Note: This piece is being co-published by NEPM and The Shoestring.
When Dalton police chief Deanna Strout received a promotional email last spring, it came from someone she trusts: the then-head of the Massachusetts Chiefs of Police Association, Mark Leahy.
“Here is a fantastic opportunity to try OPVEE, the first opioid reversal agent that is effective in dealing with Fentanyl,” read the email, which was addressed to police departments across the state and provided contact information for the company that makes Opvee, Indivior. “Free samples are available with minimal effort. Read on!”
Because the email came from her own trade association, Strout decided to give Opvee a chance. “I realized that this could make us more effective,” she said in an interview.
Some health experts who have seen that email, however, say its claim was patently false.
For decades, medical professionals have been using the overdose-reversal medication naloxone — often known by the brand name Narcan. Addiction experts say naloxone is still effective, including against the powerful opioid fentanyl. What’s more, public health experts have raised concerns about what they say are the potentially dangerous side effects and other risks associated with more recently approved, long-acting overdose reversal drugs.
Opvee is one of those. It’s a nasal spray with an active ingredient called nalmefene, which — like naloxone — is an “opioid antagonist” that attaches to the brain’s opioid receptors to reverse and block the effects of opioids. Its supporters have touted it as a powerful "fentanyl fighter," saying that several doses of naloxone are sometimes required to completely reverse a fentanyl overdose.
Public health experts’ concerns are part of the reason the Massachusetts Department of Public Health has declined to allow for easier access to nalmefene-based drugs like Opvee and other newer opioid reversal drugs, including higher-dose formulations of naloxone, that other pharmaceutical companies have marketed. So far, the department has resisted adding those drugs to a statewide “standing order” — a protocol that allows people to receive overdose reversal agents without a patient-specific prescription.
“Studies indicate these agents are more likely to precipitate withdrawal, which can increase mistrust and foster avoidance of overdose reversal assistance among people who use drugs,” a DPH spokesperson said in a statement.
Other experts have agreed. The American College of Medical Toxicology and American Academy of Clinical Toxicology, for example, warned that nalmefene "could result in significant harm if widely utilized.”
Even so, an investigation by The Shoestring and NEPM has uncovered efforts by Indivior to circumvent experts by promoting the drug directly to police departments and sheriffs offices across western Massachusetts and statewide.
Some of those law enforcement agencies then became boosters of the product. In March 2024, for example, Leahy emailed the state secretary of public safety and security and asked him to “nudge” the Department of Public Health to make Opvee more widely available.
The next month, the Massachusetts Sheriffs’ Association’s executive director suggested in an email that sheriffs should also “apply pressure” to state leaders to add Opvee to the state’s options.
"Strategic" marketing of Opvee to police
The United States is one of the only countries in the world that allows direct-to-consumer advertising for prescription drugs. And several experts say a common marketing tactic drug companies employ to sidestep public health departments is to use police departments as a wedge to get into the market.
Maya Doe-Simkins is the co-director of the national nonprofit Remedy Alliance/For The People, which buys generic naloxone in bulk and sells it at cost to organizations. In her 20 years working in health and wellness for drug users, beginning in Boston, she said she has frequently seen companies with expensive new products market themselves to police departments because of the “astoundingly huge budgets” for policing. She said police departments often follow with "aggressive lobbying” of political leaders to adopt those products.
“Then the public health folks have to push back against the electeds or they have to cave,” Doe-Simkins said. “So it's very strategic.”
Elsewhere in the country, police have become vocal supporters of Opvee. In Oakland County, Michigan, for example, the sheriff’s office heavily promoted the drug in a recent feature on NBC News that featured body-camera footage of overdose reversals using the drug.
It wasn’t long after reading Indivior’s marketing pitch that the Dalton Police Department signed up to be the first agency in Massachusetts to carry Opvee.
A month after receiving the email from the Massachusetts Chiefs of Police Association, which NEPM and The Shoestring obtained through a public records request, Indivior shipped free samples of Opvee to Dalton. The company also provided the department with training on using the drug and guidance for getting it added to their own local standing prescription order.
