Follow the Money: The antidote economy

**Sam Fenwick** (0:00)
This episode of Business Daily contains a real-life call to the emergency services in the United States.
911 I need an ambulance, my son's not breathing.

**Nab Dasgupta** (0:09)
What's the address? 10731

**Pamela Hoffman** (0:11)
10731, yes, hurry.

**Jonathan Stoltman** (0:13)
Is he blue?

**Sam Fenwick** (0:16)
A boy has stopped breathing. Somewhere in America, a mother is on the floor beside him.

**Jonathan Stoltman** (0:21)
Ma'am, I need you to calm down, how old is he?

**Sam Fenwick** (0:32)
This call is real, an actual 911 recording released by America's Drug Enforcement Administration. There's an antidote for an opioid overdose. It costs a few dollars and it can restart breathing in minutes. It didn't reach him in time. I'm Sam Fenwick, this is Business Daily from the BBC World Service. Today, we're following the money through the antidote economy, if the thing that saves a life is this cheap, where does the money go and why doesn't it reach the person on the floor?
On a side street in the Bronx in New York, a man is lying on the pavement, not asleep, not breathing. Tom Blazek is an outreach worker at On Point NYC, a harm reduction organization that sends teams onto the streets of the Bronx and Upper Manhattan. He's been doing this work for nine years.

**Tom Blazek** (1:27)
This particular overdose took place in one of the side streets located by a commercial area. The person was laying on the street. We identified the symptoms as being consistent with an overdose. One 4-milligram nasal spray of naloxone was administered.
And two and a half minutes in the person came around and became more responsive.

**Sam Fenwick** (1:56)
Naloxone, that's the antidote, the thing this whole episode is built around.

**Tom Blazek** (2:00)
The heart is racing. There's a sense of responsibility, definitely a sense of urgency. There's also just a sense of gratitude that we have naloxone, this life-saving substance that really can reverse an overdose.

**Sam Fenwick** (2:17)
Tom knows the other version too.

**Tom Blazek** (2:19)
I've lost friends to opioid overdose. Of course, incredible sense of loss and grief. I've had a friend that his sister found him in the restroom behind a locked door, and she found him, and it was too late.

**Sam Fenwick** (2:31)
So how did America get here? In the late 1990s, drug companies pushed powerful prescription painkillers, telling doctors they carried little risk of addiction.
Millions of prescriptions later, they did. When the pills became harder to get, people moved to heroin. Then, about a decade ago, fentanyl arrived, a synthetic opioid up to 50 times stronger.
From 1999 to 2020, nearly 840,000 Americans died from drug overdoses, with prescription and illicit opioids responsible for 500,000 of those deaths. So why doesn't the drug that reverses an opioid overdose reach everyone in time? Today, we're looking at the chain behind the antidote. There are four links. What it costs to make, who pays for it, and then something stranger, companies settling their opioid bills in the antidote itself, and whether at the end of it all, a kit is actually in the room when it's needed. First then, what is this stuff and what does it cost to produce? Dr. Nab Dasgupta is a senior scientist at the University of North Carolina at Chapel Hill. He runs lab tests on street drug supply, and he helped set up the Remedy Alliance, a non-profit that supplies naloxone at cost to community harm reduction programs, the groups that handed out for free on the street.

**Nab Dasgupta** (3:52)
Naloxone is the antidote that reverses an opioid overdose. When someone takes fentanyl, their breathing gets really shallow or stops.
What naloxone does is it kicks the fentanyl out of the brain and revives the breathing and allows people to survive. It's literally a miracle medication that brings people's breathing back and saves their lives. The cost of the naloxone itself is about 25 cents or less. It's pennies compared to the lives that are being saved.

**Sam Fenwick** (4:26)
So at just 25 cents for the drug, where does the bulk of the cost come from? Not the chemical, but the device.

**Nab Dasgupta** (4:34)
So the packaging of the product is really where the expense really heats up. With the nasal spray, the problem is that the actual plastic that does the spraying, the part that goes up someone's nostril.

**Sam Fenwick** (4:48)
When it first launched, the breakthrough technology of nasal spray delivery came from one components maker, Aptar. It made the spray mechanism plastics for Narcan, the best known naloxone nasal spray since 2016
Since then, other nasal spray devices have come onto the market. So what does the finished thing sell for?