DIY EpiPen

I help run a non-profit "MakerSpace", if you are not familiar with such places they are basically a membership based workshop. They are usually full of people wanting to learn new skills, make stuff, and tinker. Last week at the White House there was a meeting of MakerSpace leaders. So there was a meeting of a bunch of do it yourself, lets just build it types all together when the EpiPen news broke out. If you missed it, the manufacturer got government funds to develop the EpiPen, then recently squashed some competition, got legislation passed to require all schools in the country to have EpiPens on hand, then raised the price from around $50-$70 to $600. The group of makers said there had to be an alternative because people were saying there was just no way they could afford this lifesaving device.

They came up with a list of items that your doctor can prescribe that would allow someone to self inject the epinephrine just like an EpiPen. The cost is about $60 before taxes and shipping, with no insurance and it is reusable. There is some ongoing discussion on if it's the best, if there are other options, if it is the right size of needle for everyone, etc. The biggest concern so far is that the medicine is in a glass ampule and you would need a 'filter needle' to prevent picking up glass shards. This isn't meant to be a shopping list, but more of a list to take to your doctor as an alternative to discuss. EpiPens are serious, meant to save a life in sever allergic reactions. This alternative involves opening a vial, drawing it into an auto injector and then using it. In the panic of a severe allergic reaction its some fumbling around vs the EpiPen, so this is really meant for those who just absolutely can not afford the EpiPen and would go without it otherwise. This isn't meant to just save some money.

I don't want to just post the list and someone grab it and think 'this is the exact stuff I need'. David Norris of another MakerSpace has been putting up some additional information as they find it.  I'm going to link the Facebook page where you can see the comments and concerns. David Norris' name is linked there so you can contact him directly if you wish. He was the impromptu group head that sat down and came up with the list. I'm not sure how to link directly to the post, but we don't put much stuff up so it's right at the top.

https://www.facebook.com/TekVenture/

I don't want to seem like I'm just directing people to read our site, so here is the list anyway. But PLEASE go ready the post in case things change and I don't notice and this post here doesn't get updated. We get no money in any way for any of this. It's just meant to help some people who may really need it. It's not exactly permaculture but perhaps self reliant related in that someone without insurance and without $600 in their pocket doesn't die to a peanut or the like.

This is an excellent example of #makers coming together to find solutions to problems. Most of you have likely heard of the EpiPen price hikes in the news the last week or so. The price going from $57 each to $600 each putting a strain on those who can not afford the life saving device. But the device is just a one time use automatic injector loaded with Epinepherine. The group of MakerSpace leaders meeting at the White House this week found a solution in a day. Here is a list originated by that group. Total cost before taxes and shipping (with no insurance reductions) $59.15, refillable and makes the per use cost around $1.50.

David Norris of Cyberia Makerspace
David said:
Some of us who met at the White House this week have formed an "open innovation medical devices" group to try to provide DIY solutions to devices the medical industry is killing people over or refuses to work on. This week's Epipen announcement was an excellent example of how quickly a group like that could come up with a solution. Here is a DIY Epipen kit for $1.50 per dose (cost spread over 100 doses) that your doctor can write you prescriptions for:

Supplies:
1.) $4.45 -- 1 mL epinephrine vial (contains enough for 3 adult doses, or 6 child doses)
https://www.boundtree.com/epinephrine-0641142035-pharm-1823-335.aspx?search=0641142035

2.) $32.95 -- Autoject 2 (general use injection aid device)
http://www.owenmumford.com/us/patients-product/autoject-2/

3.) $21.75 -- (box of 100) 0.3mL syringes
https://www.amazon.com/dp/B00K86ZO20

Now you have a cheap, refillable EpiPen with an average price of about $1.50/refill.

Well, now, that's quite a scam that the epi-pen people just pulled off isn't it!  I'll steer clear of expressing my outrage because that's  cider press business.  But what with all the fair trade agreements that have been made in the last 20 years, why could USA citizens not be allowed to buy from the lowest priced reputable seller?  Never mind, that's cider press too.  

