In September, some major pharmacies in the US began stocking over-the-counter naloxone, a nasal spray that reverses opioid overdoses sold under several brand names, including Narcan and RiVive. Although naloxone is now more accessible than ever, the story of how it moved from its original use in operating rooms in the 1960s to a spray that can be administered in the home remains largely unknown to the public.
In the ’60s, hospital staff members used the newly discovered drug to alleviate side effects of opioid use, and in the ’70s they began giving it to patients after surgery to reverse opioid-involved anesthesia. But the drug was never used outside hospitals until the US’s first all-Black paramedics team, the Freedom House Ambulance Service in Pittsburgh, developed and published protocols for using naloxone in the field.
Harini Bhat spoke with John Moon, a former Freedom House paramedic who eventually became assistant director of the Pittsburgh Bureau of Emergency Medical Services, about his firsthand experience administering naloxone starting in 1972. Moon told C&EN about the health-care landscape before doctors recognized naloxone’s value in the field and about the paramedics who pioneered its use there to save patient lives. This interview was edited for length and clarity.
▸ Hometown: “Pittsburgh. However, I was born in Atlanta.”
▸ Most recent position: Retired as the assistant chief of Pittsburgh Emergency Medical Services in 2009.
▸ Education: Paramedic training, Freedom House Ambulance Service, 1971; master of public administration, Point Park University, 2016
▸ Professional highlights: Working at Freedom House. “I owe that organization a very deep debt of gratitude. I consider myself on this mission of spreading the history of Freedom House as a way to try and repay that debt.”
▸ Toughest problem you had to solve: Acceptance by the medical community while working at Freedom House. “During my first intubation in a hospital, everything stopped, total silence, with everyone looking at me. And the reason they were looking is because anytime someone who looked like me [a Black man] came through that door, they had a mop or a bucket.”
▸ Best professional advice you received: After I was laughed at by an emergency room nurse, Freedom House medical director Nancy Caroline told me, “If you don’t learn to speak the language of the emergency room, no one will ever listen to you.”
▸ Where do you hope the paramedics profession will be in 20 years? I hope they’re still around! Unfortunately there’s a shortage of paramedics, and on top of that there is a very serious diversity issue in the emergency medical services community.
▸ Hobbies: I love to garden. But when I can’t get outside, I have a very costly hobby, which is collecting DVDs. I have probably about five or six hundred.
▸ If your life were a movie, who would you cast to play you? A combination of Denzel Washington, Morgan Freeman, and Samuel L. Jackson. If you can find somebody to roll all of them into one person.
What did Narcan look like back in the mid ’70s when you first administered it on the streets?
Definitely no Narcan nasal spray back then! We titrated naloxone into an IV bag of D5 [5% dextrose solution] and water and administered it that way. It was used for years in the operating room and the emergency room until Peter Safar, the founder of Freedom House Ambulance Service, put naloxone in our ambulance med kits to reverse opioid overdoses on the streets.
The general rule was to get the patient to the emergency room as fast as you possibly could. Basically that determined whether they lived or died. But, by redesigning the ambulances themselves and fully stocking them with medical equipment and medications, we made them hospitals on wheels. So that overall focus to bring naloxone to the patient—as opposed to the patient coming to the drug itself—was an extension of practices we had already been implementing.
I look at what we did back then and try to compare it to today with the OTC nasal spray formulation. We could control the naloxone dose through titration, which kept you in a relaxed state until we got you to a more controlled environment—the emergency room—unlike using a fixed-dose nasal spray, which can result in a more abrupt overdose reversal and withdrawal symptoms. That’s why it’s always important to call 911 and seek professional medical help after giving someone naloxone nasal spray. The spray is a short-term solution to a problem, and it’s greatly needed, but it does not replace in-hospital treatment.
When did you get a sense that naloxone was a tool that was needed in the field?
When we first began implementing naloxone in the early ’70s in the Black communities of Pittsburgh, the rates of overdoses actually decreased there and increased in White neighborhoods. That’s when we knew this worked and began rolling it out across the country.
How hard was it for paramedics and regular citizens to get naloxone in the ’60s and ’70s, and how did that change over time?
We were actually the only ones using it. No one else even conceived to take naloxone from one location to the next. We had to actually prove that the different procedures and techniques that you were using could be administered by a person that’s not trained to the level of a physician.
It wasn’t until Freedom House began writing the training manual for paramedics that paramedics began using naloxone across the country. [The manual was published in 1977.]
When the training program was implemented nationwide, administering naloxone became a standard practice among paramedics.
How do you feel about the new OTC designation?
I’ve seen the change primarily as an improvement. I think it’s a very good idea to make it readily available to ordinary citizens.
Years ago, I was part of an organization called Prevention Point Pittsburgh that was a needle distribution site. In a perfect world [syringe service programs] would be something you would frown upon, but you have to look at the purpose behind it: to try to combat hepatitis or another AIDS epidemic.
Naloxone basically is the same way. You’re trying to combat a problem that is going to occur, regardless of whether naloxone is used or not. There will always be this risk as long as you have illicit drugs. In that regard, it’s a very good practice to make naloxone readily available to your ordinary citizen.
What final words would you like to leave the readers with?
One of the things that we have to try to impress upon the general public is that a person who has recently received naloxone should still seek medical treatment. Naloxone has a short half-life inside the body, and the individual could unfortunately fall back into the overdose state.
Also, Narcan’s availability at the drugstore is a remarkable progression, but I want people to realize that Freedom House used naloxone to treat overdoses back in 1972. We were a group of Black men, part of a revolution to change the outlook on medical care in the community, much of which we take for granted today. It is not about John Moon so much as it is about the individuals that worked there and the organization itself. I’m just a vehicle that’s being utilized to get that point out there.
Harini Bhat is a freelance science writer and digital creator based in San Diego who covers topics at the intersection of science and culture.
A version of this story first appeared in ACS Central Science: cenm.ag/naloxonehistory.
Recovery from addiction is possible. For help in the US, please call the free and confidential treatment referral hotline (1-800-662-HELP) or visit findtreatment.gov. Visit the National Harm Reduction Coalition website to find naloxone and other harm reduction resources near you. If you are in another country, call your local emergency hotline. You can find a directory of other helplines for addiction at helpguide.org.