Countermeasures Season 3 Episode 5 Transcript: Naloxone Access

[00:00:01] Narrator Globalization, geopolitical conflicts, climate change, and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses, and more. We’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow. In this episode, we return to the opioid crisis and the progress being made in access to naloxone, one of the key factors in reducing opioid overdose deaths. In 2023, the FDA approved NARCAN® Nasal Spray, a four milligram naloxone product for over-the-counter sale in the United States, marking a turning point in the opioid crisis. Once available only by prescription or through community programs, this medication is now more accessible than ever before. Experts point to expanded access as a critical factor in recent declines in opioid overdose deaths. But the crisis is far from over. Some communities continue to experience devastating losses, especially in rural regions and among marginalized populations. And stigma remains a barrier to widespread adoption. This episode explores naloxone accessibility through three perspectives. A recovery advocate who has lived through the crisis, a mother whose son survived an overdose because naloxone was available, and a public health researcher focused on overdose prevention and equitable access. We begin with Zac Clark, founder and CEO of Release Recovery and the Release Recovery Foundation. Zac, who is featured on the reality television series, The Bachelor, is also in long term recovery himself after years of opioid use. 

[00:01:59] Zac Clark So much of my expertise lends or relies on my personal experience. And so when I think about the opioid crisis, for me, it really looks at the three phases. So back in the 90s, we had big pharma pushing these kind of really high-powered pharmaceuticals into the marketplace, and folks began to get addicted. I’m someone who’s in long-term recovery. I just celebrated 14 years. I was an IV heroin user. I say that very openly to try and defeat some of the stigma that we talk about. And so for me, I was really in that second phase of the opioid crisis. I was using heroin, I was injecting it, and then really the third phase was fentanyl. And when fentanyl came into the market or into the scene, 2013, 14, 15, I was sober where I probably wouldn’t be speaking to folks right now as I am on this show. It did something that I don’t think we ever could have predicted. Fentanyl is obviously, it’s a synthetic opioid, it’s manufactured, it’s a lot cheaper to manufacture, so obviously very attractive to drug dealers, people that are selling drugs illegally and it’s also 50 times stronger than most of the other opioids that we had seen out there in the marketplace. So when this third wave came, the biggest thing for me, and I try to keep it really simple because there’s a lot of things we can go back and forth on when it comes to the opioid. But as someone who experienced drug use, what happened was someone like me who was using heroin starts using fentanyl without knowledge, and we start to see the overdose numbers really climb. And so for me, going back to the question, this is a long way of saying for many, many years, heroin was a dirty word. And in a lot of ways, it still is. It’s one of the reasons I speak so freely about, you know, my experience, so that people can see me hopefully and say, Oh, it’s a pretty normal guy, and he’s a heroin addict. That’s kind of the thread that I try to keep going. When people started to pass away, obviously it was very jarring. And what we are seeing now in the year 2025 around the conversation for me. So I’ve been in this space for a while now. This thing does not discriminate. So more and more people are being affected. More and more people have lost individuals in their lives very close to them. We have lost people, humans who are freshmen in college who show up on a college campus and think they’re trying cocaine or smoking pot for the first time and it’s laced with fentanyl and we’re we’re losing common folk who are experimenting for the first time and so that has really brightened the light being shined and what it has done is it is, you know, families it’s almost like a grassroots effort the conversation is starting to shift to it’s important to understand this it’s important to understand that we’re losing over 100,000 people a year to accidental overdoses, and it’s important to understand that there are things that we can do to help limit those which when you talk about a drug like naloxone which reverses overdoses and some of the other more like preventative methods and educations available. There is some hope, but it’s still bad. You know, it’s still very bad in terms of the conversation. 

[00:05:48] Narrator As illicitly manufactured fentanyl, a powerful and synthetic opioid, has flooded the drug market. The effect of the opioid crisis becomes even clearer. This shift has made the role of naloxone even clearer. We now turn to Amy McCormick, a nurse, mother, and grandmother, whose son Owen nearly lost his life to an overdose. Owen grew up like many kids in the US, skateboarding, hanging out with friends. He began taking opioids at a fairly young age, struggling for several years with his addiction. He spent time in and out of rehabilitation centers in his late teens and early 20s, and eventually experienced an overdose at age 23. 

[00:06:28] Amy McCormick Owen ended up overdosing in California and he was saved by naloxone. And that was August, it will be seven years this year from when he had overdosed. And luckily rescue was called and he was saved because they did have naloxone. 

