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(this article can be read by searching for the title on http://twitter.com/ http://twitter.com/, then opening the link in a private window) > Two doses of an i

(this article can be read by searching for the title on http://twitter.com/ http://twitter.com/, then opening the link in a private window) > Two doses of an injectable form of naloxone, Evzio, cost $4,500, up from $690 in 2014. The price of other forms of the drug, including the nasally administered Narcan, typically range from $70 to $150 per dose, officials say. The cost of naloxone [1] is an insignificant part of the cost of reviving an addict. The rest of the costs mentioned in this article are pure profiteering. [1] http://www.sigmaaldrich.com/catalog/product/sigma/n7758?lang.. http://www.sigmaaldrich.com/catalog/product/sigma/n7758?lang.... If you buy 5 grams from Sigma Aldrich, a 2mg dose costs $0.588. Add a few more cents for salt, water and packaging brings the cost per dose to $2. An EMS supplier sells a single "kit" with an intranasal atomizer for <$48 [2]... Someone on Reddit sent me 4 vials of naloxone. I sent them <$20 to cover postage. [Edit: these vials have .4mg naloxone. Needles were also included. I think the standard intranasal dose is 2mg.) [2] http://www.dixieems.com/Economy-Naloxone-Kit.asp?pid=2086 http://www.dixieems.com/Economy-Naloxone-Kit.asp?pid=2086 Naltrexone is very similar to Naloxone. It is used to keep people from getting high on opiates. Big Pharma has found a way to jack the price of this generic drug too. 15 days ago I posted about the Naltrexone rip-off: https://news.ycombinator.com/item?id=14672338 https://news.ycombinator.com/item?id=14672338

