美国国家公共电台 NPR Surgeon General Urges More Americans To Carry Opioid Antidote（在线收听）

RACHEL MARTIN, HOST:

The opioid crisis continues to ravage many communities in the U.S., so much so that the U.S. surgeon general says Americans should be as prepared to handle an opioids overdose as they would be to administer CPR. Today, the surgeon general is issuing an advisory, urging more Americans to carry the medication naloxone. It's also called NARCAN, and it's the drug first responders used to reverse an opioid overdose. I spoke to the U.S. surgeon general, Vice Admiral Jerome Adams, about why ordinary Americans should be prepared to prevent someone from dying from opioids.

JEROME ADAMS: Over half of the overdoses that are occurring are occurring in homes, and so we want everyone to be armed to respond. We should think of it like an EpiPen or like doing CPR on someone.

MARTIN: Is there any kind of risk in having everyday Americans armed with naloxone? I mean, is it difficult to administer? Are there any risks of administering it incorrectly? Do people need training?

ADAMS: One of the things that we're doing is working with pharmacies, working with providers, working with the American Medical Association and the nursing associations to increase training on how to administer naloxone in homes. But overall - and I'm an anesthesiologist who's administered naloxone many times myself - it is easy to use, and 49 out of 50 states have standing orders for people to be able to access and use naloxone in the home setting because it is a safe drug where the benefits definitely outweigh the risk, particularly in the midst of an epidemic.

MARTIN: What about paying for it? I mean, this is a medication that costs around $40 a dose, I think. The company has doubled the price in recent years, one of the primary manufacturers. Some devices that you use to administer naloxone cost as much as $600. And, I mean, there is no limit potentially on what individual pharmaceutical companies can charge, right?

ADAMS: I've spoken to the president about this personally, and both he and I are determined that the cost of naloxone will not be a barrier to folks being able to have access to it.

MARTIN: How do you ensure that?

ADAMS: Well, there are many different ways. No. 1, the president has asked for and Congress has approved $6 billion in funding to respond to the opioid epidemic - more than has ever been approved in history. There's $50 million in funding that has been allocated specifically for naloxone. No. 2, we're working with insurers. Ninety-five percent of people who have insurance coverage, including Medicare, Medicaid and TRICARE in the VA, are actually able to get naloxone at little or no copay. And we're working with them to make that copay as small as possible; and then finally, work with Adapt Pharmaceuticals and Kaleo, the two makers of at-home naloxone, to make it easier for individuals to access naloxone at low or no cost.

MARTIN: What's their incentive to keeping the price low? Will they just do it because you tell them it's the right thing to do?

ADAMS: Well, I hope that that's part of it. I know that these companies - I've met with the presidents, and they want to do the right thing. But also strictly from an economic point of view, unfortunately, there are so many people out there that need naloxone that they are going to make their money one way or the other. And I think they want to do the right thing. They just want to do it in a way that helps them sustain their bottom line. And they can do that. We can cut the price significantly and still make money for them and save lives. And that's what we're trying to do.

MARTIN: Is it possible to incentivize other companies to create generics of naloxone so that there is low-cost competition?

ADAMS: Again, we're looking at all possibilities. But right now, we have two really good FDA-approved products, and we're focused on making them available at low or no cost to as many people as possible. And I think from the federal side, from the insurer side and from the pharmaceutical company side, we've got some great potential to do that in short order.

MARTIN: You describe this measure, making naloxone more readily available, as a tourniquet, as a life-saving measure. You acknowledge that the key, though, is figuring out what to do with that person after this emergency crisis. Yes, you can administer this and they can live another day, but how do you make sure that person doesn't overdose 24 hours later?

ADAMS: Well, folks want to say unfortunately in far too many cases that the individual has failed. But when a person is coming in from multiple overdoses, I see that as a system failure. We know addiction is a chronic disease, much like diabetes or hypertension, and we need to treat it the same way. So I'm focused as surgeon general on making sure everyone sees addiction not as a moral failing but as a chronic disease and that we have good, evidence-based treatment, including medication-assisted treatment, available for individuals with a warm handoff right from the overdose. We can't have someone overdose and then send them out onto the streets at 2 a.m. because they're going to run right back into the hands of the local drug dealer.

MARTIN: Explain that moment, the warm handoff moment.

ADAMS: That warm handoff means that you come in at 3 a.m. in the morning having been resuscitated from an overdose, and we have either an immediate access to treatment available for you or what's working well in many places, including Rhode Island where I just visited, is a peer recovery coach, someone who has been through this before and who can speak to you in a language that will resonate and will basically be with you until you can get into recovery.

MARTIN: The Trump administration has talked a lot about the opioid crisis, has tried to make it a priority in combating it. The president himself has spoken a lot about law enforcement as a mechanism to do that and the need to go hard at drug dealers. What do you think about that? And what about the dealers who are in the business because they themselves are addicts?

ADAMS: Well, I can tell you from personal experience, I lived this in Indiana when I was the state health commissioner there. We are not going to be able to solve this crisis without the involvement of law enforcement. And I can also tell you from visiting many communities that folks are very concerned about the public safety aspects of this crisis. One neighbor is concerned that their son is overdosing. The other neighbor's concerned that their house is getting broken into. And so it's not either or. It's got to be both. And what I'm focused on is meeting with the attorneys general, meeting with the local law enforcement officials, making sure that if you're dealing drugs and you're putting people at risk, you're going to go to jail. But if you have a substance use disorder, that we're going to give you an option to get treatment and hopefully become a productive member of society again.

MARTIN: Vice Admiral Jerome Adams - he is the U.S. surgeon general. Thank you so much for your time, sir.

ADAMS: Thank you so much, Rachel.

(SOUNDBITE OF SLEEP DEALER'S "THE WAY HOME")