One N.H. Veteran's Push to Change VA's Naloxone Policy

Nov 1, 2016

Naloxone, also known by the brand name Narcan, is a drug that has the power to reverse a drug overdose and save lives. Doctors in New Hampshire can prescribe it to anyone who could use it to help someone survive an overdose.

But doctors at the Veterans Health Administration hospital in Manchester don’t do that. Doctors at VA hospitals only write prescriptions for the drug user—not for friends or family. One New Hampshire veteran is trying to get the VA to change that. 

Army veteran Peter Gonsalves says he has pretty good “veteran radar.” That’s what he calls the ability to spot another veteran on sight. 

The Franklin resident used it one night at an apartment in Manchester. Some people there were using illegal drugs. One of them was a guy with the short, military-style haircut. He turned to his friend, a woman who brought him to the apartment. 

“I said, ‘Is he a veteran?’ and she said, ‘Yeah, he is.’ So that’s why I started getting interested in getting this guy help. Because a lot of them don’t want to live this way.” 

Gonsalves says he feels strongly about not leaving a fellow soldier behind. So he asked this veteran: do you want some Narcan, just in case? 

He said, "Yeah, definitely." So Peter Gonsalves made an appointment at the Manchester VA and asked for Narcan. The physician there said no.

“She said, 'Unless you’re on opioid therapy or unless you test positive for heroin, we can’t issue Narcan'.”

And that’s a problem, Gonsalves says, because Narcan isn’t usually self-administered.

"Unless he physically shows someone else the kit and teaches someone else how to use it, it’s no good anyway," Gonsalves says.

Credit Peter Biello / NHPR

Since then, Gonsalves has been sending out emails—to politicians, the press, the VA—trying to get the VA to change its approach. 

Dr. Elizabeth Oliva is the VA National Opioid Overdose Education and Naloxone Distribution (OEND) Coordinator. She says the idea Gonsalves is promoting is something that should be discussed. But it’s a slippery slope.

“So if we do it for this, why wouldn’t we do it for EpiPen? Why wouldn’t we do it for Glucagon?" Oliva says. "Those are important, life-saving medications. Of course, there are good arguments to be made for those as well.”

And she concedes that there is no epidemic of allergic reactions as there is for opioid overdose deaths in New Hampshire.

The VA in Manchester says it has issued naloxone prescriptions to 216 veterans since August 2015. It would not provide data about how many veterans asked for it and were told they couldn't have it.

Here is where the VA’s official practice of prescribing Narcan gets a little strange. NHPR asked the VA multiple times for the documents that spell out the VA’s naloxone prescription policy. They did not provide one. Turns out, there is no written policy, no list of must-dos or prohibitions. 

The closest thing is a document with recommendations on how to prescribe it. James Schlosser is acting Chief of Staff at the Manchester VA Medical Center. He says this document is "guidance. This reviews the scientific literature, summarizes it for clinicians, so that our staff have the best scientific guidance available to them.”

So, if the closest thing the VA has to a policy is a recommendation, not a mandate or directive, why not use discretion?

The VA cited the Appropriations Act, saying that it "only permits use of funds for beneficiaries of the Department [of Veterans Affairs] and veterans." Schlosser treats the recommendation as a rule. He declined to comment on whether it makes sense to give Narcan to someone who knows a veteran who may overdose. 

But Jason Lucey has a different take. He’s a nurse practitioner and a member of OneVoice Opioid Task Force of Strafford County. He says in most cases, even civilian doctors won’t give you drugs if they’re not meant for you. 

"But with naloxone, when everything is boiled down, the benefits of saving someone from an overdose far outweighs the risks of giving a medicine to someone who may not need it," Lucey says.

Which is why New Hampshire passed legislation last year allowing anyone to get the drug if they could use it to save someone’s life. 

New Hampshire Congresswoman Annie Kuster sits on the House Veterans’ Affairs Committee. She says this isn't something she'd considered before.

"It’s an interesting hypothetical," she says. "I want to make sure naloxone is available for veterans who need it. There are obviously lots of sources of naloxone within our civilian healthcare delivery system."

And that's true. Peter Gonsalves could go outside the VA to get naloxone. But he says it’s a matter of honoring the VA’s mission. 

"The problem is veterans are more likely to go to the VA for help than anywhere else because that’s what the VA’s mandate was supposed to be for—to help veterans," he says.

He says in the military, you leave nobody behind, and right now, that’s what the VA is doing.

Through the month of November, NHPR will be telling stories of military veterans in the Granite State. Next week: what some veterans are saying about the issues that matter to them this election season. If you're a veteran and would like to weigh in, send an email to Peter Biello at pbiello@nhpr.org.

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