Clubber 9y ago
I don't know how long this country can survive with this rampant corruption and profiteering. When do we hit a breaking point, and what does that look like? I mean I read your response and think, "wow, that's horrible." Then realize absolutely nothing is going to be done about it.
- joshlemer 9y ago
  I guess one way it could play out is that as the corruption becomes more and more obvious, together with increasing differences in political ideology between red and blue states, an appetite for seceding from the United States could develop in some states, and if that sentiment becomes common enough, it could become a reality?
  - Melanie343 9y ago
    I get paid over $95 per hour working from home with 2 kids at home. I never thought I'd be able to do it but my best friend earns over 10k a month doing this and she convinced me to try. The potential with this is endless. Heres what I've been doing, •••••••••>>http://www.joinmate2.com http://www.joinmate2.com
  - Aaliyah5654 9y ago
    My mothers neighbour is working part time and averaging $9000 a month. I'm a single mum and just got my first paycheck for $6546! I still can't believe it. I tried it out cause I got really desperate and now I couldn't be happier. Heres what I do, •••••••••>> http://www.joinmate2.com http://www.joinmate2.com
  - Retric 9y ago
    It's IMO more likely than most people think. I really hope we don't see a civil war in our lifetime, but historically democracy's are highly unstable. This time it might be different, but then again it might not.
    - Clubber 9y ago
      A Civil War today would look like Afghanistan or Iraq, not like the one we had before. It won't be pretty and will probably end in authoritarianism the likes we've never seen.
      - maze-le 9y ago
        A civil war in a nuclear armed country could be considerable worse than that. Just consider what would happen if a faction of the army with control over nuclear weaponry took a non-neutral stance...
      - deleted 9y ago
        [deleted]
      - Retric 9y ago
        ~50% of all US war casualties occurred during the Civil War. It was very nasty, even if only 3% of the total US population died in direct fighting.
- tcj_phx 9y ago
  100 years ago, politicians were tricked into trusting organized crime to tend to the health of people who are drawn to opiates. Those politicians are dead & gone, but we're still stuck with their mistake. My mother broke her wrist 6 months ago, and was given opiates to deal with the pain of having a plate put in her wrist. She did not become an opiate addict. I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life.
  - extra88 9y ago
    By "organized crime," I assume you mean something other what's traditionally thought of as organized crime, e.g. the Mafia, but I can't tell what. > I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life. While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates.
    - tcj_phx 9y ago
      > By "organized crime," I assume you mean something other what's traditionally thought of as organized crime, e.g. the Mafia, but I can't tell what. The Mafia and other manifestations of "traditional" organized crime is exactly what I was referring to. Two years ago, when a new friend was teaching me about her addictions, I bought Johann Hari's book, Chasing the Scream: The First and Last Days of the War on Drugs [2]. Hari says that after heroin was made very difficult to obtain (circa 1915), organized crime became the supplier for most addicts. The Los Angeles Times Op-Ed A 1930s California story shows why the war on drugs is a failure also covers how the Mafia swooped in to supply the needs of addicts [2]. This is the primary article I was thinking of when I wrote the quip you responded to. [1] http://chasingthescream.com/ http://chasingthescream.com/ [2] http://www.latimes.com/opinion/op-ed/la-oe-hari-california-drug-war-history-20170616-story.html http://www.latimes.com/opinion/op-ed/la-oe-hari-california-d... > > I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life. > While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates. My mother is inherently less prone to becoming an addict because she has meaningful things to do: job, family, friends, trips, etc. My friend who taught me about addictions (mentioned above) was vulnerable to the street pharmacy because she was exposed to meth amphetamine as a pre-teen, and her brain chemistry never fully recovered. She says she was very depressed as a child/teen, and was made suicidal by her doctor when he injected her with Depo-Provera around age 20 (this is a chemical castration drug used for 3 months of "birth control"). This friend is doing well now because I provided the "connection" that Johann Hari says is so important for helping addicts out of their pit.
- Melanie454 9y ago
  I've made $64,000 so far this year working online and I'm a full time student. Im using an online business opportunity I heard about and I've made such great money. It's really user friendly and I'm just so happy that I found out about it. Heres what I do, •••••••••>> http://www.joinmate2.com http://www.joinmate2.com
- hrehhf 9y ago
  > I don't know how long this country can survive with this rampant corruption and profiteering. So far it has been 241 years.
- shams93 9y ago
  Rather than a revolutionary movement you see mass implosion, addiction, suicide and people falling apart under the weight of triple time hours or being excluded from work altogether .
- chaosbutters314 9y ago
  You mean unregulated Capitlism? It will wake up when we realize we need some middle ground between Capitalism and Socialism.
  - robotresearcher 9y ago
    Most everybody already realizes this. We have exactly such a system in place. The argument is about exactly where the balance is to be found.
  - deleted 9y ago
