Naloxone nasal spray began as a remedy for binge eating, CEO says

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

Naloxone, a medicine called an antagonist that counteracts the effects of opioids, had first gone on sale in 1971 but is injected with a syringe. It requires a small amount of training to know how to administer it to someone who is overdosing. 

Crystal and his colleagues came up with a naloxone nasal spray, intended to be more appealing and easier to administer than prefilled injectors or the other naloxone alternatives.

Crystal's California-based Opiant Pharmaceuticals Inc. partnered with Irish company Adapt Pharma to market the spray version under the brand name Narcan. 

• Narcan too pricey, frontline workers say 

The Canadian government granted temporary approval to sell Narcan in Canada in July 2016 and upgraded that to full approval a couple months later. Some police agencies had decided not to allow their officers to administer the injectable form of naloxone to overdose victims and were holding out for the nasal spray version of the drug. Frontline groups that work with people at risk of opioid overdoses applauded the move to make treatments more accessible. 

The spray costs up to $145 Canadian for two doses, though police and other agencies pay less. The injectable form can cost as little as $5 to $20 per dose

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 [US]. 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.