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Comment by kabdib | Hacker News Reader

If your kid is allergic and needs an EpiPen (or something like it), most school districts will not allow the child to attend class unless they have one at the school. Maybe two.

And of course you have to carry them. There's another two.

So that's $2400. Out of pocket if you don't have insurance, or if your insurance doesn't pay.

The EpiPen manufacturers are abusing their monopoly.

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Given the proper age, teaching kids to use syringe/vials or having a school nurse that can administer epinephrine would be a much cheaper alternative.

EpiPens are purely about the delivery mechanism. Stabbing a syringe into your thigh and injecting a predetermined amount of epinephrine into your leg isn't majorly complicated.

Maybe having a single pen on the kid and vials/syringes at the school would be a cheaper option.

I've never used an auto-injector on myself before. I have used expired auto-injectors on oranges and potatoes to make sure that I have a "real feel" for how the hypodermic needle really injects. The trainer injectors certainly don't teach you what that is like!

Having said that, I would vastly prefer an auto-injector compared to a syringe + vial. I'm not sure if I would have the proper composure/state of mine, let alone the visual acuity (eyelids swell up real bad during anaphylactic shock) needed to operate a syringe and vial during an episode of anaphylactic shock.

In more controlled situations like at a school nurse's office, where the patient isn't the administering the epinephrine to themselves, I can see the syringe and vial solution to be appropriate.

I don't think you've ever seen a child in Anaphylactic Shock if you think all you need to do is train the child to use a vial and needle. Even training school personnel is not a great idea - While an ER nurse or paramedic can handle it because they give injections every day, a teacher or even a school nurse may go for years without ever needing to do an epinephrine injection and the stress and inexperience may make them unable to perform under pressure of having a child dying in front of them.

An IM injection is easy to do when you're calm, but just filling the syringe can be difficult when you're under intense pressure.

I wonder why glucagon isn't done in the same format as EpiPens are. I'm a T1 diabetic and I have one glucagon vial at work and one at home. In the case I go low (barely responsive low) someone has to go grab it from the fridge (it needs to be there) load the syringe and use it on me.

When people sleep over I teach them how to use it and I do something like a show and tell at job from time to time so new people know about it.

It's not just 'load' the syringe. There's a liquid and a powder that has to be mixed. First, the liquid is injected into the powder. Remember to remove the protective cap from the vial and the two protective caps from the needle (apparently, people frequently forget the one on the vial and break the syringe). Then, mix by rolling, not shaking, for 30 seconds. Then, withdraw the mixture into the syringe and inject it.

Not only does it need to be kept refrigerated, the shelf-life isn't that long to begin with (about a year).

I'm also a T1D and there's a reason that, despite the various seizures I've had in my lifetime, I've never received Glucagon.

Cake icing squirted between your gum and cheek also works (although everything ends up sticky and blue by the end of it).

Edit: I didn't mean to sound like you didn't know what you were talking about, I just wanted to expand on what you were saying about 'show and tell'

Is there a reason the syringes can't be pre-filled so that the step of filling from the vial needn't be done under pressure?

Don't forget that they expire as well - I have two kids that require the pens and even with insurance it works out to quite a cost.

And that pharmacies will often try to give you EpiPens with an expiration date less than a year away, indirectly increasing the cost (since most districts will require unexpired pens, and refuse your child even if then pen is a day too old).

It's a racket.

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