“Excited that Dalton will be the first - tip of the spear!” an Indivior representative wrote to Strout. She copied on the email both Leahy, of the chiefs of police association, and Indivior’s lobbyists in Massachusetts.
It’s unclear whether Leahy wrote the false claim that Opvee is the “first” overdose reversal medication effective against fentanyl or whether that language came from an Indivior representative. Indivior, through a PR firm, did not make company leaders available to answer questions about Opvee’s marketing in Massachusetts. Leahy did not return several voicemails left on his cell phone in recent months.
Leahy retired from the chiefs of police association last summer. His successor, Michael Bradley, said in a phone interview that he didn’t have any role in the collaboration with Indivior and couldn’t say for sure who wrote the assertion about Opvee and fentanyl.
“I would suspect that any language would have come from the vendor. It could have potentially been misinterpreted along the way,” Bradley said. “Typically, the vendor would write the language that we push out … If we’re trying to connect our members with a vendor that can help them, we’re usually just transferring the information.”
It’s also uncertain whether the false claim in the Massachusetts Chiefs of Police Association’s email crosses any legal boundaries. The attorney general’s office declined to weigh in on the matter. In a statement, a spokesperson said the office is “concerned any time a company falsely markets their products.”
The statement also said the attorney general’s office, then headed by now Gov. Maura Healey, won $6.65 million in settlement money in 2021 as part of a larger $300 million settlement Indivior agreed to for “falsely and aggressively marketing the drug Suboxone.” The settlement resolved several allegations, including that Indivior promoted its Suboxone Sublingual Film "based on false and misleading claims that the film was less subject to diversion and abuse than other buprenorphine products and that it was less susceptible to accidental pediatric exposure."
Carrie Hill, the Massachusetts Sheriffs' Association’s executive director, declined an interview through a spokesperson. In a statement, the spokesperson said the sheriffs’ association supports adding all FDA-approved opioid reversal medications to the statewide standing order.
“Opioid epidemic opportunists”
Opvee’s marketing comes amid a nationwide debate about how to compassionately and effectively respond to overdoses. It’s a conversation that has taken on added urgency as some $50 billion in opioid lawsuit settlement money pours into communities across the country — money that drug makers, including Purdue Pharma, and retailers have to pay after being sued for their roles in fueling the opioid epidemic.
Around $975 million is headed to Massachusetts over the next 13 years, according to the organization Opioid Settlement Tracker. And that was before Attorney General Andrea Campbell announced on Jan. 23 that the state will receive up to another $108 million from Purdue Pharma, the makers of OxyContin. Intended to stem the overdose crisis, the influx of money has put states, municipalities, and various agencies and departments nationwide in the position of deciding how to spend that cash.
But before allocating the money, most of those decision-makers won’t have to consult those most impacted by the opioid epidemic: people with substance use disorder or who actively use drugs. In Massachusetts, for example, state leaders have decided that municipalities will receive 40% of the state’s settlement money as it arrives and don’t have to collect public input or form an advisory board before deciding how to spend it.
Some say that creates an opening for corporations that seek to profit from the opioid epidemic by selling to potentially uninformed local leaders an ever longer list of unproven products.
Doe-Simkins said this trend is especially worrisome to those working in harm reduction — a model that underscores the importance of keeping people alive more than simply stopping drug use. She said harm reduction advocates have watched big business and police co-opt their language as they push to spend money on useless or outright harmful products.
“And now we have to spend our time pushing back against stuff that is being sold to us by opioid epidemic opportunists,” she said.
“Shaking, cold sweats … having trouble breathing”
The federal Food and Drug Administration first approved naloxone for treating overdoses in 1971. Initially, the revolutionary drug was only available to first responders and medical professionals. But due to activism from people using opioids, harm reductionists and public-health workers, naloxone is now widely available.