    [deleted]
dwelch 9y ago
Furthermore, I'd imagine the cost of the naloxone alone is a small percentage of the total cost of the emergency responders + acute care given in life-threatening overdose. The article doesn't discuss a recurring theme in medicine: acute care is really, really expensive. It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose.
- tcj_phx 9y ago
  > It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose. Johann Hari has pointed out that it's very effective to just give heroin addicts pure heroin and a safe place to inject it. Switzerland has 'essentially' [edit] eliminated opiate deaths with this strategy: [edit: added 'essentially' in response to tptacek's comment below because the swiss probably haven't gotten rid of 100% of their opiate deaths] https://www.irishtimes.com/news/health/johann-hari-heroin-injection-centres-could-save-state-money-1.2216986 https://www.irishtimes.com/news/health/johann-hari-heroin-in...
  - tptacek 9y ago
    In reports about the Swiss strategy and in this story about Hari I see plausible claims that Switzerland has eliminated deaths due to needle-borne HIV, but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source?
    - tcj_phx 9y ago
      > but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source? I have edited the comment above to add a word. The friend who taught me about her opiate addiction knew how to manage her dose pretty well. Then the mental health industry got her addicted to benzodiazepines, which changed her tolerance. She overdosed on me when trying to get off the benzos. The fire department revived her, then disappeared into the night. Those two doses of Naloxone stabilized her for about 2 weeks... A lot of the deaths in the United States' present opiate overdose epidemic has to do with contamination of the heroin supply with more powerful synthetic opiates. When the supply includes elephant opiates, addicts don't know how much to use.
nimish 9y ago
If you totally discount the good manufacturing practices and traceability that pharmaceuticals have to follow, sure you can hack together a cheap substitute that might not work when the chips are down Except for biologics, many drugs are not that expensive to manufacture. The cost is in proving they will do what they say they do on the package.
- maxerickson 9y ago
  It's clear enough that the manufacturer is enjoying their market position rather than having their costs spiral out of control as demand increases.
- matthewaveryusa 9y ago
  Do you really believe that it costs upwards of 4000 dollars to track a little box with medication in it? For that money I hope each box comes with a solar rechargeable smartphone that sends a gps beacon every half hour.
  - GhostVII 9y ago
    It's not the tracking, it's the super long and expensive regulatory process, and the cost of researching the drugs. Remember that for every successful drug, there are probably many that the company spent lots of money working on, and didn't end up working out. Someone has to pay for those failed ones as well.
    - anon946 9y ago
      How does that explain that the autoinjector was $690 in 2014 but $4500 today?
      - deleted 9y ago
        [deleted]
      - mejin 9y ago
        I don't know about the autoinjector, but for a lot of medication the list price is there simply so that when the insurance company negotiates a lower price, the manufacturer will get a reasonable amount. in many cases expensive drugs can even be free if your income is low enough.
Quequau 9y ago
After struggling with alcoholism for decades I used Naltrexone to stop drinking five or six years ago. It wasn't a simple taper but when I had my last drink it was easier to walk away from than anything I could have ever imagined before I did it.
- toomuchtodo 9y ago
  Thank you for posting this; it'll help me help someone who is a self destructive alcoholic.
  - Quequau 9y ago
    If it helps I used the treatment program outlined in the "sinclair method" which I found online and bought his book off Amazon. In the country I now live in, using Naltrexone in this way isn't exactly unheard of but it was definitely not the status quo treatment program. The docs that I found to prescribe it for me really wanted me to subject myself to antabuse (Disulfiram) which is a profoundly sadistic strategy that creates a major sensitivity / negative reaction to even small amounts of alcohol that can be incredibly distressing and even life threatening. Naltrexone on the other hand simply took away most of the euphoric experience I was getting from drinking and after a 4-6 weeks of using it every time I drank, I quit after a night of heavy drinking and morning of regret. After decades of quitting only to find myself drawn back to it, it was a profoundly liberating experience to actually be sober and not want a drink at all. It still is actually (though in a different sort of way). I have to say that drinking while taking Naltrexone was a pretty weird experience because many of the signals I'd grown accustomed to for gauging my intoxication were muted... so I "felt" kinda sober but at the same time clearly was not. I think if there is a major risk in this it's possibility of deciding to drive because of "feeling sober". So that's the thing I think people need to be really cautious about.
dredmorbius 9y ago
Alternate access: https://outline.com/R36DZt https://outline.com/R36DZt NB: I have no association with outline.com, nor do I even know who's running this, though if anyone has information on that, I'd like to know. It is ... staggeringly useful.
refurb 9y ago
Big Pharma has found a way to jack the price of this generic drug too. Take a look at what companies make these generic drugs. It's not big Pharma at all. It's small companies. Most big pharma give up on a drug once it goes generic.

