Special Episode (with Dr. Nabarun Dasgupta) | Crooked Media
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October 26, 2021
Pod Save The People
Special Episode (with Dr. Nabarun Dasgupta)

In This Episode

DeRay interviews Dr. Nabarun Dasgupta about opioid addiction and Project Lazerus.



DeRay Mckesson: Hey, this is DeRay. Welcome to Pod Save the People, and this episode is a special episode. It’s just our interview with Dr. Dasgupta, who runs the Naloxone Buyers Club. I will tell you, I came across the Buyers Club and Dr. Dasgupta, and it blew my mind. This is an episode that I want to make sure you tell everybody about, that you make sure that your legislators, your mayor, your governor, that they get on it to fix the problem. If you or your life has been touched by addiction, this is an important episode around solutions and things that will help save people’s lives. My life has been touched by addiction. This is personal for me. I want to make sure that you listen, after the break.


[ad break]


DeRay Mckesson, narrating: This issue is personal to me, I want to make sure that you listen to this conversation and that you can help us fix a problem that’ll save people’s lives. Here we go.


DeRay Mckesson: Dr. Dasgupta, thanks so much for joining us today on Pod Save the People.


Dr. Dasgupta: My pleasure. Thanks for having me.


DeRay Mckesson: So I’ve been looking forward, I mean I’ve talked to you a lot recently.


Dr. Dasgupta: That’s right.


DeRay Mckesson: But I’ve been looking forward to interview because I am just fascinated by the work you do. Can you start by telling us, how did you get into work around addiction? Like what was your story to getting to this space?


Dr. Dasgupta: So I was working in a cardboard box factory in Maine, and it was between my college and grad school, and I saw people using OxyContin to be able to function at their job. At the same time, I had friends from high school who were using OxyContin in ways that, you know, made them more at risk and were causing all sorts of problems in their life. So that was kind of the personal side. When I got to grad school, I had to do an internship and ended up going back to Maine and studying OxyContin and heroin as a problem, and ended up losing a friend of mine to an overdose. And it was at that point where I realized this is a real thing. That was around 2002. And so for the last almost 20 years, this has been my focus, to prevent overdose deaths.


DeRay Mckesson: Now, can you talk about Project Lazarus? What is that? What was that? What is it?


Dr. Dasgupta: Project Lazarus is a nonprofit that we started in the Appalachian foothills of western North Carolina. It is this comprehensive, community-based program that works to help people who have pain conditions and help people who have addiction get treatment and prevent overdose deaths. We were the first program in the South to hand out the antidote naloxone for preventing overdose deaths. We were featured in the Obama White House Drug Control Strategy as an exemplary program. And when we first started, we had the third highest drug overdose death rate in the country, and we were able to drop that to being, we dropped that by 69% over three years by doing this whole community-wide intervention. We had support from the schools, from faith community, from the cops, from the medical providers, and it was just this amazing thing where you don’t, it’s not, it’s not a part of the country you expect innovation to come from when it comes to intractable drug problems, but it’s really fascinating because this was the county, Wilkes County, that was the birthplace of NASCAR. And why would you need a car that can go really fast is stripped down, and looks like a really normal car? Well, the origins of NASCAR are fundamentally intertwined with running moonshine from the stills in the mountains down to the cities. So when I first got up there kind of knowing the, you know, the harm reduction side, the community activism side, I started talking to folks. I’ll never forget this meeting where a, you know, tall, elderly, white-haired bow-tie gentleman came up to me afterwards and said, son, what was your name again? And I said, Nabarun Dasgupta. And he said, that’s not a Wilkes name now, is it? And then he went on to say that, you know, that he doesn’t need someone from outside coming in to tell him, that he can’t just lock up his sons for doing what they do to support their families. So this is a place where substance use problems and financial disadvantage have operated at the margins of the law for generations. And they were looking for new solutions. And really, you know, I helped catalyze idea, but the hard work was done on the ground with people coming together and doing the right thing.


