Should You Hack Your EpiPen?

Should wait, because of the political insiders trying in bed with Mylan (makers of the EpiPen) to make a quick buck before a cheap generic pen comes to market because the patent is running out.

Its just a matter of time when its becomes reasonable again.

Would like to see some of these political profit raiders punished for making the high costs happen..

Hey it works for the Chinese....What's sad is the medical profession holds our health hostage now...they have become highway robbers, " Your money or your life!"....In this day and age, money is your life...

you touch of a topic that can a section all its own.

For profit hospitals. I can understand running a hospital for profit, but instead they are running a hospital to satisfy returns to the stockholder.

It would be the same quality as for-profit colleges such as ITT.

Straying from the topic for a moment.... With ITT, I really don't feel sorry for the students, they have to take the majority of the responsibility of the choice they made. While a for-profit hospital, the patient usually doesn't have a choice.

I'll save profits for pharmaceuticals later, that's more involved with R&D and the like.

I don't play the video, but would it be similar to Turing.

This behavior is rampant across the entire spectrum of the healthcare industry....the epinephrine costs about $3 to fill a prescription ...It's healthcare profiteering run wild....

...and an injection for Anaphylaxis takes 0.3 ml....

https://microscopesareprudent.wordpress.com/2016/07/06/save-money-with-generic-epinephrine/

https://en.wikipedia.org/wiki/Epinephrine

https://www.canadadrugs.com/products/epipen

I've heard the true cost of the drug.

Now I understand the risks involved with development of drugs where they have to be offset with profits. But there is what too much going into the stockholders hands.

I love profits, and I love returns. But when the returns are way out of line, I get concerned. Back in the late 90's where every stock in the market was returning +20%, And really no improvement or innovation to their product.

I got concerned and started selling in the beginning 2000, or at least put it in a consistent basic stock like Fastenal or Home Depot. Fastenal had lower returns but had a consistent 8% market growth. Which at the time seemed like humble growth, but after the crash it was gold.

Trying to corner the market, with her mother's help maybe, sold some to schools at a discount price $112 with the stipulation that the schools had to buy from them exclusively for a year...probably to establish a buying pattern and lock in a huge market...

http://www.pbs.org/newshour/rundown/mylan-may-violated-antitrust-law-epipen-sales-schools-legal-experts-say/

..."After Gayle Manchin took over the National Association of State Boards of Education in 2012, she spearheaded an unprecedented effort that encouraged states to require schools to purchase medical devices that fight life-threatening allergic reactions."

http://www.usatoday.com/story/news/politics/2016/09/20/family-matters-epipens-had-help-getting-schools-manchin-bresch/90435218/

..."Manchin was appointed in 2007 to serve a nine-year term on the West Virginia board of education by her husband, then-Gov. and now Sen. Joe Manchin, D-W.Va. Gayle Manchin became the association president in January 2012, the same month her daughter became Mylan’s CEO."...

..."That Mylan has restricted domain over the EpiPen is ironic since it owes its existence to public initiative. In 1973, as fears of chemical warfare mounted, the Pentagon asked scientists at Survival Technology, Inc. to develop a first-line of defense for soldiers exposed to nerve gas. Their concerns centered on the so-called G-series of nerve agents — including tabun, sarin, and soman gas — developed for the Nazis by the German chemical company IG Farben in the 1930s and 40s. Similar to EpiPens today, the Nerve Agent Antidote Kit was intended for use with little training, to keep the patient healthy in the critical moments prior the arrival of proper medical help."

"This June 28th marks the 49th anniversary of the date of issue of the patent for which Sheldon Kaplan..."...

https://timeline.com/epipen-technology-drug-industry-b28d19036dee#.kskrc6c2w

http://www.ipwatchdog.com/2016/06/28/evo-of-tech-sheldon-kaplans-epipen-gives-doses-of-life-saving-epinephrine-for-nearly-50-years/id=70024/

http://invent.org/inductees/kaplan-sheldon/

The patent for the Epipen was granted in 1977...

https://www.google.com/patents/US4031893

Ouch!

This is an outrage.

Unfortunately, it's legal thanks to a lazy, greedy Congress who will bluster and ask blunt (as in dull) questions while taking the bribes that assure the swindlers will continue to steal our money.

