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I get a lot of ads for medicine promoted at me on Twitter. Mostly it's drugs for extremely specific cancers. This time I got an interesting one. Emergent BioSolutions paid a motherhood culture writer, Becky Mansfield, to write an advertisement for Narcan brand intranasal naloxone spray. The Twitter screenshot links to the article. Read it for yourself.

Welcome back. The ad is a spiritual channel to Hays era prohibition films. Mansfield is ignorant about drugs and drug use. She claimed to be 'shocked' to learn that teens keep drug secrets. Here's a quote that stuck out to me.

"I don’t think that I knew anyone that was doing drugs when I was in school (and if they were, I was oblivious to it.) Things have certainly changed."

Those parentheses are bursting at the seams.

Pursuit of altered states is a normal human drive. Adolescence is when we test boundaries and undergo rites of passage, which include competent drug use. Basic human nature is revelatory to Mansfield because of, not in spite of, her credentials as a teacher. She has been taught stupid things about drugs on purpose to maximize poor outcomes. There is some good logic in using her as a spokesperson. Her audience has probably repeated disinformation to their kids. When those kids realize they were mostly lied to, they are likely to take bigger risks with opioids and find out the hard way that some of it is true. Getting naloxone into those homes could mitigate the damage. But Emergent doesn't care about mitigating damage and that isn't why they bought this ad.

Naloxone has been used in opioid overdose therapy since the '70s. Nasal naloxone sprays existed before Narcan came out, but they weren't easy to use. The spray attachment was separate from the naloxone vial. It took special training to learn how this worked. The FDA approved Narcan in 2015 to answer the demand for a ready-to-use spray. While training doesn't hurt, Narcan is easy enough to use that reading the instructions is enough to administer it properly.

Emergent acquired Narcan with its maker, Adapt Pharma, in 2018. The patent's expiration date was 2035, which would have given Narcan more than 15 years of monopoly over RTU naloxone spray. They set the price of Narcan at approximately five times that of DIY naloxone kits and made poor people have to jump through hoops in order to get any kind of reasonable discount. The door that Narcan opened to potential responders was slammed back shut by its price tag.

Seeing that the problem was with access rather than Narcan itself, the FDA awarded naloxone spray approval to generics manufacturer Teva Pharmaceuticals in 2019. Realizing that lives were on the line and they had been irresponsible custodians of a critical drug, Emergent admitted that more companies needed to make naloxone spray so that everyone who needed it could get it and lololololol no. What Emergent actually did was file frivolous patent lawsuits to block Teva so they could continue extorting the few responders that already existed. The courts reasoned that 'put a 60-year-old drug in a squirt gun' did not constitute a meaningful invention and found in favor of Teva, but it took them until summer 2021 to finalize the decision. Over 100,000 people died of opioid overdoses while Emergent locked the market down.

Emergent had another problem in 2021, and that was ruining fucking everything. They had a contract with the United States government to produce COVID vaccines. Lax protocols resulted in those vaccines getting contaminated. "Oh, shit!" I hear you say. "That was them?" Yeah, that was them. Emergent was ordered to throw out millions of doses of spoiled vaccine in July. This exacerbated both vaccine shortages and vaccine hesitancy in one shot, which was really convenient because they didn't have to take off work for a second shot. Emergent revealed in November that this cost them the contract, and also 37% of their stock value.

Now it is 2022. Narcan has three competitors; Kloxxado* and two generics. Narcan managed to become a household name synonymous with naloxone while it was an exclusive property. When a company has a household name, they can lean on it. "Buy only genuine Narcan! Accept no substitutes!" It's never great logic for a drug, since the molecule is the molecule is the molecule regardless of whose name is slapped on it. It's worse logic for Emergent, since genuine Narcan was made by a company that cocked up a pandemic and generic naloxone spray wasn't. What's more, the generics make it more likely that naloxone will finally, fucking FINALLY become available OTC.

That's what teaming up with Mansfield is really about. Look, it's good to get naloxone into as many first aid kits as possible. I want that very much. But what Emergent is doing here is trying to squeeze the last remaining drips of profit from Narcan after playing keepaway with it while people fucking died. So fuck them. I hope their BioThrax monopoly gets nuked next.

*Wait a minute, what the hell is Kloxxado? Kloxxado is another example of America failing to respond to the overdose crisis competently. But it's a story for another time.