DeRay Mckesson: Can you zoom out and tell us about naloxone? What is it? Do people actually use it? What is Narcan? How do people get it? Is it a game changer or not? Like, can you just give us the 101?


Dr. Dasgupta: You got it. So this is a story about social justice, about how activists reclaim power from the medical industrial complex, and how those institutional forces are still pushing back every day with a thousand ways to say no. So when we have 100,000 overdose deaths every year, we have to kind of undo our biases and really face reality. And the reality is this: there’s an antidote that can reverse opioid overdoses. Since about 1996, millions of doses have been distributed to people who use drugs and concerned family members. These are the heroes who have saved hundreds of thousands of lives. You probably know people who have been saved with naloxone, whether they disclose that or not. Instead of making this as easy as possible to hand out, the machinery of government, of industry, has made every move possible to protect its own power and its own profits. So when we talk about opioids, we’re talking both about prescription pain, medicines like morphine and Vicodin, and also heroin, and it’s more potent cousin fentanyl. You know that scene in Pulp Fiction, where Uma Thurman character is flailing around with heroin, with a heroin overdose, and gets a shot to the heart to revive her? Well, you see, like reality doesn’t make for great cinema sometimes. What actually happens in an opioid overdose, though, is more peaceful. It looks like a deep slumber from which you never awaken. It’s really sad because it’s not something that looks obvious when it’s happening. When opioids hit the brain, though, it has a side effect of telling you to stop breathing. And we’ve known this for millennia. So naloxone works like this, it’s simple: you give it to someone who is barely breathing, the naloxone gets into the brain, kicks off the heroin, and allows your body to start breathing again. So you’ve heard of the ancient Egyptian pharaoh King Tut, right? So his empire’s wealth came from—yeah, right, everybody has—his empire’s wealth came from opium. And ancient Egyptians, the Greeks, the Persians, all knew that opioids could, you know, quote, “cause sleep onto even death.” That’s what the manuscripts say. What they didnt have is naloxone. So that’s the antidote. It was invented in 1961 by this guy, Jack Fishman, who had fled Poland ahead of the Nazi invasion and ended up as a chemist in New York. So in one of those ironies that leaves you confounded by the universe, Jack’s own stepson died of a heroin overdose in Florida 40 years after he invented naloxone. Jack has since joined his stepson in the afterlife, but in an interview his widow says, like it was hard for Jack to get naloxone, even though he invented it because it was a prescription drug. And it still is a prescription drug. It was locked up behind these prescription requirements that were slapped on it during the Nixon administration, and the FDA and pharma and doctors and pharmacists and EMS have held on to that bureaucratic designation ever since. And so there’s a thousand ways to say no to saving lives, and we hear it from pharma and corporations and legislatures all the time. And it all, the root of all the problems that we have now goes back to this being locked up as a prescription-only medication. And that’s kind of where all the problems start and cascade all the way down the system.


DeRay Mckesson: Now, can you, one more question about naloxone, because I’ve had to learn so much about this, literally because of my, because of you—is, do people like, is this like a you want everybody who uses opioids to have one dose in their house? Like, do people I don’t know. Like, what’s the saturation? How do you give it out? I know that sounds like naive, but I don’t, I literally don’t know. Should people get it at public health department in their community? Like, should I have it, even though I don’t use opiod—like, I don’t know. Like, can you explain the use to me?


Dr. Dasgupta: Totally, man. That’s not a naïve question, because as we’ve talked to government officials over the last few months, it was clear that there’s a lot of compassion, but a lot of blindness to what’s actually happening on the ground. So the, so that you can get the antidote from a lot of health departments, in a lot of states you can get it at a pharmacy. But the folks who are really at risk of overdosing are often like street involved, they may not have stable housing, they may live in rural places where the ambulances can’t even get up to the mountains are too steep. I mean, these are all real stories. And so there are these, this amazing network of 110 community-based programs that do the hard work on the ground and get the naloxone to where it needs to go. And so they’ll deliver naloxone to people’s houses. They will drop ship it to you by, you know, in the mail. They’ll, you know, stand on street corners, they’ll go to homeless encampments and hand it out to people. The training is real simple. No more than five minutes, you can train anyone to use it. Should everyone who uses opioids have it in their house? Absolutely. And it shouldn’t just be one dose. Two doses, three doses, that’s what’s in a kit, because sometimes you need more than one dose to revive people. So we give out a couple of doses. And you know, it’s something that anybody who’s on a pain medication should have on hand. But at the end of the day, it’s like the people who are using drugs and who are kind of in other vulnerable situations are the ones who are going to be at the biggest risk of overdose. And they’re the ones who we really should be targeting policy and intervention and help to.