Term limits and campaign spending limits would stop this, but there's no chance of that happening since Congress has been purchased by big pharma/oil/health care and big business in general. (Thanks to the SCOTUS for allowing elections to be sold to the highest bidder)

I developed a severe allergy to mammalian meat as a result of tick bits 10 years ago and have to carry an Epipen also.

For now, I'll (my insurance) continue to pay the outrageous price, but another alternative is to get your doctor to prescribe a vial and syringe and self-inject.

Congress and the Senate.

Heather Bresch the CEO of Mylan (owner of the EpiPen) is West Virginia Senator Joe Manchin daughter.

..."Heather Bresch (née Manchin, born circa 1969)^[4] is an American business executive and the daughter of Democratic U.S. Senator Joe Manchin. In 1992 she started working as a clerk in a factory owned by Mylan, a pharmaceuticals company, a job her father found for her. In 2007 she was accused of inflating her resume by claiming an unearned MBA degree that was given to her by West Virginia University's president, Michael Garrison, a politician, a friend of her father and a former lobbyist for and consultant to Mylan. She became the Chief Executive Officer of Mylan in 2012."...

..."In 2007, Garrison was selected as West Virginia University's twenty-second president.^[8]"...

^..."On June 6, 2008, Garrison officially announced he would resign as President of the University effective September 1, 2008.^[16] In October 2008 a West Virginia grand jury decided not to indict Garrison on criminal charges relating to the degree scandal.^[17] "..

She looks like a puppet to me...

https://en.wikipedia.org/wiki/Heather_Bresch

https://en.wikipedia.org/wiki/Michael_Garrison_(politician)

Vice is nice, but incest is best.

..."another alternative is to get your doctor to prescribe a vial and syringe and self-inject."

Unfortunately there is not always time for this approach, and the dose can be critical...In a lot of cases the victim can become completely helpless in a matter of minutes...that's why a preloaded spring powered syringe is the tool of choice....epinephrine is just another name for adrenaline, too much can be as dangerous as none...

.."The wholesale cost in the developing world is between US$0.10 and US$0.95 a vial.^[12] In the United States the cost of the most commonly used autoinjector for anaphylaxis was about US$600 for two in 2016, while a generic version was about US$140 for two.^[13]"

http://www.mayoclinic.org/diseases-conditions/anaphylaxis/basics/definition/con-20014324

http://www.rxlist.com/epipen-drug/overdosage-contraindications.htm

life imitating art.

The first EpiPen.

Gene Roddenberry should have patented everything used on his show.

I'd argue that unless one carries the auto-inject pens on their person, at all times, that is not a valid argument.

You are issued two pens in case one dose isn't enough.

Maybe I'm fortunate in my case that the onset of anaphylaxis is delayed for up to two hours after eating before the first symptoms begin to show up as hives. Still, I've had 3 trips to the ER, the last one very serious.

For now, I'll continue to use the pen.

..."Different factors like age, body weight, present medical condition, individual tolerance level and other medicines affect the typical dosage of any medication. In general, on shot of Epipen 0.3mg is used in adults as well as children weighing more than thirty kilograms and Epipen (Jr) 0.15mg is recommended for children weighing between fifteen and thirty kilograms. In case the symptoms do not alleviate within ten minutes, apply a second shot. This way, Epipen can be re-injected every five to fifteen minutes till you are fit enough to travel for further treatment or till further medical aid arrives."

https://www.canadadrugs.com/products/epipen

"Epipen can be re-injected every five to fifteen minutes till you are fit enough to travel for further treatment or till further medical aid arrives."

That's laughable!

Imagine the biggest cigar you've ever seen and that's about the size of ONE pen.

And nobody keeps more than two at hand anyway.

Move to Australia.

I'd agree with you, having come off the farm and did a lot of treatment to the animals, to prep, fill and again prep a syringe for injection, there is a lot that can happen and go wrong, especially if you begin to succumb.

And god forbid if in your haste you didn't purge the air out before you inject.

Why isn't there competition for the generic version of this device?

http://abcnews.go.com/Health/epipen-users-options-generic-alternate-drugs/story?id=41667390

..."By the first half of 2015, Mylan had an 85% market share of such devices in the U.S.,^[34] and in that year sales reached around $1.5B and accounted for 40% of Mylan's profit.^[37] The price increase in 2016 was met with widespread, sometimes vitriolic, criticism of Bresch and Mylan.^{[5][38][39][40]}

Proxy filings show that from 2007 to 2015, Bresch's compensation rose from $2,453,456 to $18,931,068, a 671 percent increase.^[5][36]"...

