The EpiPen is an auto-injector that rapidly and safely delivers a measured dose of epinephrine to an individual experiencing a life-threatening allergic reaction known as anaphylaxis. In the United States, a near monopoly has allowed the owner of the Epipen, the pharmaceutical giant Mylan, to raise the cost of their standard two-pack to upwards of $600.
This large price increase has sparked widespread outrage directed a Mylan, especially since the cost of manufacturing a single injector, complete with the drug, may be as low as $20. For example, the cost of 1 ml of epinephrine (over three times the amount contained in an EpiPen) is less than $5.
This pricing disparity has led to a number of viral social media posts suggesting cheap alternatives to the EpiPen device. The post below, for example, received over 30,000 shares on Facebook:
From a strictly factual standpoint, it would indeed be possible to obtain a cheap vial of epinephrine and a basic syringe, just as it is also true that, if properly administered, such a setup would produce the same life-saving effects as an EpiPen. However, that does not mean this procedured is a safe and effective solution.
The EpiPen is designed to be a rapid, simple and sterile solution. It is capable of being safely transported without fear of contamination and, if needed, of quick self-administration. To achieve these characteristics, the injector is preset to deliver a precise dose, is spring-loaded to ensure a full injection, and is housed in a sterile chamber that is breached only in the event of an injection.
The EpiPen system limits the amount of time needed to administer a dose and the risk of human error, and these factors can be crucial in the terrifying moments that you or a loved one is suffering an anaphylactic reaction. Research has demonstrated that it is unreasonable to think that a person could accurately measure the correct dose of epinephrine, draw it into a vial, and inject the drug, all while either in the throes of a debilitating allergic reaction or while watching someone else in the throes of such a reaction.
A 2001 study in the Journal of Allergy and Clinical Immunology investigated the efficacy of having parents administer epinephrine to infants with a traditional syringe. In that study, the parents had been trained by healthcare professionals on how to properly draw the dosage, yet the paper concluded that “most parents were unable to draw up an infant epinephrine dose rapidly or accurately.” Perhaps just as troubling, the study showed that the dosing amounts among different subjects varied by as much as 40-fold.
As reported by the World Health Organization (WHO), the timing aspect in such injections is a key concern because numerous studies have shown that the the amount of time it takes to administer epinephrine is crucial, and that many fatalities from anaphylaxis could have been prevented by earlier administration of the drug.
Potential dosing fluctuations are just as troubling an issue. According to the same WHO report, a too-low dose could prove to be ineffective at reversing the often fatal consequences of anaphylaxis, while a too-large dose could potentially trigger serious side effects — including heart attacks and death.
Speaking to CBS News, Dr. Howard Mell argued that consumers’ pre-loading syringes themselves is not a tenable solution either, as it introduces risks regarding sterilization, and the drug might degrade faster in a syringe compared to a vial. He also pointed out that the EpiPen removes the guesswork involved in determining the depth of the injection, adding that an injection that is too shallow would be less effective.
None of this is to say that the EpiPen’s increasingly high price is justified. Indeed, many legislators and patients are fighting for new laws to address this issue. There is, currently, a cheaper generic epinephrine auto-injector available in the United States called Adrenaclick, but it may be hard to find as the company is presently unable to manufacture large quantities of the product.
The final word though that does need to be said, however, is that applying a DIY solution carries significant risks according to numerous healthcare officials, so for now the EpiPen (or an Andrenaclick) remains the safest (if not the cheapest) solution.