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Melissa Harris-Perry: I'm Melissa Harris-Perry. This is The Takeaway. We begin today with the sounds of tragic and distressing experience that's become far too common for so many in our country.

Dispatch: 911, what is the address of your emergency? Tell me exactly what happened.

Female Speaker: I don't know, I found a kid overdose. I found a kid overdose. I had some Narcan in my car, so I tried giving it to him, but it didn't work. He's on the side of the railroad tracks.

Male Speaker 1: I got another bottle right here.

Male Speaker 2: Go. Here, give him this.

Dispatch: I get you. Stay with me and answer my questions. I do have the police department a call away. They will soon be there.

Female Speaker: We gave him three hits of Narcan. I don't know the kid. I don't know who he is. I don't know how old he is.

Melissa Harris-Perry: This is what it sounds like to try to save the life of someone who's overdosing on an opioid. This particular experience comes from the documentary series, Dopesick Nation by Vice TV. Harrowing moments just like this one have become part of daily life in rural communities, small towns, and big cities. According to the CDC, more than 850,000 people have died from drug overdoses in America during the past two decades. The numbers have increased sharply in recent years. In 2019, overdoses claimed nearly 71,000 lives, and during the first year of the pandemic, that number rose to 100,000 deaths.

Synthetic opioids are driving these brutal numbers, accounting for nearly three-quarters of all fatal overdoses. The opioid emergency is a human catastrophe, but it's also an economic market, responding to supply, demand, innovation, and changing conditions. Now, if you're a little rusty on your Econ 101, just remember that, in general, low supply and high demand makes prices rise, whereas plentiful supply and steady demand should make prices fall, but in the opioid market, something else seems to be a play. Let's start with the price of heroin. In the early '80s, a gram of pure heroin cost just over $2,000.

Today, the same amount costs about $500. If you are looking to get high, buying a bag of heroin will run you just $5. It's easy to spend twice that much for a daily hit of Starbucks. I hope you're asking, "How could there be such a dramatic price decrease when demand is so high? With more people using, shouldn't heroin cost more?" The answer to that is innovation. Heroin is much cheaper today because it is now much cheaper to make. In 1985, producing heroin meant waiting for poppies to grow, harvesting, and processing them, then transporting the product across international borders.

Today, with a relatively simple setup and a combination of widely available chemicals, you can create cheap, powerful synthetic opioids, namely fentanyl. Fentanyl just might be the one part of the American supply chain that has not broken in the pandemic. Demand for opioids is high, but the supply of cheap, potent synthetic fentanyl has kept pace with the demand, so prices are low. There is one rapidly rising cost in this market, the price of Naloxone. This is not a drug used to get high, this is a drug used to save lives. You probably know Naloxone by its common brand name, Narcan.

Now, Naloxone is miraculously effective at reversing the effects of an overdose. When administered swiftly, it nearly always prevents death. Because Naloxone has been FDA-approved since 1971, it's now off-patent, it should be cheap. Ten years ago, it was, you could get a life-saving single dose of Naloxone for about $1. Prices are very different today. Even before the pandemic, the New England Journal of Medicine reported price increases of 100 to 500%, depending on the formulation and method of delivery. Last week, reporting from The Guardian, detailed a continued spike in Naloxone prices.

In other words, if you want to make big profits in today's opioid market, you're much better off selling Naloxone than selling heroin. For more on this, let's talk with Melody Schreiber, a contributor to The Guardian, US, and editor of the book, What We Didn't Expect: Personal Stories about Premature Birth. Melody, it's great to have you here.

Melody Schreiber: Thanks for having me.

Melissa Harris-Perry: Also with us as Dr. Nabarun Dasgupta, senior scientist and innovation fellow at the UNC Gillings School of Global Public Health. Dr. Dasgupta, welcome to the show.

Dr. Nabarun Dasgupta: My pleasure. Thanks for having me.

Melissa Harris-Perry: I want to begin with you, Dr. Dasgupta, what is Naloxone or Narcan as I think many of us commonly know it?

