As EpiPen Prices Skyrocket, Nurses Suggesting Patients Use Syringes

[DoGoodThenGo]

Media and now Congress has finally latched onto something many in healthcare have known for quite sometime; EpiPen prices have skyrocketed to $600 from $100 over the past eight years. Families/persons who need these autoinjectors are quite angry because not all can afford the increased rates and worry about being priced out of having access to life saving medication.

According to news reports some nurses and other healthcare professionals are advising patients and or their parents/caregivers to use syringes to inject epinephrine instead. One horrified mother interviewed for local evening news was literally near tears saying she "never could do that" when advised by a nurse who was part of her daughter's medical team. Many EMS personnel have long gone back to syringes as a cost saving measure with the prices of EpiPens putting a strain on budgets.

[blondy2061h, MSN, RN]

I hate to call some of epipen sales hype, but I definitely think that the great marketing has lead to more prescriptions than would otherwise exist for it. I have talked to some people who have scripts for epipens and asked them why and they give vague reasons, like their knee swelled up once after a bee sting or they got runny eyes after eating some pistachio cookies once. I suspect some of these people would not be carrying epipens if not for the strong marketing.

[Alex Egan, LPN, EMT-B]

Using a string and vial or ampule is not a great idea. We had to address this at a job I had once, as one training organization thinks this is a great idea. Here is a small study on the issue.

Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: is the ampule/syringe/needle method practical? - PubMed - NCBI

now its small but it basically Pitts a group of trained parents against a group of physicians, a group of nurses, and a group of ED nurses. Here's the interesting part.

The parents took significantly longer (P .05). The epinephrine content of the doses drawn up by the parents ranged 40-fold in contrast to the physicians' doses (7- to 8-fold), general duty nurses' doses (3-fold), and emergency department nurses' doses (2-fold). The mean epinephrine content did not differ significantly (P > .05) among the 4 groups.

now this was under controlled conditions. I can't imagine those numbers get any better in the field with these people expearencing a real emergency.

[NurseGirl525, ASN, RN]

For all that are saying it's asking for trouble for people to draw up syringes, what exactly did people do to treat anaphylactic reactions before the invention of the epipen? My research has shown me the epipen didn't actually pass all the FDA trials and hit the market until the late 90's. What did they do?

It's just an alternative. Like I said, sitting around and complaining gets people nowhere. If people did what I suggested, I bet Mylan would lower their price and people could get their convienent pen back. After all, don't we trust diabetics to draw up their own insulin? Do you say, Well asking the diabetics to draw up their insulin is asking for trouble and we shouldn't allow it? Or what about people who give themselves shots for fertility treatments?

Drawing up medication is not hard. Many people in the general public do it everyday.

I 100% understand and agree that what Mylan is doing is wrong. It's plain wrong. But if you want to take on a giant pharmaceutical company, be prepared to do what it takes to win. Learn how to draw up a syringe. Writing blogs, complaining on Facebook, and these "open letters" to a CEO, does nothing. And by the way, she will never see your "open letter" on Facebook or Instagram. You know what she looks at? Her stock portfolio and company profits. It's all about the money.

[KatieMI, BSN, MSN, RN]

For all that are saying it's asking for trouble for people to draw up syringes, what exactly did people do to treat anaphylactic reactions before the invention of the epipen? My research has shown me the epipen didn't actually pass all the FDA trials and hit the market until the late 90's. What did they do?.

They died. In 70th, over half of kids who survived first anaphylaxis did not make it over age of 18.

Those who made it were bound to their own homes. Most were either homeschooled or separated from other kids in school at all times. No sports, no travel, no normal communications with other kids, no life.

Invention of portable injectors did not, actually, turn the tide. Improvements in food quality control, manufacturing and production, new laws (intended for general consumer protection) and public education were, IMHO, not less or even more important. But availability of epinephrine in simple form which can be used by children themselves greatly added to the fact that people like me are nowadays able to live almost normal life.

[Lunah, MSN, RN]

Does anyone remember the "bee sting kits" from the 80s? Little red plastic box? I carried one because I am allergic to bees. It had diphenhydramine tablets, a syringe, a needle, and a vial of epi. Plus some alcohol swabs. I wish I could find a picture of it! I almost got in trouble for carrying it in school until they realized what it was (or what it wasn't, lol).

[NurseGirl525, ASN, RN]

Does anyone remember the "bee sting kits" from the 80s? Little red plastic box? I carried one because I am allergic to bees. It had diphenhydramine tablets, a syringe, a needle, and a vial of epi. Plus some alcohol swabs. I wish I could find a picture of it! I almost got in trouble for carrying it in school until they realized what it was (or what it wasn't, lol).

I remember those!! I was allergic to bee stings as well. Schools carried them as well.

[Spidey's mom, ADN, BSN, RN]

I've mentioned this on another thread about the cost of epi-pens but I'm perplexed about the details of this story regarding why the costs went up so high.

We've had access to free epi-pens for undiagnosed kids who have anaphylaxis as a school district for years from Mylan. I've always been impressed. So I want to get the backstory.

