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How Narcan became the go-to opioid antidote

Small company, Big problem: How Adapt Pharma became the go-to opioid antidote drug maker

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RADNOR, PA (Circa) – The opioid crisis has ignited a public health debate across the United States. Narcan and other forms of naloxone are critical to fighting the epidemic. And small business plays a crucial role in finding a solution to this problem.

“We’re a small team, but we do some big things,” Mike Kelly, president of U.S. operations for Adapt Pharma, told Circa. Narcan is a brand version of naloxone – the opioid antidote drug – and it’s made by Adapt Pharma.

The Centers for Disease Control and Prevention (CDC) reported that in 2016, there were more than 63,000 drug overdose deaths in America. Meanwhile, the National Highway Traffice Safety Administration (NHTSA) reported that in 2016, there were over 37,460 traffic crash fatalities in the country. And the American Cancer Society (ACS) estimated that there are 41,070 deaths each year caused by breast cancer (both men and women) in the U.S. Provisional CDC numbers for 2017 point to an estimated 66,000 drug overdose deaths.

At a time when opioid overdose deaths are outpacing deaths caused by car crashes and even breast cancer, this small business has a unique and significant role to play.

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Annually in America, drug overdose deaths are surpassing car crash and breast cancer fatalities, CDC data shows. (Circa)
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The incremental increase of drug overdose deaths in the U.S. in the last decade. (Circa)

Last year, Adapt Pharma distributed more than one million boxes, each carrying two 4 milligrams doses of Narcan Nasal Spray. "Our product is delivered through the nose," Kelly explained. "It gets into the bloodstream and it knocks the opioid off the receptor so the patient can get restored breathing."

By design, the product is meant to be easy to use. Illustrated instructions on the side of the pack tell you how to administer each dose. After taking the nasal spray out of its pouch, you put it in the overdose patients' nose and push the button to release the antidote. The spray restores breathing and jolts the person back to life.

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Each box of Narcan Nasal Spray made by Adapt Pharma carries two doses of the antidote, each 4 milligrams worth. (Circa/Adam Fleishman)

Drug overdose deaths have steadily climbed higher in the U.S. and President Trump has said that fighting this problem will require "confronting the crisis in all of its very real complexity."

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The crisis has spiraled to a point that the president declared it a public health emergency and the surgeon general is urging wider access to naloxone and clearer education on the addictive qualities of opioids.

"The fact is this is a worldwide problem," Trump said in a news conference in October. "Beyond the shocking death toll, the terrible measure of the opioid crisis includes the families ripped apart, and for many communities, a generation of lost potential and opportunity. This epidemic is a national health emergency."

A community effort

Adapt Pharma, which is headquartered in Ireland, but is based out of Radnor, Pa., has less than 75 employees doing everything from sales and data analysis to research and development. But the Narcan drug maker knows it’s limits and in the last year has formed key partnerships with schools, community organizations and local authorities to get the antidote in more people’s hands. In March, Adapt expanded a program offering free Narcan nasal spray across high school and college campuses.

It’s now working to get Narcan carried in as many law enforcement vehicles as possible.

"No one was prepared for this," Kelly said. "No police departments have a line item in their budget for this, and police weren't trained for this. So everyone kind of stayed in their lane."

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The District Attorney for Delaware County said in the time it has been partnered with Adapt Pharma its overdose death rates have slowed. (Circa/Adam Fleishman)

Across the country police, EMTs and other first responders are now equipped with naloxone. The Ridley Township Police was one of the first to partner with Adapt Pharma to get Narcan in each of their cars.

"We needed to do something more aggressively," Katayoun Copeland, Delaware County district attorney and chair of the county's Heroin Task Force, told Circa. "Our law enforcement officers were responding often times faster than the EMTs were, and so what we wanted to do was to provide them with naloxone so that they could in turn perhaps save a life."

Copeland said that since Delaware County initiated its partnership with Adapt Pharma nearly two years ago, it had seen a significant change in their community.

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"Our deaths as a result of heroin and opioid related deaths have increased at a significantly slower rate than our surrounding counties," Copeland said. This year alone, the county has been able to save over 100 lives thanks to first responders having naloxone at the ready. Since they began the partnership, first responders have saved more than 1,100 people from drug overdoses. "If you look at it and you think about when the minutes can save lives, that's an incredible number, so it's been significant," she said.

"Our deaths as a result of heroin and opioid related deaths have increased at a significantly slower rate than our surrounding counties."
Delaware County DA Katayoun Copeland

Last fall, the president’s Commission on Combating Addiction issued a report with possible solutions to the crisis, such as coordinating health records and expanding access to naloxone by allowing all first responders to carry and administer the antidote, as well as increasing the number of drug courts.

As drug costs soar, the U.S. Surgeon General's office told NPR it was working with naloxone makers to keep costs low, as well as with insurers to make sure people can get the antidote with as little a copay as possible. For reference, a two-pack of Narcan Nasal Spray retails at just over $130. Adapt Pharma is selling Narcan at a 40 percent discount to first responders.

Another brand version of naloxone, Evzio, which was developed by pharmaceutical company Kaleo, is administered via a hand-held auto-injector. A two-pack of Evzio can cost over $3,700.

But you can get now get generic versions of naloxone for as little as $35 at pharmacies in 49 states without a prescription. And according to U.S. Surgeon General Jerome Adams, the majority of insured Americans are now covered to purchase naloxone. For uninsured Americans "who are or who know someone at risk for opioid overdose" can in most states buy naloxone through local public health programs for little cost.

"To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder," Surgeon General Adams said.

In March, President Trump took it a step further, suggesting the government may go after drug makers for their role in the epidemic. Delaware County has done that.

In September, the county became the first in the state to sue 11 opioid drug manufacturers – and their consulting physicians – for, as the DA put it, deceiving consumers. "We have an obligation to protect our citizens, and we believe that there are people who are responsible," DA Copeland said.

"We're not the total solution, but we're a big part of the solution... and that has to be a community effort."
Adapt Pharma President of U.S. Operations Mike Kelly
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For their part, Adapt is squarely focused on finding solutions by building out their pipeline with new Narcan treatments and forming alliances to make sure the antidote is available to everyone.

"This epidemic has been about 15 years in the making and it’s not, you know, you can’t point your finger at one specific person or group that caused this," Kelly said. "We're not the total solution, but we're a big part of the solution... and that has to be a community effort."

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