Dr. Nabarun Dasgupta: Someone overdosing on strong pain meds, like heroin, will go still like they're falling asleep. These drugs act on the part of the brain that controls the will to breathe, our most fundamental companion from birth. The drug that is Naloxone, it's something that I call the anti-funeral drug. It helps people stay alive and prevent overdoses. The antidote kicks heroin out of the brain, restoring the desire to breathe instantly. When I've given it, people were breathing again in two minutes. If you give it to someone once by mistake, it doesn't do any additional harm. It's as close to a miracle drug as you can get.

Frontline public health workers have been distributing it to people who use drugs since 1996. They've given out more than 6 million doses. Last year, 1.3 million doses alone. We can document that there are hundreds of thousands of people alive today because of this lifesaving intervention. It's the anti-funeral drug.

Melissa Harris-Perry: I want to take one more beat on this so that I understand because you were talking about healthcare professionals and frontline workers giving it to those who are experiencing overdoses since the '90s, but it's been around since the '70s. What was it initially created for? What was the initial on-label purpose?

Dr. Nabarun Dasgupta: It was initially discovered by someone named Jack Fishman who was trying to find a way to have less constipation from opioids. It turned out that this medicine actually works even better at reversing the overdose and letting people breathe again. For the first decade or two, it was used mostly in the operating room for helping anesthesiologists bring people back to consciousness after surgery. It was eventually after that, that emergency personnel started using it in the hospitals, and then eventually it came out into ambulances as well.

Melissa Harris-Perry: Got it. Thank you. Melody, I was talking in the introduction about this bizarre reality where the price of things like heroin has dropped precipitously over the same period, since the mid-1980s, but now, the price of Naloxone is absolutely skyrocketing. I've got some theories about it, but you are the researcher here, help me to understand, in your reporting, why these prices are soaring.

Melody Schreiber: First of all, prices went up, I think, you mentioned in the intro before the pandemic. Right now, the company that makes Narcan says that they actually haven't raised the price since they introduced it to the market. It came in high because of the way that it's administered. The problem is the companies making more affordable Naloxone have had some manufacturing issues. The people who need it the most are not able to access an affordable version of the drug. They have to go by the brand name, and that's 30 times higher than what they've been paying.

Melissa Harris-Perry: Melody, is that primarily about the route of delivery, or is there actually something different about the Narcan brand name versus the generic Naloxones?

Melody Schreiber: Narcan uses an inhaler. You put it in your nose, and that's a different delivery than injectable Naloxone. It's a pretty basic nasal spray, essentially.

Melissa Harris-Perry: Dr. Dasgupta, do you want to weigh in on the formulation of the generic versus is the name brand here?

Dr. Nabarun Dasgupta: Sure. Part of what complicates the simple supply and demand picture is that we don't really have a free market for Naloxone in the United States. Instead, we have this Byzantine system where money from the federal government goes to states through a Narcan formula, legislatures and health departments get involved and pick a couple of programs in each State to fund. The underground programs get the money, then they need a doctor to write a prescription. Then corporate compliance officers require the doctor to get an affidavit for that prescription.

The programs place an order with one medical supply company, then have to purchase it from a second distributor, and then finally it goes back to the program to distribute. Every step along this way is a reason for someone to say no. Because of this process, what should be $2.50 to make a Naloxone kit ends up not being available to all the programs that can do the last-mile delivery and get the drug to where it needs to go.

Melissa Harris-Perry: Melody, As part of this big story of how it goes from production to actually saving lives, being the anti-funeral drug on the ground for folks. Tell me about the OSNN.

Melody Schreiber: The OSNN has a buyer's club to help harm-reduction groups purchase Naloxone with an agreement with Pfizer, and with agreements with other pharmaceutical companies, generics, even the company that makes Narcan. The OSNN helped negotiate this deal with Pfizer in 2012 to purchase Naloxone at a greatly reduced price. Dr. Dasgupta, tell me what I'm getting wrong here.

Dr. Nabarun Dasgupta: Sure. You got that pretty much right. In 2012, Dan, Big, and I negotiated this deal with Pfizer to get us a very affordable Naloxone to the 110 programs that are responsible for reaching the most difficult-to-reach populations. The programs that have the most trust with the communities that need the Naloxone the most. The buyer's club facilitates those contracts. For the last decade, we've only had Pfizer as our supplier. In April of this year, Pfizer had a manufacturing problem at the one factory in the country where they used to make Naloxone.