“Naloxone distribution to people who use drugs is literally one of only three effective initiatives that we know of in preventing fatal overdose,” Doe-Simkins said. The other two, she said, are addiction medications like methadone or buprenorphine (brand name Suboxone) or places where users can go to use opioids under supervision, often called "safe consumption sites."
However, now that naloxone exists as a low-cost generic drug, some pharmaceutical companies have come up with new ways to market and profit from other products.
In some cases, those “new” products are just formulations of naloxone with higher doses than the typical .4 milligram/1 milliliter injection or 4 milligram nasal spray. In 2021, for example, the FDA approved the 8 milligram nasal spray Kloxxado, which the company Hikma Pharmaceuticals marketed.
More recently, several companies have secured federal approval to begin selling products using a different opioid blocker: nalmefene. In the spring of 2023, Indivior was the first to do so, securing federal approval for Opvee, the drug it began marketing last year to first responders in Massachusetts and nationwide as part of a free trial.
The company has billed Opvee as a more-effective weapon in the battle against increasingly potent opioids like fentanyl. In response to questions from NEPM and The Shoestring, Indivior’s PR firm provided several scientific papers. One study suggested that some synthetic opioids required much higher doses of naloxone to reverse; the other, funded by the company and written primarily by its employees, said that nalmefene reduced the incidence of cardiac arrests better than naloxone.
But those working in public health and harm reduction have advocated for the continued use of lower-dose naloxone instead of stronger reversal agents like nalmefene or high-dose naloxone. A study that researchers from the New York State Department of Health, New York State Police and Albany Medical College published last February showed no significant difference in the rates of survival for people who were revived from an overdose using 4 and 8 milligram naloxone spray. The study did show, however, that those who were revived with high-dose naloxone were more than 2.5 times likely to experience withdrawal signs and symptoms.
Experts say some of these reversal drugs can also be dangerous. Because they block the body’s opioid receptors, they can put people into an immediate withdrawal from opioids, which generally includes vomiting, anxiety, insomnia and other painful and even life-threatening symptoms. Indivior acknowledges as much in its prescribing information, which also says that some people may try to use large amounts of opioids in an attempt to overcome the blockade, increasing the risk of fatal overdoses.
That’s something Malcolm Visnich understands well. He was an intravenous heroin user for 10 years who now works as an overdose prevention specialist with the harm reduction organization Prevention Point Pittsburgh. Last year, Visnich presented at a nationwide summit on compassionate overdose response, describing the times people had revived him from overdoses using naloxone. His low-dose naloxone experiences were “pretty chill,” he said in an interview. But he also faced what he calls “naloxone overdoses.”
“It's throwing up, shaking, cold sweats, being disoriented … hyperventilating, extreme anxiety. I can recall panic attacks so intense that I felt like I was tripping, like hallucinating from anxiety,” he said. In one instance, he recalled, “I was vomiting so much that I was having trouble breathing.”
Visnich described those experiences as feeling like an entire week’s worth of withdrawal symptoms crammed into one hour. Since nalmefene is a longer-acting substance than naloxone, it can cause even longer-lasting withdrawals than Visnich experienced.
For those reasons, several medical organizations have come out against the widespread use of nalmefene recently, including the National Association of State EMS Officials. The American College of Medical Toxicology and the American Academy of Clinical Toxicology, in a joint statement, discouraged replacing naloxone with nalmefene as the primary overdose reversal medication. They noted that Opvee was only tested in what Indivior’s own documentation describes as “healthy subjects” who were “opioid-experienced, non-dependent.” As a result, the toxicologist organizations said the drug “has not been adequately studied for effectiveness in the actual setting and patient population: for patients with severe opioid intoxication in the out-of-hospital environment.”
“It’s so hard to gain trust”
Given that naloxone is still effective in saving the lives of those who are overdosing, some addiction experts say nalmefene-based products or high-dose naloxone could harm opioid users and are likely to create an increased burden on emergency rooms and first responders.