[00:06:46] Narrator For Amy, naloxone is not abstract policy. It is the reason her son is alive today. Her family’s story illustrates why access must go beyond pharmacies and into the hands of bystanders and communities. And researchers like Olivia Sugarman, PhD, MPH at Johns Hopkins, who studies how policies can promote access to high-quality health services for historically marginalized people, specifically people who use drugs, are asking the same question. Why? If the naloxone is simple, safe, and effective, are there still barriers to getting it? 

[00:07:22] Olivia Sugarman It’s easy to use. It’s relatively cheap. There aren’t many things controlling whether or not you can get it. It’s more just is it where it needs to be at the time that it should be. So why are people still having barriers to getting it when this crisis continues to be a thing? 

[00:07:38] Narrator Naloxone has been credited with reversing tens of thousands of overdoses each year. For Zac, the evidence of its impact isn’t in reports or numbers. It’s in the clients who arrive at his recovery center alive because someone had naloxone on hand. 

[00:07:53] Zac Clark So the impact that I’m seeing since naloxone has been made available over the counter is fascinating. And I’m seeing it in a couple of different areas. One, at Release Recovery, the program that I run, we are seeing clients and patients show up in our care who at one point had an overdose reversed with naloxone. So those are data points that I’m seeing in real time of someone who is alive where they would not be otherwise, because this drug is available. So I think of common sense. You walk into any house in America, you’re gonna find a fire extinguisher. It is way more likely that you are gonna need to use naloxone at some point than to use that fire extinguisher. And so that’s common sense. And I’m here to tell you that I am seeing people show up in my care who are alive. And so it’s working. I get the opportunity to go out to college campuses and do some tabling, which means basically we’re out there talking to people about naloxone, just being curious. You know, do you know what this is? Do you know what it does? And five years ago, I would say very few students, the young people, I think young people always provide us with more information than probably we’ve realized the young people didn’t know what naloxone was. In my most recent experience, I would say there were only a couple of students who weren’t aware. So that tells me that we are making progress, that the benefits of naloxone are out there. If you’re listening to this and you don’t know what naloxone is or does, the thing that I’m gonna tell you is that there are very little, there’s very little downside other than saving someone’s life, to having naloxone present. We are seeing progress, especially with the young people. 

[00:09:55] Narrator Naloxone can reverse an opioid poisoning, but barriers remain to accessing it. Amy has seen how stigma keeps families and communities from carrying it, even when it could save lives. 

[00:10:08] Amy McCormick Community is like the biggest part of this and decreasing the stigma is making sure everyone knows this can happen to anybody. This can happen to the richest of people, the poorest of people, socioeconomic has no boundaries, you know, with addiction. So I think it’s really, really important that we continue. I think stigma is still a huge part of this. And even in the corporate world, you know, if the numbers show this is where people are overdosing, you know, some of the highest places, they need to be trained and it needs to be present. It is such a high safety profile with such a low cost to save a life. Like now is not the time. Like I said, some funding should not be decreasing at this time. This is where we should still be ramping up, even though we’ve seen a decrease in overdose, it should still be ramping up. You know, make gains in the gym and then decide to stop. Like, we keep going. We keep going harder, harder, harder until this isn’t a factor. And I think there’s so many areas that we can still put naloxone in place, you know, in the communities and educate kids through college and healthcare workers as well, too. There’s just too much opportunity that we have missed that still can be, you know, touched in a lot of regulations. 

[00:11:26] Narrator Naloxone can be obtained in various ways. Olivia Sugarman highlights the most common distribution methods. 

[00:11:34] Olivia Sugarman There’s this really great document from, I think it’s the Reagan-Udall Foundation, but they did, it’s kind of, I think it’s called a naloxone economic overview, but they got a bunch of data around who gets naloxone. And by who gets naloxone, I mean like what kind of companies get naloxone or give it out. And they have this great bar chart of here’s CBOs, so community-based organizations, and here’s pharmacies. And by and large, most naloxone was distributed through community-based organizations. So pharmacies are a great way for people who are bystanders or who are willing to take the cost of purchasing an naloxone kit to access it. But CBOs large and above are probably the major outreach point. 

[00:12:19] Narrator Naloxone’s effectiveness depends not only on the drug itself, but on whether people can afford it, find it, and feel comfortable carrying it. As distribution expands, the conversation turns to equity. Which communities are still being left behind? Despite nationwide declines in opioid overdoses, communities continue to struggle and disparities have become more visible. Olivia emphasizes that the crisis now disproportionately impacts communities of color and minoritized populations. 