Here's the link:

EpiPen® (epinephrine injection, USP) and EpiPen Jr® (epinephrine injection, USP) Auto-Injectors

[Libby1987]

I remember my kids' 1st MD dispensing a vial of epi and syringe when my first was an infant. I don't recall the reason but something about an allergic reaction and living remotely. Just before I left the office I repeated the dose back, very incorrectly. I think I said 1 ml versus .1 ml. I think we both turned white.

However I did understand the correct dose before I left and something about planning to mark the syringe.

Pre filled is ideal, this kind of absolute life saving drug should be affordable and I'm not sure the shelf life of a pre drawn syringe but it could be kept in a travel toothbrush case type container.

[Alex Egan, LPN, EMT-B]

Studies have shown that predrawn syringes are good for about 1-3 months. It seems like a good alternative if proper training is provided.

Long-term stability of epinephrine dispensed in unsealed syringes for the first-aid treatment of anaphylaxis. - PubMed - NCBI

The issue then becomes that a lot of the laws and regulations around schools and day cares givin. Epi specifically use the phrase epinephrine auto injector. So you probably couldn't just hand this to you kid and be good to go.

[dianah, ASN]

I carry an epi-pen for a serious bee sting allergy.

I cannot imagine, during the swift onset of a reaction (literally within seconds), trying to draw up the epi into a syringe.

and I have many years' experience drawing meds up into syringes.

I cannot envision Joe Public, in the highly-charged scenario of watching one's child reacting before one's eyes, trying to draw up the correct dose.

Yes, I can imagine ppl died before the pre-filled, ready-to-use syringe kits came out.

I hope they or a reasonable and ready-to-use alternative, are made more available to the public.

[Pepper The Cat, BSN, RN]

For all that are saying it's asking for trouble for people to draw up syringes, what exactly did people do to treat anaphylactic reactions before the invention of the epipen? My research has shown me the epipen didn't actually pass all the FDA trials and hit the market until the late 90's. What did they do?

It's just an alternative. Like I said, sitting around and complaining gets people nowhere. If people did what I suggested, I bet Mylan would lower their price and people could get their convienent pen back. After all, don't we trust diabetics to draw up their own insulin? Do you say, Well asking the diabetics to draw up their insulin is asking for trouble and we shouldn't allow it? Or what about people who give themselves shots for fertility treatments?

Drawing up medication is not hard. Many people in the general public do it everyday.

I 100% understand and agree that what Mylan is doing is wrong. It's plain wrong. But if you want to take on a giant pharmaceutical company, be prepared to do what it takes to win. Learn how to draw up a syringe. Writing blogs, complaining on Facebook, and these "open letters" to a CEO, does nothing. And by the way, she will never see your "open letter" on Facebook or Instagram. You know what she looks at? Her stock portfolio and company profits. It's all about the money.

I don't think you can compare drawing up insulin with drawing up epi.

Insulin is given in a calm, non-stressful environment.

Epi is given in an emergent, stressful situation where seconds matter. That is a the beauty of the epi-pen. It's a grab and give device.

[bathrobemom, LPN]

An anaphylactic reaction is NOT the time to draw up a med in my opinion.

Some people pass out without any warning. Hopefully there is someone nearby that can help. That could be a stranger. So you now have a stranger who could have no experience whatsoever drawing up epinephrine.

Some reactions are worse than others. My worst one was so bad I feel lucky to be alive. During that reaction I could barely breathe and was filled with anxiety about dying, that "impending sense of doom" that is mentioned in the long list of possible symptoms. That's panic level anxiety for me. When you need epinephrine (mine are for food allergies) you could be having diarrhea and/or vomiting, hives, wheezing, anxiety/sense of impending doom. I also had blurry vision- probably because my lungs, throat, and nose were swelling shut.

In the ambulance there were moments were I couldn't breathe at all even while I was on oxygen. When we arrived, there was some problem with getting me oxygen from the parking area to the ER room, so I had nothing from the ambulance to the room. When I got to my room, the nurse seemed kind of annoyed that I didn't start ripping my clothes off right away. I don't know if she said anything or what, but because of the blurry vision I didn't even know she was there at first. I couldn't breathe at all and was certain I was dying so I didn't hear her talking right away either.

I was on oxygen at the hospital for over two hours. I was on a nebulizer for over an hour. When the EMTs were ready to leave, I had to sign papers. I was handed a clipboard with paper on it and a pen. I knew I was supposed to do something with it, but I couldn't remember exactly what. I waved him off, he talked to my husband and for some reason came back to me. I couldn't remember my own name. I had to think about it. Then I couldn't remember how to sign my name so I just scrawled across the paper with the pen.

I couldn't breathe, couldn't see, didn't know my own name...so...no, I don't think this is the time to be drawing up epinephrine to save my life. If that's the only choice I have, fine, I'll give it a whirl. But I think you're going to see a lot more deaths if that's what people have to rely on.

By the way, people that use insulin- use it every day, multiple times. They get a lot of practice and it's not during an emergency. I think that's an important point.