That essentially created a shortage of the cheap, affordable Naloxone that these programs have been relying on and had used to buy about 6 million doses of Naloxone. We ended up having to find other sorts of Naloxone. The company that makes nasal Narcan, the brand name, the $75 product, when we talked to them, they literally laughed at us and told us not to put the request in writing. We went looking for other companies who would be more compassionate.

In doing so, we found one company that already made a generic version of the liquid injectable Naloxone. They have given us 50,000 doses for free, and we have distributed them already in two weeks. We're working with them to manufacture a few hundred thousand doses more at a greatly discounted price that programs can actually afford, not the $75 a nasal spray.

Melissa Harris-Perry: What does this look like, Melody on the ground with harm reduction groups? What do these rising prices mean for them?

Melody Schreiber: To put it quite simply as one source did, if something costs 30 times more than it did before, that means that you're saving one life instead of 30 lives. That's as simple and basic as you get it. Because of these price issues, more people are dying, thousands more people.

Melissa Harris-Perry: Is this a carve-out moment? Is this something surprising within pharmaceuticals and that market in general? Or do we typically, I'm just saying, I was in the hospital with my mother who is in her 70s, during the pandemic, she was in for another reason, but suddenly Tylenol in the hospital costs much, much more. I'm wondering if soaring prices is normal, or if there's something specific here about this drug?

Dr. Nabarun Dasgupta: There is something very specific here that's happening that hasn't really been acknowledged. That's the difference in regulation between what's happening at the federal level versus the state level. On the state level, Naloxone is basically treated as over the counter. State legislatures and through standing orders and other directives have made it so that Naloxone can be distributed by anyone and it doesn't carry the same penalties as other prescription drugs. Now, on the federal level, on the national level, FDA still considers this a prescription drug.

You have to have a single physician for every order of Naloxone that each of these programs place. What happens is that the corporate compliance officers at the pharmaceutical companies, at the pharmaceutical distributors, are compelled to treat this like a prescription drug and keep it locked away in that pharmaceutical system. This is so acute. You asked about the inventors of Naloxone. Dr. Fishman who invented Naloxone, his stepson died of a heroin overdose because, in part, he could not get access to the medication he invented to save that life because it was a prescription drug.

We're at this point where the prescription requirement on a federal level is the root of all evil when it comes to getting more Naloxone out to where it needs to go. Until we can get parody and resolution between the way states want this medicine to be used and the way that FDA says it should be used, that's the key missing link, in addition to funding, that will unlock Naloxone to get it out to the places that are the most hardest hit.

Melissa Harris-Perry: Dr. Dasgupta, thank you. That is so helpful to understand that, and particularly in connection, Melody, with what you were saying around the steps the federal government can take. Again, let me just try to understand this. If I walk into my local pharmacy, how do I know if I'm operating at the state or the federal level?

Dr. Nabarun Dasgupta: It depends on the mood of the pharmacist. In North Carolina, for example, we can even go into a pharmacy and request it. You may end up getting the nasal spray, which costs $75. You may have a copay. One of the things that happens when you go and purchase it in a pharmacy is that there can be downstream consequences for your health finances. We had a physician who works with us, who had purchased Naloxone in a pharmacy because there was something he wanted to do and wanted to have on hand.

When he went to get life insurance after the birth of his child, he got penalized for having purchased Naloxone in the pharmacy because it was part of a list of flagged drugs that increase life insurance rates. It's not as simple as putting more of this on retail pharmacy shelves. The real solution is getting this into the hands of the programs and people who have the most trust with the communities that are hardest hit by the overdose problem. These are mostly folks who are working with historically marginalized people.

People coming out of prisons, people living in rural Appalachia. These programs that are run by and serving populations of color. That's really who we need to be prioritizing right now in the middle of this crisis and not trying to send more Naloxone onto pharmacy shelves, not trying to get more cops to carry Naloxone, and not trying to stock every school and library with Naloxone. Right now, we need to focus on the last mile.

Melissa Harris-Perry: Melody, can you weigh in here as well as it's getting clearer the ways that the federal government could really be a problem solver here, is that likely to happen?

Melody Schreiber: In the Cares Act funding, there was the possibility of making these medications over the counter, and medications like Naloxone could qualify in this program. That would make it a lot easier for harm reduction groups to access the medication. So far, the FDA has used it for things like ingrown toenails and work removers, but there's the option here to put it toward maximum use for saving lives. There are also other regulatory ways the FDA could compel the manufacturing of these drugs.