^{https://en.wikipedia.org/wiki/Heather_Bresch}

The main reason for the outrageous price?

"pharmacists in many states cannot automatically substitute a generic alternative."

Why? Could it be because lawmakers have been bribed?

It could play a role in some cases I guess....

"According to the FDA's Approved Drug Products with Therapeutic Equivalence Evaluations, commonly known as "The Orange Book," drug products must demonstrate pharmaceutical equivalence and bioequivalence to be considered therapeutic equivalents.¹ Therapeutic equivalent drugs are either A-rated (there are no known or suspected bioequivalence problems) or AB-rated (actual or potential bioequivalence problems have been resolved with adequate in vivo and/or in vitro evidence).¹ A-rated drugs may be designated AA, AN, AO, AP, or AT, depending on the dosage form.¹

Generic substitution laws are state specific. In most states, pharmacists cannot substitute nontherapeutic equivalent products. Some states allow substitution between products as long as state-specific criteria are met, such as having the same active ingredient, dosage form, dose, and route of administration. It is important to use professional judgment when substituting products to ensure safety and efficacy. A survey of state generic substitution laws is presented in the table below. The information below is obtained from personal communications with each individual state and review of each state's pharmacy rules and regulations available online. Note that the information below is current as of April 2009."

http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=&s=PL&pt=2&segment=1186&dd=220901&AspxAutoDetectCookieSupport=1

Still reeks of government trying to protect the population "from itself ". Actually from peoples own stupidity. How many people daily inject themselves with the proper amounts of Insulin? Somehow the utter total dependence on medical technology to provide fixes for every conceivable medical issue in the USA is one source of the problem.

By the way, what is the cost for the Epipen in China?

You, obviously, do not understand the problem with these allergies.

The government is protecting big pharma, not the public.

Yup!

Just follow the money.

Bingo!

Bought or at least rented.

As a comparison Microsoft CEO Satya Nadella's compensation was $17.7 million this year.....

After hearing about the price hikes I was a little nervous while filling the script but my insurance also ate a huge chunk of it--I think I paid a $30 copay for a 2-pack. Haven't had to use them yet, knock on wood.

Where do you think those insurance payments you make go to? You pay, the insurance companies don't give charity...

True, but I've been shocked by copays before. Typically along the lines of a drug for which insurance has decided to end support, with supposedly no alternative. My kids both have chronic medical conditions (asthma and epilepsy), and we've had to fight our insurance company a few times to either avoid $100 copays on a doctor-preferred drug or stop them from overruling the doc in favor of a substitute.

At those prices, I'm all for the hack! In fact, if I couldn't get the epinephrine, I'd look for ways to synthesize it myself.

haha...

"Buy 2-Chloro-1-(3,4-dihydroxyphenyl)ethanone, 97% (500 g, $283 Alpha Aesar)

Do a substitution of the chlorine with methyl amine (use a large excess of methyl amine).

Reduce the carbonyl stereoselectively using 1H,3H-Pyrrolo[1,2-c][1,3,2]oxazaborole, tetrahydro-1-methyl-3,3-diphenyl-, (S)- with Borane Dimethyl sulfide complex in THF. "

Reference https://www.physicsforums.com/threads/is-it-possible-to-synthesize-adrenaline-in-the-lab.180557/

Synthesizing is nor so much the problem as verifying the purity.

My college Organic Chem lab manual had procedures for synthesizing many of the drugs I take or have taken, but I'd never risk trying them.

Is the patent/protection on the drug, the delivery method or some combination of these?

Sounds like the US have found a means to subsidise the local producers while locking (legislating) out imported alternatives. (this way it's not "taxpayer subsidised" since the funds never go through revenue.

There surely must be other delivery methods for epiniphrine. (Heck, with some fairly simple equipmet I could hack an insulin autoinjector inless than 5 minutes for this and in less than another 5 minutes hack a replacement vial.) For production,would only need minor modifications to limit maximum dosage. If the vial was "single dose limited", then would avoid the posibility of immediate re-injection through time involved having to remove the spent vial and load the next one.