DeRay Mckesson: Now, was it always legal for you all to be, for like for naloxone to be given out? Is it by prescription? Are you guys like skirting the line? Like, how does this work?


Dr. Dasgupta: You’re right, it’s by prescription. Since 1971! It’s been prescription only. And these community programs are doing what they need to do to save lives. And sometimes that means skirting the law. Sometimes that means exploiting gray areas. In recent years, there’s been a bunch of like “state standing orders” they’re called. So the state legislature or the state health director says you can give out naloxone, it’s allowed. And so that relieves some of the pressure. But the crazy thing is, is that those laws were kind of made in a vacuum. Those orders were written in a vacuum. And when we take those orders to a pharmaceutical company and say, hey, can you send this program a ton of naloxone, we’ll pay for it. The pharma companies push back and say, well, you know, this order doesn’t have the word purchase in it, it just has the word distribute in it. And the theme here is, like every place we go to get help to get this antidote out, we get a no. We get any way that people can say no, they say when it comes to this medication. So, you know, another example is even the pharmaceutical ordering systems, the software engineers stand in the way because we say, you know, we’ll have a doctor who’s writing a prescription for naloxone for a bunch of community programs and everybody’s on board with it, it’s totally allowed, but the pharma software systems don’t—need it to be one prescription license number, to one mailing address. And so that doctor can only prescribe it for one program. And there’s all these practicalities at every step in the system that is just another way for someone to say no. And every time there’s an opportunity for someone to say no, they say no. It’s amazing.


DeRay Mckesson: Let me do two zoom outs, or one zoom out, really. The first is there are two version of the naloxone, I believe: it’s injectable, and then nasal.


Dr. Dasgupta: You got it. So the nasal spray costs about $75 for a pair of them that would go into a kit. The liquid injectable that most of the programs use costs about $2.50 for the naloxone that goes into a kit. And so we’re talking like a 30-fold difference between the branded product and the cheaper generic, which is what actually gets out and saves the most lives.


DeRay Mckesson: And then can you talk about the opioid data lab?


Dr. Dasgupta: So the opioid data lab is where I work at the University of North Carolina, Chapel Hill. I’m an epidemiologist and I like to tell true stories about health with numbers. And sometimes we have to do the data collection to get the numbers that we need to really tell the story for an advocacy point. So we, so that’s what we do. We’re funded by the FDA, by CDC, some private foundations, and we make it a point to outsource—to make public all our code, all the datasets that we can make public. And we research all kinds of things about the opioid crisis in general, from how it affects pain patients to how to stop overdoses, historical things as well.


DeRay Mckesson: We’ll be back with more from Dr. Dasgupta after the break. Don’t go anywhere. More Pod Save the People is coming.


[ad break]


DeRay Mckesson, narrating:  Let’s get back to Dr. Dasgupta.


DeRay Mckesson: I met you because of the Buyer’s Club. So can you talk to us about the Buyer’s Club? Why it’s necessary, what it is, was it always legal given that this is prescription? So we know nothing about the Buyer’s Club. Teach us.


