By Sarah Sarder

The Dallas Morning News

DALLAS — With opioid-­related deaths on the rise each year in the U.S., Texas has become the first state to offer a lifesaving overdose drug online, freeing users of the stigma associated with drug use.

Last week, Texas began offering Naloxone, an opioid antagonist, for purchase online. Experts say the drug reverses opioid overdoses and is not addictive.

The website, www.naloxone exchange.com, is the brainchild of James Lott, 33, a Chicago pharmacist who hoped removing the stigma from the purchase and increasing accessibility online would allow anyone to prepare for the worst.

“We’re focused on social benefit,” Lott said. “This is going to change lives and expand access to people all over the country.”

Texas is a sort of pilot state for Fiduscript’s Naloxone Exchange, which intends to launch in other states in a few months, though there is no hard timeline yet, Lott said.

The expansion to other states is complicated by different guidelines and requirements and by the various times when each state granted approval to Fiducript to pursue its online purchasing model.

To date, the company has secured direct or indirect approvals from 25 states including Texas. Lott says the goal is to expand to all 50.

In many states, the review process is made easier by a standing order, which allows people to obtain Naloxone without a prescription from a doctor. That doesn’t make it an over-the-counter drug, but it allows trained pharmacists to sell it on the spot instead of requiring a doctor’s visit.

In Texas, that means people who suffer from opioid abuse or need the drug for their loved ones could obtain Naloxone at any trained pharmacy location, including chain stores such as CVS or Walgreens.

The accessibility of the drug is complicated by multiple barriers: price, location, lack of awareness and stigma, especially in rural areas.

“Rural places tend to be small places, and the pharmacist knows you and sees what you’re getting,” said Bree Watzak, a pharmacist at the A&M Center for Optimizing Rural Health. “I think the anonymity of ordering it online will be a really positive thing.”

When the opioid crisis began, Lott worked in a town in Washington that gave out the drugs “like candy,” he said. That’s where he began to see the effects of the crisis and the challenges of getting patients the medication they needed _ and the concept for his company Fiduscript was born.

In order to get a picture of how those barriers influence people affected by drug abuse, Lott partnered with his alma mater, Chicago State University, and assistant professor in pharmacy Rahul Garg.

Garg conducted a nationwide survey focused on access to Naloxone, stigma around buying it and whether people would prefer to get it online.

Of just over 500 valid responses, about 40% said they were not at all comfortable talking to a doctor about the drug. Nearly half said they would prefer to purchase it online.

“The survey tells us if there’s an option to buy Naloxone online it could increase access,” Garg said. “I hope it becomes more widespread and more online pharmacies start selling it, and we see more insurance coverage for Naloxone.”

Cost was the primary barrier named in the survey. Naloxone can cost $20 for a generic, harder-to-use version and up to $4,100 for an EpiPen-like auto-injectable with voice commands. Narcan, a nasal spray version, costs about $140 for a two-dose pack.

Lott said one of his main goals for Fiduscript is to make the drug more affordable. At present, the site offers three versions of the drugs, all in two-pack kits.

The generic Naloxone costs $116, Narcan goes for $178 and Evzio, the auto-injectable, costs $4,200, though none of the prices can be viewed before entering one’s information for purchase.

The price differences stem from the additional items in the kits, Lott said, which include a case and nasal attachments for the generic drug.

Among chain pharmacies, CVS is one with a major deal for Narcan — two doses cost just $90. But no major chains have introduced online Naloxone sales. Garg, the pharmacy professor, said that may stem from the differing regulation issues in various states.

Allison Benz, executive director for the Texas State Board of Pharmacy, believes it comes down to profit.

“These things usually revolve around money,” Benz said. “If someone feels they can make money doing it, they probably will.”

As for Fiduscript, Lott said the company attempts to make just enough of a profit to keep the lights on. The platform does not accept insurance, though it may in the future, and allows payment with flexible spending accounts or health savings accounts.

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