“It's so hard to gain trust with people who use drugs, for understandable reasons,” said Liz Whynott, the director of harm-reduction programs at the western Massachusetts-based community health organization Tapestry.
Whynott began working in harm reduction after discovering Tapestry through its needle-exchange program when she used heroin in her younger years. The selling of powerful new overdose-reversal medications, she said, is “just another example of how the medical system, the pharma industry are not really listening and respecting the experience of people who really understand this on the ground.”
Visnich agreed. He said that during his years using drugs and being homeless, nobody ever asked him about his experience with products or services. He felt excluded from those kinds of conversations, he said — a dynamic that harm reduction organizations like his and Tapestry have worked to change.
The failure to listen to those who use drugs can result in dire consequences, Whynott and Visnich said. When Visnich had his overdose reversed with far too much naloxone, he said he immediately tried to get high again, putting him at risk of another overdose. And in the months afterwards, his behavior changed in another dangerous way: he said he used heroin alone much more frequently because he was scared of having a similar experience.
“It probably wouldn’t hurt to have it”
When Deanna Strout, Dalton’s police chief, heard about Indivior’s offer to give local police departments free samples of Opvee, fear also seemed to be on her mind.
“It probably wouldn't hurt to have it, especially if one of our officers get exposed,” she wrote to her executive assistant in an email.
For years, headlines across the nation have told cautionary tales of first responders overdosing after incidental exposure to fentanyl during traffic stops. But toxicologists say that risk is extremely low and largely a myth that has spread among law enforcement and the media.
But in a phone interview, Strout described fentanyl exposure as “a really, really dangerous experience.” She said she wants to keep first responders and civilians alike safe from danger and that having Opvee on hand, in addition to naloxone, is part of her strategy for doing so.
“The DPH and these people, they're not in the field,” she said. “They don't respond like we do. They have very controlled clinical environments. We don't have that luxury. So I appreciate their opinion. My job and our job is to save people's lives and that's our priority. We don't have the luxury of a nice, neat office space or a hospital setting.”
Whynott said while she empathizes with people’s fear of overdoses, she prefers more funding and distribution of already proven and less expensive interventions like naloxone. She also supports the creation of “overdose prevention centers” — places where people can use drugs in a monitored setting that also provides them health care and other resources. Polling has shown the proposal is popular statewide.
At the end of 2024, the Massachusetts Legislature passed a sweeping substance-use bill that, among other provisions, will increase access to overdose reversal agents by requiring insurers to cover them without prior authorization or cost sharing. However, lawmakers ultimately cut from that bill a provision that would have allowed communities to open overdose prevention centers.
“Lagging expectations”
Dalton is not the only police department to which Indivior has marketed Opvee. According to SEC filings by Indivior, the company has looked for its initial customers among first responders, municipalities and their health departments, community groups like schools and substance-abuse centers, emergency departments, federal agencies, and jails and prisons.
Indivior previously told investors it hopes Opvee will generate as much as $250 million in annual sales. In July, though, a company SEC filing suggested that adoption of the product among target customers was “lagging expectations.”
Nevertheless, other companies are still entering the market for nalmefene products. In August, the federal government approved an auto-injector created by Purdue Pharma — the same company whose marketing of OxyContin played a key role in fueling the opioid crisis to begin with.
And other law enforcement agencies in western Massachusetts have expressed interest in Opvee after Indivior’s pitches.
Hampden County Sheriff Nicholas Cocchi — who was sent the sheriff’s association email about Opvee — said in a statement that he “would consider using” Opvee because of its “reported effectiveness.” That’s despite the fact that Cocchi’s director of nursing raised concerns about the drug in several memos obtained in a public records request.
But despite the interest, there’s no indication that Opvee will become widespread in Massachusetts. As of late January, Strout said that although her officers are carrying Opvee, they hadn’t yet used it. And Indivior’s emails from last spring said only a few other police departments had responded to the company’s pitch, including Hampden and Pelham. Pelham’s police chief said he couldn’t confirm that. Hampden’s police chief did not respond to requests for comment.
