The city agencies charged with responding to overdose scenes spend thousands of dollars on the antidote that keeps victims alive.
Each year, Louisville Metro emergency crews and first responders across the city administer hundreds of doses of naloxone, the drug that counteracts the effects of opioids and saves lives.
The need for the antidote is at an all time high and agencies are forced to ante up.
Naloxone cost the city's Emergency Medical Services — or EMS — $268,000 last year, a 52 percent increase from 2015, which was a 160 percent increase from 2014, according to information provided by Lt. Col. Lee Dennison, assistant director of the agency in charge of administration.
Likewise, Metro Corrections officials in 2016 spent more than double than in 2015, a spokesman said.
It's unclear just how much police or other agencies spend on naloxone, however. The police department's communication office did not respond to multiple requests for an interview and the city's budget office denied a request for any purchase orders submitted by city agencies to known naloxone suppliers, saying the information wasn't readily available and to produce such information would be a "significant undertaking."
Still, experts say the costs are likely to keep rising. Opioid addiction is considered an epidemic on the rise and the drug of choice has never been more potent.
"It's not just heroin," said Russ Read, founder of the Kentucky Harm Reduction Coalition, a nonprofit focused on reducing overdoses and addiction.
Heroin is often blended with fortifying substances like fentanyl or, worse, carfentanyl, Read said.
"Potent product means more need for antidote," he said.
It's Not Cheap, But it Saves Lives
The small, peach colored boxes of naloxone are stacked tight on a small shelf in a small closet near the rear of the ambulance garage on Broadway.
They're near the dextrose and epinephrine and glucogon. The closet is full of the supplies EMTs and paramedics carry to keep people alive in emergency situations.
Lt. Col. Dennison, the assistant director of the EMS, picks up a small box and flips it open.
He's been an EMT for more than two decades. He remembers the first time he saw a person die on the job. He remembers the first time a thankful mother stopped him in a store to show off her son — who Dennison had kept alive years before.
Naloxone is not a new item in ambulances, he said. Emergency crews have carried it for years.
Lately, though, the rise in overdoses has turned naloxone into a must have for ambulance crews, police, jail medics and countless others engulfed in opioid addiction.
Nationally, opioid related overdose deaths have never been higher, according to the National Institute on Drug Abuse.
The drug overdose rate in Kentucky is one of the highest in the country, according to the Center for Disease Control.
In Louisville, more than 360 people died from an overdose last year, according to a recent report from The Courier-Journal.
Ambulance crews carry about a dozen or more doses of naloxone every time they leave the garage in Louisville, Dennison said.
Doses cost up to $40. Sometimes victims need two, maybe three doses before they regain consciousness, he said.
It's not cheap, he admits, but it save lives.
"I don't really put a dollar amount on someone's life."
'If there's a demand, the cost will go up'
In Louisville, agencies make their own orders for naloxone. This leads to orders from different suppliers at varying costs.
Metro Council member Marilyn Parker, vice chair of the council's minority Republican caucus, is critical of that approach.
Her career as a nurse put her on the frontlines of the opioid addiction at University Hospital and today she considers it the city's most pressing issue.
Parker said agencies should nix the siloed model of procurement and leverage their needs to seek lower costs and higher efficiency.
"It seems like that would be an improved method," she said.
On a national scale, the increasing price of naloxone has stirred concern among advocates and elected officials.
A U.S. Senate committee in 2016 launched an investigation into rising costs of prescription drugs and found at least one maker of naloxone had boosted prices by 1,000 percent. Committee members then penned a letter to manufacturers to seek an explanation of the price hikes.
Joseph S. Ross, associate professor of medicine and public health at Yale University, co-authored a recent letter in the New England Journal of Medicine that, in part, suggests government policy could help reduce the cost of naloxone.
Ross and his colleagues also suggest bulk purchases of the antidote to create demand needed to attract more manufacturers.
Dennison, the EMT, smiles and shakes his head when he talks about the bolstered cost of naloxone. A few years back a single box cost about $11, he said.
"If there's a demand, the cost will go up, that's just the way it is," he said.
But a new deal with a new supplier is expected to yield some cost savings, Dennison said.
EMS officials will soon finalize a contract with a supplier to begin purchasing a nasal spray to combat overdoses, he said. The 4mg doses will be double the size of the current dose, which likely means fewer doses will be needed.
"The idea is the city will save money," said Dennison.
'We enable people to live'
Opioid addiction brings an array of costs to city and social services, said Russ Read, with the Kentucky Harm Reduction Coalition.
City agencies are taxed well beyond the cost for overdose antidotes, he said. Emergency crews also respond to more calls. Broken families leave behind children to be cared for. Addicts lose jobs and cost employers.
He knows naloxone isn't going to cure the addiction. But preventing a fatal overdose can give people a second chance at life, another opportunity to help themselves.
"People say we are an enabler," he said. "We enable people to live."
