I saw this meme floating around facebook recommending a way that people could save money on the Epipen in the middle of this overcharging scandal.
The suggestion is that people request their doctor write a prescription for a vial of epinephrine and syringes to accompany it. Then all you’d have to do is learn how to carefully measure this and administer it. Simple, right?
[glares in go fuck yourself]
There are a handful of disorders for which people administer self-filled syringes. Diabetes is one of them that we’re all pretty familiar with. In most cases when a diabetic gives themselves insulin, they have time to test their blood sugar, carefully meter out how much insulin they need depending on a number of factors, and they can do this at regularly timed intervals.
Know where they did not get their advice to get self-administered syringes? From a meme on the internet. They got their medical advice directly from their doctors and there was professional training on how to appropriately self-administer their medication.
They also didn’t do it out of desperation to save money. Think this shit over for a minute.
People self-administer other injectable medications that come from a bottle with a syringe in a controlled and planned setting. Insulin. Heparin. Other random medications that you rarely hear about and, I guarantee you, are used when you aren’t having trouble breathing.
What’s the manner in which people self-administer Epipens?
*taps fingers and waits*
It happens when you’re having severe allergic reactions. These are not “someone get the benadryl, Aiden is a little itchy and I don’t think his chakras are aligned anymore.” These are for “holy mother of fuck, Madison Rainbow’s lips are turning blue, this is no time for superfoods, get the real shit.”
Want to get the vial of epinephrine and the syringes for $10?
First and foremost, good luck trying to keep your hands steady.
Those three words that your doctor said when he first instructed you on if you ever needed to use this trigger a backfire in your brain:
“Now, don’t panic…”
Your heart rate skyrockets to that of an epileptic hummingbird.
While time is paradoxically standing still and running too fast to think, you’ll start second guessing everything that seemed so simple when your doctor trained you.
It was so sterile and mechanical. Now it’s your child, and they’re growing pale.
You’re only thirty seconds in. And it’s ugly already.
You question if that many cc’s are still the same as the last time you were in the office. You’ll think, “isn’t Cameron two years older now? Do they need more epinephrine now? Are they going to start breathing again if I don’t measure this exactly right?”
Then the panic really starts to set in as your child starts to make a frantic hiccoughing noise while their chest spasms, lurching, begging for air.
Al you want to do is make this end. Your child has been drowning for a full minute. And you’ve just now managed to get the cap off the syringe. Your hands are still shaking.
Then you remember those times you saw a thing on CSI about a bubble of air in the syringe being deadly- was that true or was that a lazy screenwriter?
A minute and thirty. Jesus. H. Tapdancing.
Am I supposed to tap this thing? Is that just going to waste time?How do all those junkies on Intervention get this done and live?Did I just not pay attention? Am I doing this wrong?Am I doing this wrong?
It’s been two minutes. It was the longest goddamn two minutes of your life. You’re not sure how many heart attacks you had, a lifetime worth at least.
Another thirty seconds of fumbling to get the thing pulled back. Is that the right amount? More? Less? Fuck fuck fuck fuck fuuuuuuuck.
And as your child’s lips are turning cyanotic and you can’t hear any more noises coming out of their throat, you barely manage to pull back any random amount of epinephrine that your frantically shaking hands can muster as you shove your thoughts of every last doubt and fear you have away because, at this point, seconds count.
You’re sure you had to get that syringe into your child’s leg sooner than that.
And then they breathe. And you have a sigh of relief, and then the questions start again.
“Three minutes. What happened to them in three minutes of waiting?”
If you think I’m exaggerating for dramatic effect (I’ve met me, I’d be suspicious as well), a study showed that patients took an average of nearly two and a half minutes to prepare a syringe with epinephrine from a vial. This was both with the materials right in front of them AND without the stress of their child struggling to breathe in front of them. They also were not able to draw the dose accurately on a consistent basis.
Furthermore, it’s been pointed out to me from a few nurses and doctors that you generally purchase epinephrine in a glass vial. This requires a filter syringe to be used to ensure that you are not injecting small glass shards into your veins, adding more time to a process that’s already time dependent. I’ve worked with these types of vials in the lab, and it’s not too uncommon for them to shatter or cut somebody. Let me know how well you think this would work when you’re struggling to breathe.
In the study, they were in controlled situations after some training when there was no anaphylaxis for them or a relative to react to frantically. What happens when there’s an actual emergency? How long will it take? What are the odds that they’ll pull an inaccurate dose of epinephrine in a moment of panic and fix the breathing but cause a cardiac incident?
