — in 1976 as a candidate to replace morphine. However, preliminary testing showed that it wasn’t significantly more effective than morphine, so it was scrapped. But UpJohn patented it anyway, making its contents available to the public.
“So, what happens is, drug dealers in foreign countries — it looks like it’s primarily China where this is coming from — is they’re trolling the internet looking for these patents,” Millett’s staffer, Jeff Turner, told the committee during the bill’s hearing. “And they’re trying to find these patents and see what sort of designer synthetic drugs that they can come up with that are not banned under federal law or any state law and that they can sell on the internet.”
Even though the U.S. Drug Enforcement Administration (DEA) added U-47700 to the federal list of controlled substances in November of last year, Turner said he was still able to find the drug available for purchase online.
“I googled “Pink” in my office and I found a website that was selling it,” he told the committee. “It said it was based in South Korea, but, you know, there’s no way to tell. It said it was for animal testing, but it also recommended cutting the dosage in half if you try it. So, that’s what’s out there right now. You can still get it online.”
In her sponsor statement introducing HB24, Millett pointed out that animal testing revealed the drug could potentially be eight times stronger than fentanyl and 800 percent more potent than heroin. Overdoses have been linked, nationally, to 46 deaths since 2015.
“Of the opioid-related overdose deaths in Alaska since January 1, 2014, 29% involved fentanyl and synthetic opioids,” the Advisor Board on Alcoholism and Drug Abuse, house in the Alaska Mental Health Board, added in a letter supporting HB24. “The Division of Public Health reports that three of this [sic] deaths involved U-47700. Designer drugs like U-47700, like other opioids, pose a significant threat to the public health and safety of Alaskans.”
Part of the problem with opioids, Millett told her House colleagues, is the difficulty in keeping up with new drugs that come onto the market. She compared designer synthetic opioids to Spice — where manufacturers have engaged in a prolonged campaign to beat regulations, tweaking the chemical makeup of the drugs just enough to distinguish them from those already scheduled.
“It’s hard to predict what the synthetic makeup of that drug will be, unlike kratom which is a natural supplement. We can put them on the list once we define them,” Millett said, but encouraged a broader discussion about how to better combat the explosion of opioid variations flooding the market. “They’re getting more stronger, more potent, and they’re coming out of — not out of the U.S. but out of countries outside of the U.S. … [O]ne could go online and buy U-47700 through an internet website. Outlawing this in the State of Alaska will make that not available.”
A Developing Problem for Opioid Overdoses
Last year, the Alaska State Legislature passed an important bill dealing with the state’s opioid crisis — specifically, the problem of overdoses. The Alaska State Troopers reported that, in 2013, opioid overdoses constituted 79 percent of all overdoses. The Anchorage Police Department saw a 94 percent increase in heroin seizures that year.
Senator Johnny Ellis (D-Anchorage), now retired, introduced Senate Bill 23, which was signed into law last year. The bill legalized public access to Naloxone. As I wrote last year,
SB23 is… aimed at making a lifesaving drug that reverses the effects of a heroin overdose available to the public. The bill also removes civil liability for healthcare providers prescribing Naloxone, marketed under the brand name Narcan. Naloxone is not a controlled substance, is not addictive, and has no effect if mistakenly administered to someone not experiencing an overdose.
When administered during an overdose, Naloxone can prevent effects like the stoppage of breathing and loss of consciousness that happen during an overdose and allow emergency responders an extra 30 to 90 minutes to get on site and treat the victim.
The passage of SB23, Alaska became the 29th state to enact a law providing both access to Naloxone and immunity from those administering it. Three more have signed on subsequently.
That’s a great thing. But it also created a demand for a supply. And the manufacturers decided to capitalize off of that.
Naloxone is most efficiently administered as an auto-injection, much like an Epi-Pen. The FDA approved the first (and only) auto-injector in April, 2014. It is called Evzio and is made exclusively by Kaléo, Inc., based in Richmond, Virginia.
Kaléo has decided to jack the price of one package of Evzio from it’s initial price of $690 to $4,500. Other variations of the drug, have similarly spiked. A nasal spray manufactured by Amphastar, for instance, has increased in price by 96 percent during the same time period.
“According to the ongoing Federal survey of retail drug prices (available on the Center for Medicaid/Medicare Services), the price of Evzio increased more than 6-fold between October of 2015 and February of 2016,” Jay Butler told me via email. Butler is the director of the Division of Public Health for the Alaska Department of Health and Social Services. “The price of the naloxone nasal spray (trade name NarcanIN) has remained stable.”
He said that SB23 removed civil liability barriers to access to naloxone, but made no provisions for purchases.
“The state was able to get a 5-year federal grant for OD prevention, and we have used that to launch Project HOPE (Harm-reduction and Overdose Prevention and Education), which includes increasing access to OD prevention kits that contain naloxone nasal spray,” he added. “The price of that formulation has not increased.”
But, after the grant expires, opioid overdose prevention may be left to the whims of the free market of prescription medication. That might warrant some attention.