You could use the Defense Production Act, which you can invoke pretty much anytime there's a national security crisis, and with a 30% rise in overdose deaths in the first year of the pandemic, that sounds like a crisis to me. There are different regulatory avenues for making this more widely available, from production to, as Dr. Dasgupta says, the last mile here of delivering to the people who are at most risk of dying from an overdose, which is easily preventable, it could be affordable.

Melissa Harris-Perry: Dr. Dasgupta, I will let you have the last word on this. Are there members of Congress or are there officials operating at the federal level within the FDA and other sources who are carrying this, who are pushing for exactly the kinds of changes that you say can make such a big difference?

Dr. Nabarun Dasgupta: We've had really good response from the US Senators who we've spoken to, and we have more meetings lined up. The question isn't if we should do this, it's how. Let's figure out the mechanics. I think this is a classic situation when there is a discrepancy between federal law or federal regulation and state-level medical practice. Congress is really the one that needs to step in because FDA is tightly bound by their rules that they have to follow.

I think if Congress could pass a law that would authorize the cheap, generic liquid injectable form of Naloxone to be without a prescription requirement, that would be the single greatest thing that would help us to prevent deaths in the immediate future.

Melissa Harris-Perry: Dr. Nabarun Dasgupta is Innovation Fellow and Senior Scientist at the UNC Gillings School of Global Public Health. Melody Schreiber is a contributor to The Guardian, US. Thank you both for joining us.

Melody Schreiber: Thanks for having me.

Dr. Nabarun Dasgupta: Thank you.

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Melissa Harris-Perry: We've been discussing the life-saving drug, Naloxone, and we wanted to know if you've had personal experiences where it was necessary for you to use this drug. Here's what you told us.

Neil: Hi, this is Neil from Ohio. I'm a former paramedic, and yes, I have used Narcan on many occasions. The interesting thing is that it generally acts quickly, and the person receiving it generally responds badly. They're really mad when you take their eyes away.

Sherry: Hi, this is Sherry from Springfield, Oregon. In regards to Narcan, it's a new thing. I'm cleaning sober for like forty years, but in the day, I saw someone go down and die when they didn't have Narcan.

Pete: This is Pete from Oakland. I'll never forget this. I was walking to a meeting in San Francisco and saw an unhoused person lying on the ground, struggling, eyes rolling back, biting their tongue. Then saw the bouncer from the bar next door, then I stopped to make sure this person was breathing, tried to assess how he'd respond. I looked over to the bouncer next door and they calmly walked over and said, "We've got Narcan on hand. All of our staff are trained. Let me take it from here." He administered the Narcan. The person woke up. That may have saved that person's life that night. Everybody should have it. It's really important.

Participant: I had to use some Narcan one time as a security guard in a mall. I was the first on the scene as I was flagged down by some people who saw some people who were acting weird. I was talking to them, and before I knew it, they had both fallen down in the middle of the food court. I was waiting for more backup to arrive. Basically, they had a low pulse and we knew that they were on some kind of drug, but they hadn't been able to tell us, as they were kind of out of it before they slipped out of consciousness. We were able to get the fire department on the way.

As they were there, myself and the other security guard went through one of the men's backpacks and we found one of the Narcan nasal sprays. We administered it to the man to whom the backpack belonged. By that time, the paramedics had basically shown up and they rushed him into an ambulance and off to the hospital. I regret not going to the hospital afterwards to make sure that they were alright.

Deborah: My name is Deborah, and I am calling from Columbia, South Carolina. My family resides in northwestern Ohio, and they have been affected by the opioid epidemic. Right now, my niece's husband is in the hospital fighting COVID and also fighting addiction, hepatitis C, you name it. He's not even forty years old. He's leaving behind a nine-year-old daughter, and of course, my niece, and she has two other children that are three and one. Now they're onto the fentanyl, we were hoping this was going away, but due to alcoholism as well, it's hard to fight all of these addictions. It really has affected everyone in my family.

Melissa Harris-Perry: Thank you so much for sharing your stories with us. We always want to hear from you. Never hesitate to give us a call at 877-869-8253. That's 877-8MYTAKE. Or, find us on social media at The Takeaway and share your stories with us there.

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