Each Friday, the Fayette County Health Department’s needle-exchange program gives clean needles and offers HIV testing to an average of 160 people in less than five hours.
But the health department can no longer offer naloxone, a drug that reverses a heroin or opioid overdose, to drug abusers who are most at risk of overdosing. The drug is sometimes referred to by the brand name Narcan.
The agency distributed 925 doses from September to April, when the money ran out from a grant that the University of Kentucky College of Pharmacy had received to buy the drug. On average, the department distributed about 50 naloxone kits every Friday, the only day the needle exchange is open.
“There is a need for more funding,” said Dr. Kraig Humbaugh, Fayette County’s public health commissioner. “They still ask for the kits every week. We are hoping to get funding in the future to restart the program.”
Amy Baker, program administrator for Lexington’s Substance Abuse and Violence Intervention program, has applied for a federal grant of more than $2 million — $500,000 a year for four years — that would pay for more naloxone kits for the Fayette County Health Department and other groups, plus education and outreach efforts. In addition, Baker has applied for a $100,000 U.S. Department of Justice grant, which would pay for a Lexington Fire Department staffer who would provide follow-up care and referrals to drug treatment programs for those who survive overdoses.
Baker said the city will know by October whether it will get the grants, but she admits that the competition is stiff. Local governments and health departments across the country are competing for a limited amount of federal and state grant money to pay for naloxone as drug overdose deaths climb and the cost of the drug increases with demand.
“Many cities can’t pay for naloxone for police and fire,” Baker said. “There is a growing need for funding.”
In 2016, the number of overdose deaths in Kentucky hit in all-time high of 1,404. At the same time, the cost of naloxone has surged. In 2005, it cost as little as $1 a dose. In 2013, it was less than $20 a dose. Now, the price per unit for many governments and nonprofits is closer to $40, according to a report from Human Rights Watch, a nonprofit.
Fayette County had the second-highest number of overdoses in the state: 162, up from 141 in 2015, according to an annual report from the state Office of Drug Control Policy that was released earlier this year. Only Jefferson County had more overdose deaths.
Without naloxone, the number of overdose deaths in Fayette County and statewide would be much higher, public health officials said.
The Lexington fire department, which uses city money to pay for naloxone, is one of many Kentucky agencies spending more on the drug each year.
In 2015, the fire department spent $46,132 on 1,214 doses of naloxone. In 2016, those numbers climbed to 1,496 doses and $56,848. In the first three months of 2017, the fire department administered 531 doses.
“We expect the 2017 expenditure to be more than in years past,” said Chris Martin, the fire department’s executive officer for emergency medical services.
Rising drug overdoses also contributed to the Urban County Council’s vote earlier this year to add a 12th ambulance and 12 employees to staff it as part of the city’s $358 million budget for the fiscal year that began July 1. The annual cost will be about $1 million a year.
The number of calls to the fire department was up 9 percent and the number of patients treated was up 15 percent over the same time last year, fire officials said during budget hearings in May. Overdoses played a key role in that jump, although the increasing age of the city’s population also was a factor, fire officials said.
Thanks to donations from a local bank, Lexington police officers also carry naloxone.
Central Bank of Lexington has donated $50,000 over the past 12 months to help offset the cost of providing naloxone to police.
Police Chief Mark Barnard told the council at a meeting in May that the police and fire departments have had to use multiple doses of naloxone to reverse a single overdose. Officials think that’s because a mixture of heroin and fentanyl, or heroin and carfentanil — which is much more potent than heroin — is sometimes sold on Lexington streets.
“It used to just take one dose,” Barnard said. “Now it’s taking two, sometimes three doses to bring someone back.”
Stephen Kelly, executive vice president of marketing for Central Bank, said the bank’s director of security is a retired Lexington police officer. The security chief told the bank staff about the city’s struggle to pay for the drug.
“We are very much aware of the obstacles that they face: They were critically short of funds to treat these overdoses,” Kelly said. “We felt that it was our obligation to help them as much as we could.”
Since September, when Lexington police first started carrying the drug, 82 officers have administered Narcan in 74 cases, according to police records.
‘Last 10 doses on the shelf’
Other cities and counties in Kentucky also are scrambling to find money for naloxone as the number of overdoses climbs.
In Clark County, Winchester Fire Chief Cathy Rigney is down to her last 10 doses. The county’s Agency for Substance Abuse Policy received a state grant that paid for 215 doses of naloxone for the Winchester Fire Department almost 12 months ago.
“At first, we thought there was no way we were going to use all of it,” Rigney said earlier this month. “Now, we’re worried. I just put the last 10 doses on the shelf.”
Melissa Stocker, the coordinator for the substance abuse policy agency, said the grant also paid for naloxone for the Winchester Police Department, the Clark County Sheriff’s Department and the county school district. An additional 200 naloxone kits were distributed at four community forums after people received training.
Stocker said she is applying for the same grant next year.
“We will be supplying law enforcement and the schools the same units again if we are granted funding,” Stocker said.
The Kentucky Office of Drug Control Policy awarded more than $324,682 to local agencies this year to buy naloxone. In addition, the office awarded $1.8 million in tobacco settlement money for other drug-control efforts that could include buying naloxone, said Mike Wynn, a spokesman for the Kentucky Justice and Public Safety Cabinet, which oversees the drug control policy office.
In addition, the Cabinet for Health and Family Services awarded approximately $500,000 in federal money to local hospitals and other health care providers to pay for naloxone. That money largely went to providers in areas with high numbers of overdose deaths: Lexington, Louisville, Northern Kentucky and parts of Eastern Kentucky, cabinet officials said.
Rigney said the Winchester Fire Department will dip into local funding to pay for naloxone while waiting for grant money.
“We will be in the same boat as everyone else,” she said. “We will be paying for it at market price — which keeps going up. But we have no choice. Unfortunately, we are not seeing a drop in demand.”