During a freewheeling recent press conference, President Trump declared that America was “drug-infested” country. “Drugs,” Trump said, “are becoming cheaper than candy bars.”

What the President failed to mention: the price of one lifesaving medication—naloxone—is more expensive than caviar.

Throughout the 2016 presidential campaign, Trump promised to solve America’s opioid crisis, which claimed 33,000 lives in 2015—the most deaths in a single year in U.S. history, according to recent federal statistics. Trump’s plan to combat the epidemic included widespread access to naloxone, a drug that can reverse the effects of an opioid overdose. But as the need for the drug has grown, it has become increasingly expensive and hard to get for many addicts and the front line workers who try to help them.

“All the politicians, Obama, Trump, everyone says, ‘We’re going to solve it’,” says Gordon Merry, director of West Virginia’s Cabell County EMS, which serves Huntington, a city that saw 26 opioid overdoses over four hours last August. “I haven’t seen anything that has changed.”

Meanwhile, the price of naloxone is soaring. Evzio, a form of naloxone manufactured by Kaléo that’s administered through auto-injection, rose from $575 per package in 2014 to a whopping $4,100 in 2016. Another version of the drug, made by Hospira, has risen from from $9.20 for 10 vials in in 2005 to $158.30 in 2014, according to Truven Health Analytics. The price of the naloxone nasal spray Narcan has remained stable—around $125 for a two-pack—since it was approved by the FDA in 2015.

“The best word for what’s happening now,” says Paul Ginsburg, director of the Center for Health Policy at the Brookings Institution, “is profiteering.”

Naloxone price hikes parallel a spike in demand for the drug that’s fueled by the opioid epidemic, stretching government budgets—the drug is often administered by first responders—while creating a robust market for the drug.

In late November, Dr. Leana Wen, Baltimore City’s Health Commissioner, and 10 other health officials wrote a letter to President Trump asking the new administration to prioritize public health, specifically solutions to the opioid epidemic. “In the campaign, President Trump talked about the problems of drug addiction,” says Wen. “We hope that this will not just be rhetoric but resources will be devoted to this issue too.” So far Wen and her colleagues haven’t received a response.

Experts attribute the rising naloxone prices to a combination of soaring need, drug-industry consolidation and an onerous FDA-approval process, which can stifle competition. Critics contend that price gouging may also be at play.

Kaléo CEO Spencer Williamson says Evzio’s list price of $4,100 “is not a true net price to anyone…due to numerous discounts and rebates that are negotiated in the supply chain.” Most patients with insurance pay nothing out of pocket, says Williamson, while uninsured patients with household incomes of less than $100,000 can also access Evzio free of charge.

Kaléo says it also offers product grants to some nonprofits and government agencies that demonstrate a need for the drug. For instance, Kaléo has granted 2,200 kits to the Cabell-Huntington Health Department, where the overdose death rate is nearly 10 times the national average. “The more naloxone there is, the more lives will be saved,” says Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health Department. “I have to admit, if we didn’t get the grant, we wouldn’t have the drug. We don’t have the finances.”

Yet even beneficiaries of naloxone grants acknowledge that demand outstrips affordable supply. In Palm Beach County, Fla., for instance, the Fire and Rescue department spent nearly $205,400 on naloxone in 2016, compared with $57,500 in 2015.

In Baltimore, first responders are facing similar constraints. “We have to decide who is the most likely to die and make a guess on which patients we distribute naloxone to,” says Wen, the health commissioner, adding that the price they pay for naloxone more than doubled over the course of just a few years. “It doesn’t make sense that at a time of great demand this medication is being priced out of our reach.”

In Newtown, Ohio, police chief Tom Synan says the opioid epidemic in his community is worsening. The county averages up to 70 overdoses a week. “That’s our new normal,” he says. Synan, who serves on the Hamilton County Heroin Coalition steering committee, says his officers use the naloxone nasal spray Narcan, and the department has not been hit with major cost increases. But the overall trend is disconcerting. “These are life and death situations,” says Synan.

If his earlier promises hold true, Trump will eventually train his lens on drug companies—and drug prices. A White House spokesperson says the administration is extending grant programs to help get naloxone in the hands of first responders, has encouraged Medicaid programs to include naloxone access for low-income people, and has made sure Veterans Affairs programs offer naloxone for eligible veterans.

Still, some say more drastic action will be necessary. Ohio has already taken action: in November the state reached an agreement with Adapt Pharma, the manufacturer of Narcan, to freeze the price of the naloxone nasal spray for Ohio law enforcement, first responders, state and local government agencies, and community-based organizations for a year. These entities can buy 48 or more Narcan units for $75 each, a 40% discount from the $125 wholesale price.

“It’s hard to justify the price increases you see on purely economic grounds,” says Darius Lakdawalla, an economist and professor of pharmaceutical development and regulatory innovation at the University of Southern California. “The case is pretty strong for government interference.”

Especially when lives are at stake. Laurie Fugitt, co-founder of Georgia Overdose Prevention, a volunteer group, hopscotches across the state teaching people how to administer naloxone to themselves or their loved ones. She equates naloxone to a fire extinguisher. You never want anyone to use it. But it should be there just in case.

“A lot of people have no idea that there’s even an antidote for an opioid overdose,” says Fugitt. “Back in the day, a vial of naloxone cost a couple of bucks. Now, everybody is trying to get their piece of the pie.”

With reporting by Zeke J. Miller

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