Insider Q&A: Narcan exec talks merits of spray for overdoses

Dr. Roger Crystal's company was struggling to find new uses for an old drug that reverses overdoses. Then the opioid epidemic hit.

Naloxone had first gone on sale in 1971 but was injected with a syringe. Crystal and his colleagues came up with a naloxone nasal spray, intended to be more appealing than prefilled injectors or the other naloxone alternatives.

Crystal's Opiant Pharmaceuticals Inc. partnered with Adapt Pharma to market the spray version. Adapt revived the brand name Narcan, which had fallen out of use after naloxone went generic.

The spray went on sale in the U.S. last year. It costs $125 for a twin-pack; police and other groups pay $75.

Crystal talked to The Associated Press about the development of Narcan. The interview has been edited for length and clarity.


Q: How did you come to develop Narcan?

A: The company started back in 2009. We were using naloxone nasally for binge-eating disorder. The first years of the company were all about that. We had some encouraging data but it was going to be difficult to establish a market in binge-eating disorder. At the time, the opioid crisis in the United States became apparent. In 2012, we thought 'Let's pivot.' In this area of overdose, we really felt we could do something.

Q: Can you break down the market?

A: Not many people want to inject other people. Having a simple to use, reliable, FDA-approved nasal spray was extremely desirable. Once you have a nasal spray, you open up a huge patient population and bystander population who are now willing and able to use it.

We reported for the first half of 2017, net sales were at least $25 million. It's fair to say that was a huge rise from 2016.

Q: You have conflicting pressures — from the public and stockholders. Is the price going to rise?

A: Not that I'm aware of, no. In a way I'm divorced from that because Adapt has entire control of pricing. But if you try and take the price to high levels, the margins will improve but there will be less customers as a result. You want people to keep coming back. You want them to be committed to using Narcan nasal spray. It's encouraging that on Twitter you can see police officers in certain counties holding up Narcan like a trophy. They're proud. They're empowered. They can do something about an overdose rather than arriving to a cold body.

Q: Despite the spray's availability, drug deaths rose last year, and many involved opioids.

A: When there is naloxone available it does make a difference. But there's low penetration in the overall market. This is a problem that has grown over more than a decade. It's not going to stop overnight.