So a "used" epi-pen's internal syringe might contain 4-5x more epinephrine than actually goes into a standard dose? I assume this means most of the expense of making it comes from the housing/mechanics. (And recouping whatever cost of QA/approvals.)

I haven't worked with this class of medical device, but I expect the major cost of the unit is in the approvals and lawsuits.

So far as the pen itself - They've got some injection-molded plastic, where the mold costs are amortized across the production lifetime. A needle + syringe, which are probably subcontracted from Becton Dickinson. A spring. A printed label. And the medication itself (probably the #2 cost).

The assembly of the above all had to conform to the FDA's Good Manufacturing Practices rules. Every part & ingredient had to have trace-ability to their source. With documentation thereof.

When we got our device approved (in a looser classification than this) we had to get UL approval ($50k per test, per device, per test-run), and we had 3 people on staff whose sole purpose was navigating the FDA paperwork and their approval process. I never heard what that cost was, but it was substantial. And then we had an IP attorney, and corporate defense attorneys to respond to the inevitable lawsuits.

The drug itself is very cheap. With an Rx you can purchase an ampule with about 3 doses for < $10.[1] You can administer it with an insulin syringe, which I don't think requires an Rx. Of course administration is a lot more tedious and requires some training.

I worked at a summer camp where we would carry 1 or 2 pens plus a bunch of ampules if we were in a wilderness situation where we couldn't get to emergency care and needed more than one dose.

[1] http://www.buyemp.com/product/epinephrine-ampule

The drug is cheap...because it's unpatentable (as a molecule anyway) and is old enough that any patents would be expired anyway.

The marketing of autoinjectors has some legitimate public health value, but it's also a clear business strategy to get new drug prices for an ancient drug

If you have something concrete to say then say it. You're only lowering the quality of the conversation by making vague assertions in the style of "one weird trick" followed by mystery links to random places on the web.

How is this lowering the quality of the conversation? This is an insightful comment with a relevant video that shows that each Epipen actually contains 4 or 5 doses of epinephrine. Certainly relevant, as we are discussing how people nationwide are struggling to obtain enough of this drug.

Also, I would hardly call a link to YouTube "a mystery link to a random place on the web".

This "one weird trick" may save your life if you experience anaphylactic shock and do not have multiple auto-injectors available, for whatever reason (cost, some have expired, remote location, etc).

I discovered this technique a couple of years ago and was interested in it. I tried replicating the use with some expired autoinjectors. As far as delivering subsequent doses, I was able to reliably deliver 2+ more doses (into oranges) from my expired injectors. I feel better prepared for an emergency now.

I have never needed to use my autoinjector. I had one incident where I was very close to shooting up my thigh but the symptoms were just "mild" enough that I did not. I met another person with severe food allergies at THOTCON this year who described to me in detail two separate incidences where he felt it was necessary to administer two doses. I hadn't really given much thought to multiple doses before hearing his stories (one of which included a medically induced coma). Now I make sure to have at least two doses on hand. My doctor certainly didn't express to me the potentially dire necessity of multiple doses!

Of course, this bushcraft advice doesn't hamper my cautiousness about having autoinjectors around everywhere I may need them. I have a pair at my home, my office, my parents home, and my backpack (always with me when I travel). Eight autoinjectors, that need scheduled replacement, is a luxury I can afford. Others may not be so lucky and may be helped by these bushcraft techniques.

I do need to research the issue more though because my insurance currently covers eight autoinjectors (not EpiPen brand, but a "generic"? Lineage Therapeutics brand [0]) at the rate of $15 per two 0.3 mg injectors. I'm not sure if I'm lucky, have great insurance, or what.

[0]: http://www.epinephrineautoinject.com