All of this is happening because of desperation due to the actions of a horrifically greedy company. Don’t let this be unclear; it’s not a parent’s fault if this DIY kit sounds like a good idea at first given what Mylan is doing. The Epipen has been a game changer in giving peace of mind to people with severe anaphylaxis. However, Mylan purchased it and jacked the price simply because they could to the point where people are taking medical advice from a meme. This desperation is not the parents’ fault. All blame falls squarely on Mylan.
8/29/2016 edit: The misinformation spreading in this meme is no better than bullshit that says green juice can cure cancer. Whether it’s bad information because it’s telling you to use a “natural” cure that’s completely unproven and useless or it’s a cure that’s proven and just won’t give you your medication in a way that’s useful, I don’t have any agenda other than to tell you the science if you’re being given a dangerous message that preys on your desperation. You deserve better than that.
For this, I’ve been called a lot of nasty things and accused of being a lot of things, none of them true. Mainly I’ve been accused of working for Mylan or owning stock in the company. The company must have the weirdest social media policies if I could get away with saying the things I said about the company CEO and practices and still be an employee there. Read further for all the alternatives to Mylan’s Epipen that I highly recommend, which seems to undermine that train of thought.
Following up with some comments from my website, after initially posting this to my facebook page, several of my followers who use various medications delivered by injection weighed in with their thoughts:
8/29/16 Edit: Since initially posting this blog, a few alternatives on the market have been pointed out to me and I hope people will look into them. Again, I’m not on Mylan payroll (a thing I can’t believe I have to even say), I just had not seen links to generics and I am *very* glad that lower priced options are on the market. I originally mentioned one autoinjector that’s comparable and currently on the market at a significantly lower cost is Adrenaclick, but it’s utilizes a slightly different mechanism and you will need to have a conversation with your doctor on how to use it. Please talk to your doctor about if it’s a good fit for you. I have a nurse and a physician assistant on my staff and they concurred that the difficulty level and speed of administration are preferable to the syringe and vial of epinephrine. The other option is to inquire if your pharmacy stocks generic epinephrine injectors and ask your doctor to specifically write a prescription for a generic epinephrine autoinjector. Costco, CVS, and Walgreens all carry a generic autoinjector, and if your local one does not currently have it in stock, they will order it for you.
Without a prescription SPECIFICALLY for a generic autoinjector, your prescription will be filled for an Epipen. Please consult with your doctor about this and inquire about generics for an option that’s appropriate for you, will deliver your medication in a time appropriate fashion, and not break the bank. Additionally, please talk to your doctor if you switch autoinjectors to make sure you know exactly how to administer it long before the moment comes for when you really need it.
After co-pay for the generics or Adrenaclick, they might be a bit more expensive than the DIY kit. They will be far less expensive than the Epipen. The punchline is that it’s worth it.
So the good news is that there are options other than Epipen. The prices aren’t perfect, but they’re better. Fixing the conditions that got us to this point takes work because Mylan is a symptom of the problems in the pharmaceutical industry, and to nip it, it takes legislation, not just yelling at Mylan or a coupon for a temporary patch. The company needs pressure to be put on it from customers (and the loudmouths currently running for office need to throw down some serious plans about pharmaceutical industry investigation and reform) without making potentially fatal decisions in the meantime.
Money and money alone is driving good people to gamble with their health. Before taking advice from a meme, please look into the alternatives that are listed here. If you’re a parent who’s considered this, I urge you to stick to one of the available autoinjectors. Are the actions of Mylan terrible? Yes. Please use an autoinjector from another company.
One would hope I could point out misinformation that could potentially save a life without being told that I’m shilling for something, but welcome to the internet.
One would hope that eventually the pharmaceutical industry wouldn’t look as terrible as the bullshit artists, but even if they’re making medications that really work… they both suck.
One would hope that the morally bankrupt head of a pharmaceutical company eventually would say “I had a good run making $18 million a year, just a correlation and not a causation I assure you. Why yes, it’s about the same percentage increase as the price increase in the Epipen. Totally coincidental. No, I wasn’t winking, I had something in that eye. However, as a magnanimous person who is doing this out of the bottom of my heart and not out of intense media scrutiny, $600 was an overreach for a co-pay while I’m only charging $1oo to the Canadians, proving it’s possible but I’m just overcharging because I like
living in Prada conducting research or something. Instead of throwing you a coupon for it to be just moderately ridiculous at $300 a pop, the pharmaceutical equivalent of Let-Them-Eat-Cake, I’ll come down from my ivory tower and give you as good health care as the goddamn Canadians have because even I knows that a meme shouldn’t be what drives my customers off a cliff to potentially fatal medical decisions.”
Or maybe not.
Murika or something?