Chris, thanks for bringing this to my attention.  I used to carry a syringe and ampoule of epinephrine around with me in case I got stung by a bee.  That was before I was a nurse, that was before epi pens were invented.  Finally I gave it up.  The packaging on the syringe had deteriorated to the point it was no longer sterile, and the expiration date on the epinephrine was long passed.

Also, I never heard of "maker spaces" and bet there is not one within 200 miles of where I live (virtual boonies), but what a marvelous idea.

This business of a substitute for an epi pen is a good idea, and the shopping list is great, and I have some comments below, but they are not based on familiarity with currently available supplies.  I've just looked at the links listed and what is for sale there.

Things to consider:  When the epi injection is needed, you'll have to break the ampoule, draw up with the filter needle, then change the needle to inject.  Then inject.  If a person needs an epi pen, they may not have time to go through the procedure.

I'm a little curious why the epinephrine is not prescribed in one of those "rubber" top vials.  Does no one package it that way?

Though the vial may contain enough for many doses, once opened, all the doses need to be used or discarded. You can't store an open container for reuse at the next event.  You don't usually have an "epidemic" of anaphylactic shock on your hands, with several "patients" needing epinephrine.  Nor is it considered safe or "best practice" to keep a loaded syringe on hand, unless it was "factory loaded" and sterile packaging applied, and expiration date noted.  

Chris' original post does say it is for a life or death situation, and it is nice to have an option when $600. is not an option, but in that case, it seems like one could just use the sterile syringe and inject without the "autoject" appliance (the most costly thing on the list), and loading the autoject is sure to delay the moment when the injection can be given.

At best, and it is a lot better than nothing, a person will get one dose out of the multi dose glass ampoule.  And for that reason people going this route might need to consider buying more than one ampoule, along with those sterile syringes, which come with a sterile needle, a very short needle, which is just right for where the epi is to be injected, but not so easy to use for "drawing up".  So, whether it is a filter needle or not, an additional needle will likely be needed to get the epinephrine into the syringe.  And that is not on the list.  

If it is me or my kid, please don't bother messing around with the autoject.  As the page states, it is only to prevent "needle anxiety" and "self injection anxiety", and in a life or death situation, I just want the shot and I want it asap, I'm more interested in getting the injection before my trachea closes.  I don't have much time!

If anyone is going to pursue this, be aware of expiration dates.  There should be a few years window of time between when you buy it, and when it outdates.  Same is true for sterile syringes.  Sterility does not last "forever".

And, when you get your supplies, get enough that you can practice at least one time opening the ampoule, which contents will then be wasted-- $4.45, open one syringe $0.21, and one of the needles you get to use for drawing up, (price unknown, but 35 cents when I buy sterile non filter needles at the feed store to draw my goat's blood).  Keep the opened and no longer sterile supplies for practice.  Anyone who might need to do this for themselves or someone else needs to be familiar with the process and equipment, not trying to figure it out for the first time when someone's, maybe their own, body is trying to shut down operations permanently.

One last thing, to open an ampoule, the little glass bottle with the epinephrine in it, first you have to shake the liquid down into the bottom part of the little bottle.  There is a constricted area on the neck of the little bottle (like the waist of an hourglass).  You open the bottle by snapping / breaking the glass at the constricted place.

Here is a photo, to make what I have written make more sense.

Lastly, when I went looking for an image of a glass ampoule of epinephrine, there was also an image of epinephrine in the other kind of sterile bottle.  TRY to get that one.  No need for the extra needle.  Just poke the needle already attached to the syringe through the rubber and draw the dose into the syringe and you are ready.  Probably cuts the response time in half.  Seconds count.

I am not saying to do this, but, in a hurry, many a person has been injected right through their clothes, thin cloth, not through a pocket or anything.  Not sterile I know, but when there isn't arm or leg skin available, seconds count.  And when you go to get the Rx from an MD, discuss all this with them.  See what they say.  If you know an EMT or nurse ask them about it.  See what the instructions say, that come with the epi pen.

And it is my most fervent wish that no one ends up needing to use this.