Opioid Epidemic Band-Aids?

Monday, June 3, 2019

by Nahla Rizkallah, PharmD, RPh, MSCC

Drug overdose deaths continue to increase in the United States. The Centers for Disease Control and Prevention (CDC) reports that on average, 130 Americans die every day from an opioid overdose.[1] Best practices in preventing opioid overdose deaths include improving opioid prescribing, prevent opioid use disorder, reverse overdose and treat opioid use disorder.

Naloxone, an opioid antagonist, is a life-saving drug that can reverse the effects of an opioid overdose when administered in time. 

Signs of an opioid overdose may include any of the following:

  • Small, constricted “pinpoint pupils” (miosis);
  • falling asleep or loss of consciousness;
  • Slow, shallow breathing;
  • Choking or gurgling sounds;
  • Limp body;
  • Pale, blue, or cold skin.

 Naloxone acts to rapidly reverse opioid overdose by binding to opioid receptors to reverse and block the effects of opioids, and quickly restore normal breathing in a person whose breathing has slowed or stopped as a result of overdosing with heroin or opioid medications. Repeat dosing may be required after 2-3 minutes if the desired effect is not observed. Expanding naloxone could reduce drug overdose deaths and save lives. In response to our opioid epidemic, access has been expanded through standing orders at pharmacies, distribution through local and community-based organizations, access and use by law enforcement officials, and training for basic emergency medical staff on how to administer the drug. 

Naloxone is available as an injection and nasal spray with considerable disparity in pricing (see the table below). The FDA recently approved the first generic naloxone hydrochloride (Narcan®) nasal spray which will improve availability in providing another first-line alternative therapeutic and cost-effective alternative vital tool in in emergency overdose reversal treatment. It is important to note that several injectable naloxone products have been commercially available for years. An advantage to the naloxone spray and the auto-injector is they are approved for use by those without medical training.



Average Wholesale Price

Naloxone 0.4mg/ml injection

$12.00 per ml

Naloxone 2mg/2ml injection

$39.60 per 2ml

Narcan 4mg/0.1ml nasal spray

$75 each or $150 per package of 2

Evzio 2mg/0.4ml injection (auto-injector)

$4,920 per package of 2


Shifting gears to treating opioid use disorder (OUD), evidence-based treatments recommend medication-assisted therapy (MAT), a comprehensive way to treat OUD. MAT include use of medications such as methadone, buprenorphine or naltrexone, with counseling and behavioral therapies.[2] Suboxone (buprenorphine/naloxone) film, a partial opioid agonist and opioid antagonist, now has FDA approved generic agents and pricing is expected to decrease with additional generics launched by various manufacturers - see pricing below for the commonly encountered strength 8-2mg.



Average Wholesale Price

Alvogen - generic


Sandoz - generic


Mylan - generic


Indivior (brand name – Suboxone)



While these treatments may be considered band-aids in realm of the opioid crisis, they present important and more cost-effective options which expand access to necessary treatment and quelling this crisis.

ExamWorks Clinical Solutions strives to provide the most accurate and defensible MSA by utilizing technology and compendia databases which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace. 

For questions about medications, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or


[1] Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at