Generic naloxone price increases: Amphastar’s naloxone injection Narcan cost $20.34 in 2009. It cost $39.60 in 2016.

Hospira’s naloxone injection cost $62.29 in 2012. It cost $142.29 in 2016.

Kaléo’s auto-injecting naloxone device Evzio cost $690 in 2014. It cost $4,500 in 2016.

A New Way to Make Money

Abuse-deterrent drugs on the market today Targiniqoxycodone and naloxone Embedamorphine and naltrexone Hysinglahydrocodone Morphabondmorphine Xtampzaoxycodone Troxycaoxycodone and naltrexone

“There is no proof that these are effective at ending the opioid epidemic, and they’re just as addictive as the regular formulations.” Judy Rummler, Chair, FED UP! Coalition

Admitting Their Mistakes

“I would cite six, seven, maybe 10 different avenues of thought or avenues of evidence, none of which represented real evidence.” Dr. Russell Portenoy

A 12-Month Wait for Treatment

“Once I was free, I wasn’t getting sick and I was able to get into a shelter, I knew I didn’t want to go back [to heroin].” Krystle Pellegrino

The Smallest Victims of Opioids

“We tend to have more overdoses than we do fires,” firefighter Kevin Doherty said. “So it’s a piece of equipment that we can’t go without now. Just like we have the hose.” But naloxone isn’t without controversy. The drug has been available in generic form since 1985, but a 2016 review published in the New England Journal of Medicine found prices of several versions of the drug have increased as the opioid epidemic has worsened.Comparatively, Mylan, West-Ward and Adapt’s versions of naloxone have not changed in price in the past two years.After admitting that their drugs were subject to abuse, several pharmaceutical companies said they’d fix the problem by making their drugs more difficult to misuse. In August 2010, the FDA approved a reformulated version of OxyContin which had abuse-deterrent properties. The drug is difficult to crush, break or dissolve. After years of post-market analysis, the agency allowed Purdue to add abuse-deterrent language to the drug’s label. Once again, other companies followed Purdue’s lead. They developed drugs that were difficult to crush and melt. They also made pills that released naloxone when crushed, which would block the euphoric effects of the opioid.The drugs may have contributed to increases in heroin use in recent years. Reports indicate that people prescribed abuse-deterrent drugs often turn to heroin or other opioids on the street. None of the drugs are completely safe. With enough effort, they can be crushed or dissolved. People can abuse them by taking doses higher than those prescribed by a doctor. Developing and patenting the drugs gave pharmaceutical companies an opportunity to continue to make money without competition from generics. “They’re just as addictive as regular formulations,” Judy Rummler, chair of the FED UP! Coalition, told Drug Rehab.com. The coalition advocates for federal action to end opioid addiction and overdose deaths.“Because there are new patents, the pharmaceutical industry has found a way to make a lot of money on these things,” Rummler said. “That’s something that people need to be made aware of. There is no proof that these are effective at ending the opioid epidemic, and they’re just as addictive as the regular formulations.” An Associated Press and Center for Public Integrity investigation revealed that companies made a combined $2.4 billion on abuse-deterrent drugs in 2015. Purdue’s abuse-deterrent OxyContin formula is the most popular, and patents protect it until 2030. The pharmaceutical industry has spent hundreds of thousands of dollars lobbying for legislation that requires insurers to cover the abuse-deterrent drugs. Since 2012, 21 bills pushed by industry lobbyists have become state law, according to the Associated Press report.The pain advocates of the 1990s and early 2000s have since backed away from their exaggerated claims. Many of them had always said that chronic pain patients should be evaluated for past substance abuse issues and be closely monitored. But they often relied on scant evidence to prove their claims. “A number of people in the leadership have basically sort of retreated,” Meldrum said. “A number of government agencies are sort of retreating as well.” In 2011, Kolodny and PROP uploaded an interview featuring Portenoy to YouTube in which the longtime opioid advocate showed regret for previous statements. “I gave so many lectures to primary care audiences in which the Porter and Jick article was just one piece of data that I would then cite,” Portenoy said in the video. “I would cite six, seven, maybe 10 different avenues of thought or avenues of evidence, none of which represented real evidence. “What I was trying to do was to create a narrative so that the primary care audiences would look at this information [in all] and feel more comfortable about opioids in a way they hadn’t before. In essence, this was education to destigmatize, and because the primary goal was to destigmatize, we often left evidence behind.” “Clearly, if I had an inkling of what I know now then, I wouldn’t have spoken in the way that I spoke. It was clearly the wrong thing to do.”In a 2012 interview with The Wall Street Journal, Portenoy said he may have focused on the benefits of opioids without emphasizing the risks. “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation?” Portenoy said. “Well, against the standards of 2012, I guess I did. We didn’t know then what we know now.” Other organizations also owned up to their role in the epidemic. In an email to CNN, the Joint Commission’s executive vice president for health care quality said the organization had relied on faulty research. “There is no doubt that the widely held belief that short-term use of opioids had low risk of addiction was an important contributor to inappropriate prescribing patterns for opioids and the subsequent opioid epidemic,” Dr. David W. Baker said. “The Joint Commission was one of the dozens of individual authors and organizations that developed educational materials for pain management that propagated this erroneous information.” In 2016, the American Medical Association approved a resolution to remove pain as a fifth vital sign from professional standards, joining the Physicians for Responsible Opioid Prescribing in lobbying the Joint Commission to soften its pain management standards. The VA has also removed language involving pain as a vital sign from its standards.After she relapsed, Pellegrino and her husband lived on the streets of Long Island for years. She thought about going to a methadone clinic for help. One of her friends had gone to a clinic and been able to recover. But the waiting lists for the methadone clinics on Long Island were 12 months long.Pellegrino and her husband eventually moved to the streets of Manhattan, begging for food and money for drugs. Everyone on the street was using drugs. When they couldn’t find them, they would go to the methadone clinic to avoid withdrawal, she said. In the city, the waiting lists were shorter. In the summer of 2015, Pellegrino decided to go for the first time to avoid getting sick when she couldn’t afford heroin. “Ever since then, I’ve never used an [illicit] opioid,” Pellegrino said in December 2016. “I’m still on the methadone, but I’m tapering off and by the New Year, I’ll be off methadone. Once I was free, I wasn’t getting sick and I was able to get into a shelter, I knew I didn’t want to go back.” Her husband is in recovery, too. Neither has relapsed during the last 18 months of methadone treatment. “The progress is slow,” Pellegrino said. “We live in a New York City shelter together. We go to the methadone clinic. We both have jobs. We’re struggling to get an apartment.” She said she battles immense feelings of guilt for losing custody of her son, who currently lives with her in-laws on Long Island. “Once we get an apartment, we’ll be able to go to court and fight for child custody,” Pellegrino said. “That’s my goal.”As opioid abuse and addiction increased in the United States, the number of babies born addicted to the drugs also grew. In 2003, 5,000 babies were born dependent on opioids because their mothers used the drugs during pregnancy . That year, Congress passed the Keeping Children and Families Safe Act, a law that funds a variety of child protective service programs. But the number of babies born with neonatal abstinence syndrome, a syndrome in which newborns experience withdrawal, increased each year from 2003 to 2013. More than 27,000 drug-dependent babies were born in 2013, according to a Reuters report.