Naloxone has been a life saver. But Missouri lawmakers may gut the program

For weeks now, Rachel Winograd has been fighting to make sure Missouri continues to fund life-saving naloxone for first responders and others across the state. That ought to be a no-brainer: The drug—often referred to by its brand name, Narcan—has been credited for Missouri seeing a “significant” drop in drug overdose deaths for two years running. 

But few things remain a no-brainer when politics are involved, and so it’s been in Missouri this year. First, lawmakers in the Missouri House zeroed out an $8 million allocation for naloxone, a move that (if approved by the Senate) would reduce the state’s overall naloxone funding by 54 percent. And it wasn’t like the state’s well-documented budget issues were to blame for the cut. Because the money comes from the state’s portion of an opioid settlement, it must be used for prevention, drug treatment, and recovery. The only competition would be other expenditures under that umbrella (like, say, last year’s $7 million allocation to test wastewater at schools for fentanyl, an idea that some experts are quite skeptical about). 

Winograd’s team at the University of Missouri–St. Louis has been tasked with purchasing naloxone and distributing it across the state through funding from the Missouri Department of Mental Health. She’s been thrilled to see the results—and horrified by what such a big cut would mean to people in need. Researchers funded by the National Institutes of Health suggests that a cut that big to the state’s supply could result in an additional 100 overdose deaths in the next year alone. 

“That translates to $1 billion in societal costs, those deaths,” she says. “By 2030, that’s over 400 additional deaths and $5.6 billion in Missouri costs.” 

And while theoretically some police or fire departments might opt to make naloxone purchases on their own, smaller departments are less likely to have the time or resources to do that—much less the ability to score competitive pricing. “They don’t benefit from negotiated prices for purchasing, and that’s why it really makes sense for us to be this centralized hub,” Winograd says. “We’re able to get these pharma companies to compete with each other to get the lowest price, because we do such big orders.”

Winograd has been making her case as best she can in the halls of the Missouri Senate as it crafts its changes to the version approved by the House. And on Wednesday, she got some good news, and then some potentially really bad news. 

The good news is that a Senate committee has restored $5 million of the allocation for naloxone. The bad news is that, in addition to that number still falling $3 million short, lawmakers also apparently tweaked the language in a way that might not track for someone who’s not following the issue, but immediately grabbed Winograd’s attention.

Instead of allocating the money for naloxone, she says, the current draft language allocates it for Narcan. That brand-name drug is significantly more expensive than the generic alternatives that have previously put in bids to supply the state. A cost comparison she shared with SLM shows Narcan is sold for $33 a box. Alternatives like Padagis and Amenal are $25.95 and $23.75 a box, respectively. “That adds up when you’re buying hundreds of thousands of boxes,” she says. It could mean as much as 94,000 fewer doses.

It’s not clear which senators are even aware of the change. Senator Rusty Black (R-Chillicothe), who chairs the Senate appropriations committee, did not respond to a message seeking comment. 

Records show that Emergent BioSolutions, the manufacturer of Narcan, has a lobbyist currently working in Jefferson City. (That lobbyist did not respond to a message seeking comment yesterday.)

The company was previously criticized for refusing to allow its product to be sold over the counter, seemingly valuing its profits over getting the drug in the hands of more people, the Washington Post reported. (That was finally remedied in 2023.) The newspaper also reported on allegations that the company “moved aggressively to lock up lucrative state contracts to supply the nation’s biggest customers—hindering broader distribution of the antidote while the opioid crisis worsened.” 

In a statement, company spokesman Assal Hellmer said, “Decisions about how public funds are allocated, including which naloxone products are purchased, are made by state officials through established legislative and procurement processes. Our engagement with policymakers, like that of many healthcare companies, is focused on providing factual information to inform good stewardship of public health decisions. We share the goal of expanding access to all opioid overdose reversal medications and support efforts to ensure naloxone, a life‑saving medication, is readily available to communities that need it.”

Winograd is doing everything she can to inform the senator who are haggling over, and will ultimately sign off on, the state budget. (After that, it goes back to the House, and then to the governor.) 

But it’s hard, in part because the process can be opaque. She’s not a lobbyist, nor does her team have one on retainer. UMSL, of course, has one, but they have their hands full advocating for the university’s overall interests, which in higher education has been a full-time job this year.

“I’ve been really lucky the last  eight years, when the opioid crisis has been a bipartisan issue with a lot of public support,” Winograd says. “This has been a wake up call that all this infrastructure is way more fragile than I understood it to be.”

Of the overall allocation for naloxone, she adds, “I want us to be a fair and reasonable and responsible player in this system, and so I am aware that Missouri is facing incredibly tough fiscal times, and that we are looking at huge cuts to rural public transportation and disability services for children and elderly home care. I am not saying that this is more important than any of those things. What I’m saying is, this is not competing with any of those things because it’s from opioid settlement money.” 

And if the money is there, why not get the state the most bang for its buck—no matter the brand name?