Over the next year, New Mexico plans to spend at least $1.73 million, a mix of federal grants and state general funds, to comply with a state law mandating the distribution of the opioid antagonist naloxone and education to treatment centers, law enforcement, corrections officials and elsewhere.
The law, which Governor Susana Martinez signed into existence in April, is supposed to broaden the state's effort to curb opioid abuse. The funding came partially as a result of behind-the-scenes persuasions by a pharmaceutical company that manufactures a nasal-spray naloxone formula called Narcan, emailed correspondence obtained by SFR shows.
Last September, months before lawmakers introduced the naloxone bill in the state House, a representative from the company Adapt Pharma, which is the only manufacturer of FDA-approved intranasal naloxone, contacted officials from the state's Human Services Department to discuss purchasing the emergency overdose medication.
Adapt Pharma is a private company that releases little information to the public, but it has also won lucrative contracts elsewhere, including a $14.8 million exclusive deal with New York City and state signed last week.
The emails indicate that Adapt Pharma representative Theresa Baillie met in January with Karen Cheman, the prevention director at the behavioral health services division of the Human Services Department, to discuss how Narcan could figure into a federal grant for New Mexico to confront its opioid epidemic.
In later communications, Cheman cites the state’s status as “number one, two or three in opioid overdose deaths from the early 1990s until 2015,” as the reason her department was interested in purchasing large quantities of Narcan from Adapt Pharma.
The $1.73 million for fiscal year 2018, which was approved by the Human Services Department and the Tax and Revenue Department in early July, is broadly broken down into two areas.
An initial $536,570 will finance the HSD’s Office of Peer Recovery and Engagement’s plan to create regional wellness and recovery centers, develop agencies that provide opioid addiction recovery services and expand the number of people who are properly trained in responding to opioid addiction and overdose, including the administration of Narcan.
The goal of training a larger number of people in addiction and overdose response is to expand the number of agencies across the state offering medication-assisted treatment to people with opioid use disorder. Medication-assisted treatment, or MAT, relies on a mix of pharmaceuticals like methadone and buprenorphine (Suboxone) as well as more traditional therapeutic approaches such as a 12-step program to treat a person’s addiction.
One million dollars in federal funds was also set aside to purchase thousands of Narcan kits at $75 per kit and training modules in support of expanding MAT services in New Mexico. Every kit comes with two single-use spray devices that each carry 4 milligrams of Narcan. One spray is generally enough to curtail the most severe consequences of an overdose, but not always.
The remaining $194,258 will be used to finance training programs and special projects housed in HSD's behavioral health services division, initiate a new agency called Recovery Communities of New Mexico to plan and implement MAT peer trainings alongside the Office of Peer Recovery and Engagement, and launch a MAT-qualified treatment hub that will serve Mora, San Miguel and Guadalupe counties.
An additional $440,196 in state general funds apart from the $1.73 million will finance a pilot program to supply Narcan to people being released from jail in nine counties, including Chaves, Colfax, Luna, Rio Arriba, Roosevelt, San Juan, Sandoval, Sierra and Taos.
Bernie Lieving, the overdose prevention coordinator for the Santa Fe Prevention Alliance, is a one-man connector of local and state efforts to stem New Mexico's opioid crisis. He is currently under contract with the Human Services Department to distribute Narcan orders to treatment centers, public officials and communities across the state, and provide them with education on opioid addiction and treatment.
"All the peer-reviewed evidence in professional journals shows that distribution of naloxone does not increase at-risk behaviors; in fact, it decreases risky behaviors," Lieving tells SFR. "When someone says we're enabling people, I say yes, we're enabling them to stay alive."
The state’s latest effort to distribute Narcan and expand trainings is based on a pilot program initiated last year by Santa Fe County Community Services Department and the Prevention Alliance headed up by Lieving. As part of that program, the county gave the Prevention Alliance $100,000 for Narcan distribution and education.
An initial round of Narcan kits were given to emergency first responders in the county, including police and the fire department, but the first serious effort to put Narcan in the hands of citizens came about through an agreement between the Alliance and Santa Fe Public Schools. Lieving says he provided training on how to administer it for school nurses and teachers.
“We already had contacts with the schools, and thought they might be willing to allow [Lieving] to actually distribute the Narcan [to them],” says Kyra Ochoa, the health care assistance program manager at the county’s Community Services Department. “It was a bit of a bold move to approach them and ask them, and it was a bold move on their part to agree.”
The county financed the program from May of last year to March of this year, with $85,000 of the $100,000 earmarked for the purchase of Narcan. In that time, Lieving says he handed out 628 kits and trained 489 people on how to administer it, and recorded 27 resuscitations as a result of its use.
In addition to law enforcement and school officials, Lieving gave out Narcan and provided trainings to recovery centers and homeless shelters throughout the county, and even did a presentation at Meow Wolf. The county still partially finances the distribution of Narcan to first responders through its emergency medical services budget, but most of the kits will now come from the state.
“We started the project here, and now it’s become institutionalized to some degree [at the state level],” says Rachel O’Connor, director of the county’s Community Services Department.
Keith Humphreys, a professor of psychiatry at Stanford University and a former drug policy advisor in the Obama administration, praised New Mexico’s efforts to distribute naloxone as innovative but cautioned against viewing Narcan as a silver bullet.
“Both naloxone and treatment, as important as they are, will never be a solution by themselves,” Humphreys says. “Good treatment gets people on the path to recovery and health, either with medications or without, gets them back in their jobs, helps them with family responsibilities—that’s good treatment.”