Most people who depend on the drug epinephrine to treat potentially fatal allergic reactions (whether their own, a child’s, or a loved one’s) are well aware of the price-gouging scandal surrounding Mylan Pharmaceuticals’ EpiPen. And despite recent adjustments by the company to make the auto-injector more affordable, many still worry about how much it will cost to keep the life-saving medication on hand.
That’s left some people wondering if they really need an auto-injector after all. Wouldn’t it be much cheaper, some have asked, to just get a prescription for epinephrine and inject it with a regular old syringe?
The question of this so-called EpiPen hack has been raised on social media, health blogs, and even the local news. So to get an idea of how realistic this scenario is (and if it’s actually a good idea) we asked Bob Lanier, MD, executive medical director of the American College of Allergy, Asthma, and Immunology. Here are his thoughts on DIY epinephrine—the good, the bad, and the downright scary.
First things first: Do you really need epinephrine?
“The first question to always ask is whether a patient really needs epinephrine,” says Dr. Lanier. “A lot of people are given EpiPens by their pediatrician or primary care doctor because they have a positive lab test to some allergen, but they’re never really evaluated by an allergist.”
Unfortunately, this can lead to a lot of unnecessary worry. “There’s been a media blitz around anaphylaxis, and there’s concern now that every sign of hives or swelling is equivalent to potential death,” he says. “In many cases, that’s not true.”
If you or a loved one has been given an EpiPen, make sure you know it’s truly needed before you start considering alternatives, says Dr. Lanier. Once you’ve seen an allergist and your condition is definitively diagnosed, read on.
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DIY doses are a good idea in theory
Before 1987, when EpiPens hit the market, epinephrine was pretty much only delivered via standard syringes. “For the most part, we survived pretty well back to the beginning of time without auto-injectors,” says Dr. Lanier.
Epinephrine is cheap, and so are syringes. “I could make up a kit with a pre-filled syringe for about 35 cents that could have the same effect as a $400 auto-pen,” says Dr. Lanier. That’s one reason he only uses syringes himself when he treats allergic reactions in his practice.
There’s another advantage to the DIY approach, too, at least for a trained professional: While EpiPens are only available in two doses, a syringe allows for customized doses—less for small children and more for larger, heavier adults, for example. It even allows for smaller or larger needles, which can also be helpful for different size patients.
But in an emergency, there can be serious downsides
One of the best things about EpiPens is that they can be used with one hand, while measuring liquid medicine into a syringe requires two. “That may not seem like a big difference, but there are certain situations, on the playground or while you’re driving a car, for example, that one-handed operation is crucial,” says Dr. Lanier.
Not to mention, breaking open a vial of medicine and drawing out the correct dosage isn’t something most people want to be doing in an emergency situation.
“The question is, can a doctor teach someone adequately to do this?” asks Dr. Lanier. “We’ve found that even nurses have a little trouble with this, so you can imagine what it might be like for a panicked parent or someone having an allergic reaction themselves.”
We don’t have to imagine, actually: One 2001 study found that it took parents nearly two and a half minutes, on average, to draw a dose of epinephrine for infants using a syringe. Many of those doses were inaccurate, even then.
Can’t my doctor make me a pre-filled syringe?
Carrying a pre-filled syringe everywhere you go can solve some of these problems, Dr. Lanier says, but they bring up additional concerns. A teacher or school nurse may be unwilling to inject a syringe of unknown material into a child, for example. Even if a doctor or pharmacist labels it and includes prescription information, the process would be more daunting for a typical bystander than the practically foolproof EpiPen.
(Then again, Dr. Lanier says, many people are afraid to use the EpiPen. “People show up all the time at the ER with the auto-pen in hand, wanting for someone else to do it for them,” he says. “In that sense, a syringe kit may not actually be that different.”)
Epinephrine can also be easily damaged by light and heat, so a DIY kit would have to be prepared and carried very carefully, and refilled more often than an EpiPen, in order to make sure the medicine doesn’t become ineffective.
Preparing a pre-filled syringe could also open doctors and pharmacists up to legal challenges if something did go wrong with the medication, Dr. Lanier adds. As a matter of fact, he says, pre-filled syringes used to be commercially available until a few isolated problems forced the manufacturers to shut down.
Dr. Lanier recommends that people talk with their doctors about the pros and cons of these low-cost alternatives, and decide together whether they’re worth considering.
“I think the chances of an average family physician or pediatrician prescribing this option are remote,” he says. The possibility of an allergist prescribing it to a well-established patient, he adds, is much better.
Which takes us back to Dr. Lanier’s original point. “First and foremost, you should only be considering this if you have a condition serious enough to be seeing an allergist,” he says. “Once that’s established, a doctor who knows your condition can help you decide what’s best.”