Dr. Dasgupta: Absolutely. So the Buyer’s Club is this really incredible group of community activists who’ve been operating in the shadows for a decade and getting naloxone out to the places that need it the most and into the hands of people to save lives. And so the way the Buyer’s Club operates is back in 2012, Dan Big, who’s the grandfather of naloxone in the United States, has passed away since then. He and I negotiated a deal with Pfizer to get really cheap naloxone out to the programs that were saving lives. And the programs have operated under this model for, under this contract for almost a decade. In April of this year, Pfizer notified us and said, hey, sorry, the one factory that makes naloxone in the United States for us is having a manufacturing problem, so there’s going to be no naloxone produced for almost a year. And it was not related to the COVID vaccines, different facility. In fact, the facility is down the road here in North Carolina and this kind of ground truthed what was going on there. And so what you have is all these programs that had budgeted for, you know, 200—sorry, $2.50 per kit for naloxone now having to pay $75 per kit for naloxone. And as you can imagine, the money runs out real quick when you’re spending 30 times more than you planned. So the programs over the last few months have started to ration the naloxone. Now, the Buyer’s Club is what coordinates all the purchases between the 110 programs and Pfizer. And it’s a volunteer effort run by Eliza Wheeler and Maya Doe-Simpkins, and they’ve done this as a public service, as a volunteer effort for a decade, nights and weekends. Like real American heroes. They’ve been instrumental in helping these programs save hundreds of thousands of lives. And it’s been all volunteer. And so we’re at this point where all of the programs are starting to ration their doses, right? Can you imagine like seeing someone in front of you who you know has a drug problem and saying, well, I don’t know if I can give you this lifesaving antidote to have on hand in case you overdose. And those are the decisions that are happening every single day in communities throughout the country. And the solution has been really difficult to come by. We have, we started talking to different pharmaceutical companies. One pharmaceutical company, the one that makes the nasal Narcan, literally laughed at us and told us not to put the request in writing. Other companies just wouldn’t answer our calls. And so it’s been super frustrating. We did find one company who was willing to work with us, and they donated 50,000 doses, which was really awesome, and we’ve gotten, we’ve been able to distribute those already. And they’ve agreed to make us some custom batches for cheap so we can do some short gap measures to help with the problem. But it only gets us to like solving half the shortage. The Buyer’s Club last year distributed 1.3 million doses of naloxone, and the shortfall when Pfizer went offline in April is about a million doses. So we’re a million doses short. Of those doses, we’re thinking that about 12 to 18,000 additional preventable overdose deaths will happen because of this shortage. And a lot of those deaths have already occurred because the programs just haven’t had enough naloxone to distribute.


DeRay Mckesson: And it seems like Pfizer was a good partner, right, has been a good partner. I mean, like they didn’t they didn’t choose to close down the plant to screw you guys right?


Dr. Dasgupta: You’re right. Pfizer has definitely been a great partner for us. They have, you know, they’ve stepped up. They’ve told us that they’re going to prioritize getting naloxone to our programs first when the factory comes back online. Yeah, they’ve been, they’ve been really helpful. And the manufacturing problem affected not just naloxone, but also other liquid injectables that they make.


DeRay Mckesson: And I heard you correctly, there’s literally only one company that does the nasal spray.


Dr. Dasgupta: There’s one new nasal spray that just came to market last month or so. And then there was another naloxone that was just approved yesterday by the Food and Drug Administration. And that one is this super potent prefilled syringe that is like the equivalent of 12 doses of naloxone and is kind of this like nightmare drug that is way too potent for meaningful use and is going to be very expensive. So we’re concerned about that.


DeRay Mckesson: Why would they make that. Why would make it? Why would you do that? Is like a secret thing that we don’t know?