[00:12:48] Olivia Sugarman So thinking about equitable ways to distribute naloxone. So we’ve seen a disproportionately high rate of overdoses in communities of color and minoritized populations, which is alarming. But I also think that speaks to more general inequities in harm reduction services or health services in general. And that’s not a new story. I think we’re just seeing a symptom of a story that’s been the case for a long time. That said, now that we know that that’s the case, there is an opportunity to say overdose rates are happening more often in these communities. These are the tools that we know work or can work or that we can tailor to work to be specific for people who either haven’t been engaged in naloxone distribution before, people who may not know about naloxone, perceive their risk to be lower for overdose, or people who have wanted naloxone for a long time but have never had the opportunity to get it because it’s just not available. So I think we’re at a really key moment where I think the imperative really needs to be paying attention to the data. It’s there. It’s in our faces. It’s just about acting on it. 

[00:13:54] Narrator For Zac, equity is also about defeating stigma. He says the opioid crisis has reached so many communities now that attitudes are shifting. 

[00:14:04] Zac Clark When I think about and in talking about the stigma associated with naloxone, I do believe we are making progress. We have to be, you know, I have to believe that. I mean, I’m just this is my work. This is my life. This is one of the things that I care most about after my family and, you know, friends and whatever else we live for. So I have to believe that. And I have to know that. And the reason is the longer this world spins, the more people are going to be affected by an overdose. And when all rows lead back to that, more and more people are going to be exposed to this thing, which means more and more people are going to understand the vital nature of naloxone. And, you know, for a long time I had my big three, right? Keys, wallet, cell phone. It’s now the big four, you know, because naloxone is in that mix, and I just wouldn’t want to be in a position where I’m out in the world, and someone’s overdosing, and I’m not there to help. I think that the area where there’s probably some improvement is just making sure that it is in every deli and in every restaurant and in every place of employment. Because a lot of these organizations assume that while they’ve heard the stories, it’ll never happen to them. Just like a family member. It’ll never happen to them. And that’s where I think we’re misguided. For me, I would much rather be ahead of the curve and have it available. And so the stigma’s real. I mean, anytime you’re talking about street drugs and something that makes people feel like they are less than if they are associated with, there’s gonna be stigma, and someone might refuse to carry naloxone because of what they think other people might say about them. And that’s just the reality of the world we live in. 

[00:16:10] Narrator As naloxone becomes more common, strategies for reaching people where they are become increasingly important. Olivia says that some of the most promising efforts involve non-traditional distribution, vending machines, libraries, and even barbershops.

[00:16:27] Olivia Sugarman  So public health vending machines are basically almost kind of what they sound like. So they’re basically a different version of a candy vending machine. And it has all kinds of different supplies in it. So sometimes it’s things like a naloxone box. It can be a wound care kit or underwear or condoms, or I’m trying to think of an example. There’s actually one down the street from you right now. A Sharps box, like a small sterile sharps container for disposing of your syringes. It’s anonymous. You go up to it. It’s available anytime you want, as long as it’s in stock. Put in a pin. Usually it’s some anonymous pin, and you get whatever you need. I think it’s a great tool. I can’t speak to whether or not they’re deployed specifically in my minoritized communities, but they’re a great tool. A similar tool that takes this kind of static approach when you need it is something called a nalox-box. I think it’s truly just like a box that’s hung up on a wall or in some public area. You take it when you need it. I’ve also heard of radio ads talking about the importance of naloxone, the utility of naloxone on predominantly black radio stations or radio shows that have predominantly black audiences. Churches are now getting involved in the effort. So having congregations do naloxone trainings, having naloxone on site. Some libraries are also now carrying a lot of them, which I think is really cool. 

[00:18:03] Narrator Despite the progress we’ve made, the opioid crisis continues to be a major public health issue in North America and beyond. Naloxone is only one part of the potential solution to this public health emergency, but it is a critical tool for keeping people alive in the face of opioid poisoning. The voices of Zac, Amy, and Olivia remind us that progress is possible through lived experience, through community, and through policy. Expanding access, reducing stigma, and ensuring affordability will determine how far we go in saving lives. As the opioid crisis continues to evolve, naloxone remains a symbol of both urgency and hope. If this subject resonates with you, please revisit seasons one and two of Countermeasures, where we explored the roots of the opioid crisis in depth. Thank you for listening to Countermeasures. If you found this episode meaningful, please consider leaving us a rating or review. The views and opinions expressed by the guests are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates. Guests are not representatives or spokespersons for Emergent BioSolutions, and their appearance on this podcast is not an endorsement.