Current price for true "Epipen" in Aus is $37.30 (Around $US25) if prescribed by a doctor under our health scheme, or $100 each if discretionary purchase. We also have an alternative "Anapen" by another manufacturer, so I suppose that will keep the B@$^@#ds honest and the prices reasonable.

I'm curious why someone hasn't developed an inhaler. Entry into the bloodstream is faster and no infection concern.

I wonder if it's because of the respiratory difficulties caused by severe anaphylactic reactions. I don't think an inhaler would be effective against a closed throat.

As long as you are breathing, it should work.

Take it from one who has been there, you're not getting much air into the longs because the alveoli swell up and restrict the ability to absorb any O², or anything else.

Last time I visited the ER I was panting heavily and turning blue at the same time.

Epinephrine constricts the blood vessels of the airway lining and very little gets absorbed.

20 years ago, it was brought to attention that a good way to fight with biological weapons. The best use for dispersion and infect is to lace toilet paper with it.

the second one is to lace the almighty dollar.

Should You Hack Your EpiPen?

uhhmmmm, What would Mcgyver do?

let me think...

Got it....

You missed the sharpened basketball inflator for the end of the grease gun.

just a sec.... I'm almost done here.

So what he's saying is that if the epinephrine from the inhaler won't go into the lungs, hit them with a blowtorch for a little while to get things flowing. NEAT!

Interesting one. In the UK the adrenaline (epinephrine) costs £5.82 for 10 1mg ampoules (the dose required being 0.3-0.5mg). A syringe and needle are a few pence each. A pack of alcohol wipes is cheap enough but not really necessary. If you were motivated enough to learn the drawing-up technique as well as the injection technique, you could have an emergency kit for less than a dollar. Alternatively you could have a prefilled syringe for £10.40 (about $16), which is the route I would suggest.

For the aforesaid motivated individual I see no advantage of an Epipen over a prefilled syringe other than that it is rather more robust. Likewise, I see little to worry about in a self-constructed injector to operate a prefilled syringe. The important thing is the site and technique of the injection.

I'm going to throw another possible, much more inexpensive alternative, out there.

The only drawback is that you have to take it early in the onset of anaphylaxis. Because you have to be able to swallow.

The last time I went to the ER for an anaphylactic reaction they gave me the usual Benedryl as well as believe it or not, Immodium AD. Turns out it's good for more than just the runs.

I was rather surprised when they told me this. He said it is the same as the OTC just in a higher dose.

They gave me 150mG of Benedryl by IV. That's equivalent to 6 pills (@25mG ea.) of the OTC stuff. Which is the max dose recommended on the packaging. I can't remember the dosage of the Immodium that they gave me was though. Probably the max pack dosage as well.

Your mileage may vary, but if you are starting to suffer the effects of anaphylaxis, which can kill you in a rather short time, if not dealt with quickly. They are good remedies that are likely to be in the medicine cabinet. Just make sure to tell the ER docs what you have taken and the dosage. So, they don't give you more of it and cause an overdose.

*BTW I weigh 84 kilos if that would affect the dosage.

Okay, time for a disclaimer. I guess some people can have allergic reactions to both Imodium AD and Benadryl. The above comment is based purely on my personal experience. I am not a Medical professional nor have I stayed at a Holiday Inn last night. Anyone who takes my advice, the medical advice of some mystery screen name, on the internet. Does so at their own risk. It is guaranteed to be worth at least what you paid for it. Nothing.

Same for me--I took a double-dose of children's Benadryl (didn't have the adult kind in the closet at that point) before I progressed to the respiratory symptoms. I think that stopped it in its tracks, then the ER gave me a steroid and more Benadryl. Immodium I hadn't heard of...that's interesting. Makes me feel better to have the EpiPens in case of a true emergency, though.

I went in to the ER once for that and was given Benedryl and Zantac.

I cannot believe I'm reading this. Imodium (loperamide) has absolutely no effect on the progress of anaphylaxis. Indeed, there is a faint risk of its causing anaphylaxis itself. The rest of the recommendation is reasonable. Benadryl is an antihistamine, and histamine is the chemical released in the course of the allergic reaction which causes the swelling. However both antihistamines and steroids, which also help to relieve the swelling, take some time to work. They are more useful when taken before the exposure as a preventative measure. In an emergency there is nothing that acts as quickly as epinephrine.

Well, believe what you want, I am merely relaying my experience. I thought I had made that clear by now.