Dr. Dasgupta: There’s this general phobia of fentanyl. So fentanyl is this opioid that’s in heroin now. It’s contaminating heroin, it’s put there intentionally. And the molecule itself is a whole lot more potent than traditional heroin. There’s this general fear there because there’s like this super potent fentanyl in heroin, that we need stronger drugs to combat it. And that’s not true. It’s pharmacologically not true, in practice on the ground it’s not true. It’s just a, you know, it’s like one of these drug war myths that is really indelible. You need, you get stronger drugs, you need stronger antidotes. But the ones we have already in the concentrations that we have, have worked for decades and work just fine. But it’s like all part of this narrative. There is this incredible story out of San Diego recently where a young cop was, yeah, it was on a traffic stop. This is all from body cam footage. And there was some heroin that was found in the vehicle during that stop and there was like a little bit of it on the dashboard. You could hear the supervisor saying, watch out, watch out! That stuff probably has fentanyl in it. The deputy, you know, is getting something out of the car, comes out and says, oh, I’m starting to feel woozy, and then passes out. The sheriff’s sprays naloxone up their nose. They come back to life. And the sheriff posts this video on their Facebook page saying, like, hey, look, you know, there’s some really bad stuff out there and this fentanyl, you know, we saved this cop’s life. But it turns out that that guy did not have an overdose. He had a panic attack. Because there’s all this, there’s all this like myth and hype around how bad fentanyl is, that it obscures the pharmacological realities that, you know, you can’t get it from touching fentanyl, you can’t get it from just looking at it on a dashboard. It’s something that is actually manageable. And drugs that we have now, the antidotes that we have now work fine. Sometimes you have to give a couple of doses, but they work fine. And when you talk to people who work in ambulances and paramedics, oftentimes the, you know, they’re in the field, there’s this panic, there’s this adrenaline rush of trying to revive someone, and they’ll often push a bigger dose. And what happens when you push a bigger dose is you put the person into withdrawal very quickly. And so they wake up agitated and vomiting and pissed off. And what’s really amazing is when you do community-based distribution with people who use drugs and they’re the ones administering it, they’ll go slower and bring the people back to life without causing that crazy withdrawal. And so what you hear from the medical professionals is really different from the reality on the ground when you have people who are more compassionate and more connected to the individual who’s overdosed, who are trying to bring them out without making them sick. And it works. I mean, this is as close to a miracle drug as we have in modern medicine, and there’s no reason to keep it locked up any longer.


DeRay Mckesson: So, so what’s the fix? Like, what can we do to make sure, the fact that you all buy half the doses in naloxone in the US is wild. That there’s like a group of volunteers that have saved countless lives that people didn’t even know about? Why, why is the money from the federal government not sort of doing this? What is the fix?


Dr. Dasgupta: So there’s two fixes. One is to revamp how the money is distributed. And the second is to make, is to get rid of the prescription requirement for naloxone. So the first one, right, the money, the money question is that right now, the federal money for overdose prevention goes from an agency called, that’s part of HHS called the Substance Abuse and Mental Health Services Administration, or SAMHSA. And SAMHSA sends the money to each state, and the state has usually a health department that distributes the naloxone money to community groups. And so it’s this trickle down thing. But where the system falls apart is that the state health departments consistently over decade, over a decade, pick the most photogenic programs. They pick the ones that have, you know, that can handle all the institutional paperwork that’s needed. They don’t take into account which programs are reaching the most people. Because of this, 53% of the programs in the Buyer’s Club get exactly $0.0 of federal funding for overdose prevention. They have to run bake sales and GoFundMe pages to hand out naloxone to stop overdose deaths. When we have 100,000 overdose deaths per year in the United States, it’s mind-blowing that half of this critical public health infrastructure is teetering on GoFundMe pages. It’s just mind-blowing that we can’t find a better system. The way that the money flows from the feds to the states is broken, and fixing it state-by-state is just not going to happen. And when we reached out to states during the shortage and said, you know, can you send some more money to the programs, we only got like a handful of states that did something about it. And when they saw the price tag of the $75 naloxone, they kind of balked and, you know, gave some money in a few states but it wasn’t, it wasn’t a centralized solution that was needed. So I think we need to have a federal purchase of naloxone that is distributed outside of these existing antiquated systems. The programs that don’t get money from the feds are predominantly those serving people who are the most marginalized. So people with, who are on Native American reservations or living nearby, people of color, or programs that are serving communities of color or run by people of color, people with a history of incarceration, rural Appalachia—those are the programs that systematically get excluded from the current way of funding it. The second thing that needs to be done is to have FDA finally get their act together to make the prescription requirement for naloxone go away, at least for harm-reduction programs. FDA in the past has been proactive in pushing for over-the-counter naloxone and ,but their whole model was predicated on pharmacy, like retail pharmacy like “go buy this at Walgreens with your health insurance” kind of thing. And what they what they did was they spent taxpayer money to make it easier for naloxone to go over the counter, but they only did the work for the expensive branded versions of naloxone, the one that cost $75, and another one that cost, that isn’t on the market anymore, that cost $4,500 per kit. So it was, you know, it’s clear where the priorities are and that—and then COVID actually kind of helps open the door to making this a non-prescription product. And the way that works is that the CARES Act, the big kind of omnibus spending bill that was created in response to the pandemic last spring has a new provision in it to give FDA broad authority to make any product they want over-the-counter or get rid of the prescription requirement. And they have exercised that authority for anti-flatulence medications, wart removers, and ingrown toenail products. You would think that during a nationwide surge in overdose deaths, that there would be things that are more pressing than grandpa’s gas, but that’s what they chose to prioritize.