Clubber 9y ago

I don't know how long this country can survive with this rampant corruption and profiteering. When do we hit a breaking point, and what does that look like? I mean I read your response and think, "wow, that's horrible." Then realize absolutely nothing is going to be done about it.

joshlemer 9y ago
I guess one way it could play out is that as the corruption becomes more and more obvious, together with increasing differences in political ideology between red and blue states, an appetite for seceding from the United States could develop in some states, and if that sentiment becomes common enough, it could become a reality?
- Melanie343 9y ago
  I get paid over $95 per hour working from home with 2 kids at home. I never thought I'd be able to do it but my best friend earns over 10k a month doing this and she convinced me to try. The potential with this is endless. Heres what I've been doing, •••••••••>>http://www.joinmate2.com http://www.joinmate2.com
- Aaliyah5654 9y ago
  My mothers neighbour is working part time and averaging $9000 a month. I'm a single mum and just got my first paycheck for $6546! I still can't believe it. I tried it out cause I got really desperate and now I couldn't be happier. Heres what I do, •••••••••>> http://www.joinmate2.com http://www.joinmate2.com
- Retric 9y ago
  It's IMO more likely than most people think. I really hope we don't see a civil war in our lifetime, but historically democracy's are highly unstable. This time it might be different, but then again it might not.
  - Clubber 9y ago
    A Civil War today would look like Afghanistan or Iraq, not like the one we had before. It won't be pretty and will probably end in authoritarianism the likes we've never seen.
    - maze-le 9y ago
      A civil war in a nuclear armed country could be considerable worse than that. Just consider what would happen if a faction of the army with control over nuclear weaponry took a non-neutral stance...
    - deleted 9y ago
      [deleted]
    - Retric 9y ago
      ~50% of all US war casualties occurred during the Civil War. It was very nasty, even if only 3% of the total US population died in direct fighting.
tcj_phx 9y ago
100 years ago, politicians were tricked into trusting organized crime to tend to the health of people who are drawn to opiates. Those politicians are dead & gone, but we're still stuck with their mistake. My mother broke her wrist 6 months ago, and was given opiates to deal with the pain of having a plate put in her wrist. She did not become an opiate addict. I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life.
- extra88 9y ago
  By "organized crime," I assume you mean something other what's traditionally thought of as organized crime, e.g. the Mafia, but I can't tell what. > I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life. While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates.
  - tcj_phx 9y ago
    > By "organized crime," I assume you mean something other what's traditionally thought of as organized crime, e.g. the Mafia, but I can't tell what. The Mafia and other manifestations of "traditional" organized crime is exactly what I was referring to. Two years ago, when a new friend was teaching me about her addictions, I bought Johann Hari's book, Chasing the Scream: The First and Last Days of the War on Drugs [2]. Hari says that after heroin was made very difficult to obtain (circa 1915), organized crime became the supplier for most addicts. The Los Angeles Times Op-Ed A 1930s California story shows why the war on drugs is a failure also covers how the Mafia swooped in to supply the needs of addicts [2]. This is the primary article I was thinking of when I wrote the quip you responded to. [1] http://chasingthescream.com/ http://chasingthescream.com/ [2] http://www.latimes.com/opinion/op-ed/la-oe-hari-california-drug-war-history-20170616-story.html http://www.latimes.com/opinion/op-ed/la-oe-hari-california-d... > > I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life. > While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates. My mother is inherently less prone to becoming an addict because she has meaningful things to do: job, family, friends, trips, etc. My friend who taught me about addictions (mentioned above) was vulnerable to the street pharmacy because she was exposed to meth amphetamine as a pre-teen, and her brain chemistry never fully recovered. She says she was very depressed as a child/teen, and was made suicidal by her doctor when he injected her with Depo-Provera around age 20 (this is a chemical castration drug used for 3 months of "birth control"). This friend is doing well now because I provided the "connection" that Johann Hari says is so important for helping addicts out of their pit.
Melanie454 9y ago
I've made $64,000 so far this year working online and I'm a full time student. Im using an online business opportunity I heard about and I've made such great money. It's really user friendly and I'm just so happy that I found out about it. Heres what I do, •••••••••>> http://www.joinmate2.com http://www.joinmate2.com
hrehhf 9y ago
> I don't know how long this country can survive with this rampant corruption and profiteering. So far it has been 241 years.
shams93 9y ago
Rather than a revolutionary movement you see mass implosion, addiction, suicide and people falling apart under the weight of triple time hours or being excluded from work altogether .
chaosbutters314 9y ago
You mean unregulated Capitlism? It will wake up when we realize we need some middle ground between Capitalism and Socialism.
- robotresearcher 9y ago
  Most everybody already realizes this. We have exactly such a system in place. The argument is about exactly where the balance is to be found.
- deleted 9y ago
  [deleted]

dwelch 9y ago

Furthermore, I'd imagine the cost of the naloxone alone is a small percentage of the total cost of the emergency responders + acute care given in life-threatening overdose. The article doesn't discuss a recurring theme in medicine: acute care is really, really expensive. It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose.