You are correct, that there is nothing to match the speed of epinephrine. That being said, Benadryl is still effective. I am just giving other options, in case you don't have an Epi dose to hand.

Let's put it this way. I am medically qualified and you are not. Whom should one believe?

In what specialty?

I wouldn't consider most internists qualified to prform cardisc surgery.

Ah suspect the qualification he refers to is his ability to insert his arm up to the elbow in the backside of some critter of the bovine persuasion.

In poor taste!

You're dead on. It tastes really bad.

Don't worry about me - I'm quite accustomed to patients who know more about medicine than their doctors. The mystery is why they bother to consult a doctor in the first place.

It's interesting how it seems each ER has their own preferred cocktail of meds for Ani-Shock. I see that the Benadryl is the consistent favorite for the base.

Growing up with severe allergies, I am no stranger to Benadryl. It has saved my backside countless times.

I'm sure the Benadryl is to treat the allergic reaction and the other ingredient (Imodium, Zantac, Steroid), must be to assist in opening the airways.

For the immediate, on scene, self treatment, I think the Benadryl is what matters.

Like I said in my disclaimer, I am going from my own experiences with allergies over the last 37 years. Do you own homework and find what works for you.

Not all allergies are created equal...Some people are more allergic than others....The Epipen injectors are for people that have a severe reaction, can go into anaphylactic shock, where the body shuts down, this is different than hives or itching as mild reactions that occur, and hay fever and other pollen allergies are widespread....Benadryl(diphenhydramine) by tablet is good for these, and a little more severe Benadryl can be injected....But some people have a severe reaction that requires a little more....

"Anaphylactic shock: A widespread and very serious allergic reaction. Symptoms include dizziness, loss of consciousness, labored breathing, swelling of the tongue and breathing tubes, blueness of the skin, low blood pressure, heart failure, and death."

"The most common cause of anaphylaxis in the community is from eating a food to which you are allergic such as nuts, peanuts, eggs, mammalian milk, soya, wheat, fish and shellfish. These 8 foods account for 90% of cases of food induced anaphylaxis. Peanuts and tree nuts (such as Brazil nuts, Hazelnuts, Almonds and Walnuts) are the foods most likely to provoke a reaction.

Even eating a tiny amount of a particular food can cause anaphylaxis. Some people are so sensitive that breathing in the food essence can trigger a reaction (as in a Restaurant when the person at the next table is eating fish or kissing a person who has recently eaten peanuts)."

http://www.allergy-clinic.co.uk/more-about-allergy/anaphylaxis/

I take sodium styrene polysulfonate for high potassium...the bottle is clearly marked "for oral or anal use", (it doesn't taste too bad) I wonder if people who take epinephrine could just "stuff it" if they don't like needles...seems to be an alternative delivery method for many drugs...

I don't think it's a good idea to be putting input into the output slot....

Actually there are good precedents for the rectal administration of drugs, particularly in children when nobody is around with the skills to put a needle in. Rectal diazepam is a standard emergency treatment for a seizure in children. The use of suppositories is a quite popular alternative to tablets on the continent of Europe, for both children and adults. Further back in history Pirogov, a Russian surgeon in the Crimean war, used rectal ether as a general anaesthetic.

The problem is with the formulation and with the drug itself. Even for the same drug, an oral tablet and a rectal suppository are made up quite differently to ensure proper absorption. In the case of epinephrine, rectal administration is a non-starter, as it constricts the blood vessels of the rectal wall, thus preventing any useful further absorption.

Some streets are only one way.

I think how it's administered depends on how fast it reacts.

Wow, a lot of opinions here as well as satire and few very knowledgeable comments.

What I've gleaned from one was discussed is that one should tread lightly if you are going to hack your EpiPen. And in this case, ignorance is not bliss.

I'll stick with the grossly obscenely overpriced prescription unit.

I think my allergy may be milder than some other people's.

After all the sound and fury, sounds like two things come to front.

An alternate supplier of an epipen type device is needed. It will happen.

Alternates exist, needle and bottle or even prefilled needle would work, but not as conveniently.

Government price capping (and perhaps subsidy for cases where the cost is actually high and can be proven) for sole source medicines might be worth considering.

If you try to save a few bucks and make it yourself, you have to accept the risk of possibly killing yourself.

Hospitals love selling immodium by the dose. Buy cheap and sell dear.

OK, so more than three things.