Lakes region reacts to new Naloxone rules

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Moira Hoff receives an inhaler of Narcan from Needle Exchange volunteer Hilary Esslinger last June in Portland as part of city efforts to prevent overdoses.

RAYMOND — Last week, the Maine Board of Pharmacy signed off on new rules for the distribution of naloxone, an overdose-reversing drug that can block the effects of opioids such as heroin.

The new regulations would allow licensed pharmacists to prescribe naloxone, also known under the brand name Narcan, directly to people 21 years and older. Pharmacists looking to prescribe naloxone would have to first complete two hours of training on how to dispense the drug, counsel customers, and provide them with instructions on proper use.

Currently, pharmacists can fill prescriptions for naloxone but cannot initiate them.

Before the new rules can go into effect they are subject to a 30-day public comment period and subsequent reviews by the pharmacy board, Maine Attorney General’s Office and Secretary of State.

Board of Pharmacy President Joe Bruno, who is also a Raymond Selectman, said he hopes the pharmacy board can review the comments quickly “in record fashion.” Bruno’s goal is to have the new rules in place by May 1.

He emphasized that while the rules would expand prescribing authority to include pharmacists, some form of prescription will still be required.

“It is not an over-the-counter drug,” Bruno said in an interview Monday. “This just gives pharmacists prescriptive authority.”

Bruno, a former Republican state representative and minority leader of the Maine House, has received criticism from the Maine Democratic Party over the board’s decision to raise the minimum age from 18 to 21 for people who could be prescribed naloxone by a pharmacist under the new rules.

“Joe Bruno’s unilateral change of the rules was nothing more than a face-saving measure meant to protect the governor, whose opposition to naloxone has always been ill-founded if not outright absurd,” Maine Democratic Party Chairman Phil Bartlett in a press release last week. “Unfortunately, this last-minute, unnecessary change will only result in the restriction of this life-saving medication when the entire point of the law was to improve access.”

Bruno pushed back in an interview, saying that he “didn’t really want to make it a political discussion” but the Democrats’ allegations about him were “irresponsible and pretty slanderous.”

Ultimately, Bruno felt that the board was stuck in the middle of a political back-and-forth and the only way to move forward was to compromise with Gov. Paul LePage on the minimum age.

“There’s blame to go around everywhere,” Bruno said. “The body that has the least blame is the Board of Pharmacy.”

According to Bruno, the board’s action to raise the minimum age to 21 for naloxone prescriptions from a pharmacist was a compromise born out of pragmatism rather than policy considerations.

“It was my way of getting the rule out of the governor’s office and moving it along,” Bruno said. “It was all about compromise and it was all about pragmatism.”

Bruno said the pharmacy board had agreed on 18 as the age requirement earlier in the rule-making process, but the minimum age “was the only sticking point” with LePage.

Julie Rabinowitz, LePage’s press secretary, said in an email to the Forecaster that LePage directed a senior policy advisor to sign off on the new rules after being consulted that “the age to buy naloxone over the counter without a prescription had been raised in the rules to 21 to be consistent with other recent law changes raising the age of majority to purchase cigarettes to age 21.”

Members of the Lakes Region recovery and law enforcement communities have welcomed the possibility of increased naloxone access under the new rules, though some don’t agree with the minimum age being set at 21.

Dr. Peter Leighton, who said he has about 110 patients working to overcome addiction at his medication-assisted treatment practice in Bridgton, supported the possibility of naloxone being more accessible to people through the rule change, but disagreed with the minimum age being 21 rather than 18.

“It’s not an abusable drug, and it will definitely save a person’s life,” Leighton said.

Leighton also described the overdose-reversing drug as an important “Band-Aid” that cannot replace long-term treatment.

Cumberland County Sheriff Kevin Joyce, A Democrat who lives in Standish, said his officers starting carrying a spray form of naloxone in August and have since administered it to six individuals to revive them from an overdose.

“We’re trying to save lives here,” said Joyce, who didn’t agree with raising the age from 18 to 21 in the new rule, but felt that “something is better than nothing, in this case.”

Paul Fillebrown, the director of operations for the Bridgton division of United Ambulance Services, said he does worry naloxone “is kind of a crutch” for some people struggling with addiction who might use it to test the limits of opioids. But Fillebrown still sees it as a tool in the fight against addiction.

“If it can save one life, it’s worth it,” Fillebrown said.

According to Fillebrown, his division has administered naloxone 13 times over the last three years to people between the ages of 27 and 56.

Cathy Finck, president of the Lakes Region Substance Abuse Coalition, also welcomed the new naloxone prescription rules and didn’t take issue with the minimum age change if it meant the rules were moving forward.

“We’re very happy with the decision we’re hearing,” she said last week. “At least it’s getting out there.”

Finck, Fillebrown and Leighton are all involved with the Lakes Region Substance Abuse Coalition, which recently held an opioid overdose prevention training event in Bridgton that included information about naloxone.

Finck said the training was “very successful” and was encouraged that more people in the area now have an understanding about naloxone and how to administer it.

“We now have people in the community trained to use it,” she said.

Matt Junker can be reached at 781-3661 ext. 123 or mjunker@theforecaster.net. Follow him on Twitter: @MattJunker.

Forecaster staff writer David Harry contributed to this story.

Moira Hoff receives an inhaler of Narcan from Needle Exchange volunteer Hilary Esslinger last June in Portland as part of city efforts to prevent overdoses.

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