tcj_phx 9y ago
> It'd be far more cost-effective to reduce the need for acute care by providing access to addiction treatment before things get to this point. Easier said than done I suppose. Johann Hari has pointed out that it's very effective to just give heroin addicts pure heroin and a safe place to inject it. Switzerland has 'essentially' [edit] eliminated opiate deaths with this strategy: [edit: added 'essentially' in response to tptacek's comment below because the swiss probably haven't gotten rid of 100% of their opiate deaths] https://www.irishtimes.com/news/health/johann-hari-heroin-injection-centres-could-save-state-money-1.2216986 https://www.irishtimes.com/news/health/johann-hari-heroin-in...
- tptacek 9y ago
  In reports about the Swiss strategy and in this story about Hari I see plausible claims that Switzerland has eliminated deaths due to needle-borne HIV, but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source?
  - tcj_phx 9y ago
    > but no claims anywhere that prescribing heroin has eliminated all opiate fatalities. Can you cite a more rigorous source? I have edited the comment above to add a word. The friend who taught me about her opiate addiction knew how to manage her dose pretty well. Then the mental health industry got her addicted to benzodiazepines, which changed her tolerance. She overdosed on me when trying to get off the benzos. The fire department revived her, then disappeared into the night. Those two doses of Naloxone stabilized her for about 2 weeks... A lot of the deaths in the United States' present opiate overdose epidemic has to do with contamination of the heroin supply with more powerful synthetic opiates. When the supply includes elephant opiates, addicts don't know how much to use.

nimish 9y ago

If you totally discount the good manufacturing practices and traceability that pharmaceuticals have to follow, sure you can hack together a cheap substitute that might not work when the chips are down Except for biologics, many drugs are not that expensive to manufacture. The cost is in proving they will do what they say they do on the package.

maxerickson 9y ago
It's clear enough that the manufacturer is enjoying their market position rather than having their costs spiral out of control as demand increases.
matthewaveryusa 9y ago
Do you really believe that it costs upwards of 4000 dollars to track a little box with medication in it? For that money I hope each box comes with a solar rechargeable smartphone that sends a gps beacon every half hour.
- GhostVII 9y ago
  It's not the tracking, it's the super long and expensive regulatory process, and the cost of researching the drugs. Remember that for every successful drug, there are probably many that the company spent lots of money working on, and didn't end up working out. Someone has to pay for those failed ones as well.
  - anon946 9y ago
    How does that explain that the autoinjector was $690 in 2014 but $4500 today?
    - deleted 9y ago
      [deleted]
    - mejin 9y ago
      I don't know about the autoinjector, but for a lot of medication the list price is there simply so that when the insurance company negotiates a lower price, the manufacturer will get a reasonable amount. in many cases expensive drugs can even be free if your income is low enough.

Quequau 9y ago

After struggling with alcoholism for decades I used Naltrexone to stop drinking five or six years ago. It wasn't a simple taper but when I had my last drink it was easier to walk away from than anything I could have ever imagined before I did it.

toomuchtodo 9y ago
Thank you for posting this; it'll help me help someone who is a self destructive alcoholic.
- Quequau 9y ago
  If it helps I used the treatment program outlined in the "sinclair method" which I found online and bought his book off Amazon. In the country I now live in, using Naltrexone in this way isn't exactly unheard of but it was definitely not the status quo treatment program. The docs that I found to prescribe it for me really wanted me to subject myself to antabuse (Disulfiram) which is a profoundly sadistic strategy that creates a major sensitivity / negative reaction to even small amounts of alcohol that can be incredibly distressing and even life threatening. Naltrexone on the other hand simply took away most of the euphoric experience I was getting from drinking and after a 4-6 weeks of using it every time I drank, I quit after a night of heavy drinking and morning of regret. After decades of quitting only to find myself drawn back to it, it was a profoundly liberating experience to actually be sober and not want a drink at all. It still is actually (though in a different sort of way). I have to say that drinking while taking Naltrexone was a pretty weird experience because many of the signals I'd grown accustomed to for gauging my intoxication were muted... so I "felt" kinda sober but at the same time clearly was not. I think if there is a major risk in this it's possibility of deciding to drive because of "feeling sober". So that's the thing I think people need to be really cautious about.

dredmorbius 9y ago

Alternate access: https://outline.com/R36DZt https://outline.com/R36DZt NB: I have no association with outline.com, nor do I even know who's running this, though if anyone has information on that, I'd like to know. It is ... staggeringly useful.

refurb 9y ago

Big Pharma has found a way to jack the price of this generic drug too. Take a look at what companies make these generic drugs. It's not big Pharma at all. It's small companies. Most big pharma give up on a drug once it goes generic.