Michele Hamby found her daughter Breana unconscious in her bedroom, crouched between the bed and dresser, her alarm clock ringing incessantly. A needle was still in her hand.
In Arizona in 2013, Hamby couldn't have gotten the drug naloxone, an antidote to reverse a heroin overdose, without a personal prescription. Emergency services arrived within ten minutes and attempted to revive Breana, giving her four doses of naloxone, but it was too late.
"If I had had naloxone, I possibly could have saved her," Hamby, 49, says of her daughter's death. "But I'll never know."
Her story is part of a Human Rights Watch report published Thursday that argues the federal government and individual states create significant barriers to accessing naloxone and other overdose prevention resources.
Three years after Breana's death, Hamby learned that her son Chandler, who had also struggled with addiction but had been clean for more than ten months, had died of a heroin overdose. It was just a few days after what would have been his sister's 28th birthday.
"When my second child died, I said, I am going to stop this," Hamby says.
Hamby helped campaign for Arizona to pass a law in 2016, allowing pharmacists to dispense naloxone without a prescription under some circumstances. Across the country, state governments and the District of Columbia are gradually taking action to allow naloxone to be bought at a pharmacy without an individual prescription.
While these changes are steps toward making the medication more accessible, 14 states still don't have any "Good Samaritan" laws protecting people who call emergency services to the scene of an overdose from prosecution, according to the report, and some still do not grant protection from civil or criminal liability for administration of naloxone.
Kansas, where overdose deaths among 12- to 25-year-olds have quadrupled in the last decade, signed a bill into law earlier this month allowing first responders to administer naloxone and for pharmacists to give people the drug without a prescription.
"It's a heavy lift to get a state legislature to act," says Megan McLemore, a senior health researcher at Human Rights Watch and author of the report. "What would really clear that obstacle, which is substantial, is for naloxone to be an over-the-counter drug." McLemore says that naloxone, which has been on the market for 30 years, should be as easy to get as Tylenol.
"If you injected me right now, and I don't have an opioid in my system, nothing would happen to me," she says. "It would have almost no effect. That's how safe it is."
The Food and Drug Administration said last year it is exploring options to make naloxone more accessible, including ways to assist drug manufacturers in submitting an application for an over-the-counter version of naloxone.
Between 1996 and 2014, naloxone reversed at least 26,000 overdose deaths, though the number is likely higher as many cases go unreported. Many of these reversals were done by drug users helping another user.
Kendra Williams, 24, whose story was also featured in the report, was a self-described "full-blown heroin addict" as a teenager. "Naloxone saved her life a number of times," McLemore said in an interview with Human Rights Watch. "Today, she hasn't used heroin for a couple years, has a baby, and is in nursing school."
Williams now carries the antidote with her everywhere and estimates she had personally reversed at least 25 overdoses with naloxone. The report proposes harm reduction programs, like syringe exchanges, can be used to help to get naloxone directly into the hands of addicts. Opponents argue that syringe exchange programs sanction drug use.
A ban on using funding for certain aspects of syringe exchanges was lifted in 2016 following severe outbreaks of HIV and Hepatitis C in rural counties of Indiana, Ohio and Kentucky, including an outbreak in Austin, Indiana, when Vice President Mike Pence was governor.
"The federal approach has actually become bipartisan," McLemore says. "There has been support in Congress for syringe exchange."
Federal funding can now be used to pay for staff and overhead costs of syringe exchange program. Some states do not support these programs, however, and there are glaring gaps between syringe exchange programs and the 220 counties the Centers for Disease Control calls "vulnerable" to HIV and Hepatitis C outbreaks.
Meanwhile, the price of naloxone has risen from about $1 per dose in 2005 to $20-$4,500 per dose, depending on the format (various needle and nasal spray options are currently available). President Donald Trump has vowed to tackle high drug prices and said on the campaign trail that the "terrible drug epidemic will slow down, and ultimately stop."
"He seemed genuinely committed to it," McLemore says. "But we are very concerned that his health policy is going to undermine that goal. Treatment expansion will shrink if he repeals the Affordable Care Act. And if Medicaid is left to the states, they can do whatever they want with naloxone and it may not be covered by the state."
She is presenting her report to members of the Trump administration in May and hopes to engage with the administration's newly formed opioid commission. Then it's time to get to work in Kansas and other states, McLemore says, to find harm reduction advocates and work with them to stop unnecessary deaths.
Michele Hamby left her job as an account executive and now dedicates much of her time to combatting the opioid epidemic. She estimates she has distributed at least 50 naloxone kits in the last month in Arizona, but she knows expanding overdose prevention resources will take more than an individual effort.
"Our government has got to do something more," Hamby says. "I am going to do anything I can so that my babies have not died in vain."
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