DeRay Mckesson: How have your conversations been with legislators or the administration? Is the FDA working against this? Are they, how’s it looking?


Dr. Dasgupta: Like I said, there’s a thousand ways to say no. And every time we’ve brought this up with the FDA, with other executive HHS officials, there’s always been some reason why there’s, that this isn’t the right time. And we’ve been saying this for 10 years that we need this to be over-the-counter and every time there’s another reason. Recently, our conversations with senators, Senator Booker’s office, Senator Baldwin’s office, Senator King’s office—we’ve had a lot of compassionate staffers who understand what’s going on, and we’ll keep working with them to try to get a better, a better way to do this. And you know, in the midst of all this, what has, the folks who have stepped up are philanthropists. And there’s been, The Open Society Foundation, for example, has been funding naloxone distribution for a decade. And there’s a bunch of small community foundations that have stepped up and given money to churches to get more naloxone out, things like that. So it’s, you know, the response has been all over the board. The people with power are the ones who say ‘no’ way more than the folks on the ground who see why this is really important.


DeRay Mckesson: Where can people go to [unclear] you’re doing, to help you out, like how can people follow your work?


Dr. Dasgupta: So there are harm-reduction programs, community-based programs, that are doing naloxone distribution all over the country. Supporting them, sending them a little donation—those help. Each of those donations will actually go to saving lives. I think there is some political organization and activism that’s needed. We need to be able to negotiate deals with the pharmaceutical industry and get a better supply chain for naloxone. So the Buyer’s Club is working on those things. We need more federal support to actually be able to get naloxone out. So calling your senators, asking them to make naloxone over-the-counter, get rid of the prescription requirement is really, really helpful. My Twitter account N A B A R U N D will give you plenty of updates on this. And then the OSNN Buyer’s Club website is O S N N B U Y E R S C L U B dot com. And we’ll be posting updates on there.


DeRay Mckesson: Well, I learned so much talking to you. Let’s stay in touch. Anything I can do to help. Those listening, if you work on Capitol Hill, please get your people to do something about this. If your cousin happens to run the FDA, please get them to do something. If you know people with access, please get them do something. If you have a phone or a computer, you have power too. Please help on this. I think we have a chance to do something big. Thanks so much, Dr. D.


Dr. Dasgupta: Thank you for your time. I appreciate it.


DeRay Mckesson: Well, that’s it. Thanks so much for tuning in to Pod Save the People this week. Tell your friends to check it out. Make sure to rate it wherever you get your podcast, whether it’s Apple Podcast or somewhere else. And we’ll see you next week. Pod Save the People is a production of Crooked Media. It’s produced by Brock Wilbur and mixed by Bill Lancz. Executive producers are Jessica Cordova Kramer and myself. Special thanks to our weekly contributors, Kaya Henderson, De’Ara Balenger, and Sam Sinyangwe