Why I Traveled to Stanford and MIT With Naloxone In My Pocket.

Founder of Fiduscript (and Naloxone Exchange), James Lott presenting at the Stanford Graduate School of Business, Black Business Conference. Stanford, California. April, 2018.

I literally couldn’t shake my nerves. “I’m at Stanford! How the hell did I get here?” I thought. The nerves came from the high social status tied with everything Stanford, along with a crowd of investors, business people, and the university community. I was representing my company, Fiduscript a startup that provides life-saving resources to substance users online. Fiduscript was among only 3 other companies invited from more than 30 that applied nationwide for the Stanford Graduate School of Business, Black Business Conference. Even more surprising, two weeks prior I was presenting in Boston at Massachusetts Institute of Technology (MIT) Hacking Medicine conference.

I guess I should actually address how I got here. I am currently a graduate student, studying public policy in Chicago, but was born and raised in Louisiana. Louisiana is a state that is quite simply, lovely and unique. We are lively, fun, and community oriented people, but we need several more resources. I attended public school throughout grade school n the capital of the state, Baton Rouge. I remember a time where my high school begged many of us to go to college, even if the end goal was to secure a two-year associates degree. Also, I experienced that whole single immigrant mom thing that you sometimes hear about in these stories about challenges. This is why it is surprising at least to me, and against all odds, that I had the opportunity to present my startup at such prestigious institutions.

I became a pharmacist and immediately was assigned to work in a small community in Washington State that had the most lovely people, but for better or worse had a “pill mill” culture. We dispensed thousands of opioids to folks in this town. From the start, I knew it wasn’t right. So many patients received these medications that you not only became numb to dispensing them, but sometimes, and even more scarily, you hardly questioned why. While it was potentially a dangerous scenario, it was the doctors’ order. I remember at times receiving shipments from our drug distributors which contained about seventy-five 100-count bottles of different opioids that took me hours to put away, at least two to three times weekly.

I often thought about why so many people were using these drugs. It’s complicated for sure; I learned this lesson about the complexity of pain management in pharmacy school, and from really getting to know my patients. Some patients had cancer, others spinal reconstruction, and so on. However, not all patients are good candidates for these large amounts of opioids (or other controlled substances), each month. The last straw before I could not fill another prescription without seriously questioning the treatment was an experience I had with a patient.

Pharmacists and doctors have a tool called the PMP, or Prescription Monitoring Program. Essentially when you visit your doctor’s office or pharmacy and are prescribed a prescription for a controlled substance (e.g. Oxycodone, Adderall, or Xanax), the doctor or pharmacist should log in to the PMP to assure that their patient is responsibly utilizing their drugs. It is a great tool to use as a healthcare professional, but at the time when I was a practicing pharmacist the PMP system was inconsistent, inconvenient, and definitely needed an update. However, I still saw great benefit and promise in this young technology because I was able to make interventions that I would not have the opportunity to make otherwise.

A well-groomed, twenty-something came to my pharmacy seeming to have just finished a day at her corporate job during 5 o’clock rush hour. The crisis was not coined yet, but I had a remarkable experience with this patient. My team was trained to run a PMP on all patients, but the system was down. This was the typical annoyance. I was forced to give her the prescriptions for the antibiotic and opioid she received from her dentist without doing any due diligence. However, something instinctually told me that I should follow-up. I trusted my senses and 2 hours later when the system decided to correct itself, I was dumbfounded by what I had found. This young, corporate American had received 50 prescriptions from 35 healthcare providers in the last 3 months, all for opioids.

I’d never seen such blatant abuse of the health care system and wondered how many other doctors and pharmacist saw what I did in the PMP, and what actions they potentially tried to take. To make a long story, shorter, I contacted the patient to confront her about her poor and dangerous choices and asked her to stop. One week later, I monitored the PMP further, and she continued the business, as usual, visiting three more pharmacies. I contacted the Drug Enforcement Administration, the regulatory agency that enforces controlled substance laws and they conducted an investigation in which I fully cooperated. My experience with this patient essentially transformed me into an opioid epidemic activist.

Within one year of the incidence, Fiduscript was born. Starting a company went against everything I ever knew, hoped, or thought I wanted to do, but it felt right. I initially began by attempting to create a reliable, more user-friendly PMP system. After almost 18 months of red tape, and consistent failure I decided to pivot. During that (at least to me) short course of 18 months, the opioid epidemic was in full swing — daily news reporting, daily news headlines. What I believe terrified people the most, was the number of deaths this public health crisis caused. Also, daily horror stories associated with these drugs; addicted mothers and opioid babies, siblings dying within the same day in different parts of towns. America has always had an obsession via media with this stuff, and I’m not sure why. This is a two-sided crisis, prescription opioids, and illicit opioids (i.e. heroin, fentanyl) which makes it even more complex. My hope is that the fear-mongering that the media has caused both positive and negative responses to is actually working towards better outcomes in the future.

For our part, I believe our company, Fiduscript is at the forefront of innovation in terms of sustainable and scalable solutions that may help correct the opioid epidemic. In January 2018, the pivot we made was to expand access to Naloxone online. Naloxone is a life-saving medication that can quickly reverse the effects of an opioid overdose. Our pivot got us accepted into the University of Chicago Booth School of Business Social New Venture Challenge (SNVC).

This is the #1 ranked business school in America, with the #1 ranked university business competition, so we felt very honored to be a semi-finalist. We felt especially validated by our mission from an unanticipated source. In April, 2018, the United States Surgeon General Dr. Jerome Adams made a huge announcement. Dr. Adams issued the first public advisory warning since 2005, to the general public, asking that high-risk users of opioids and their loved ones have access to Naloxone at all times.

Progressive legislation has allowed Naloxone to be easier to access via (most, but not all) pharmacies, however, this isn’t always the case. Stigma, especially in non-urban communities continues to be a major barrier to accessing this and other life-saving resources. This is where Naloxone Exchange (www.naloxoneexchange.com), by Fiduscript comes into play. Naloxone Exchange by Fiduscript is an online marketplace that allows anyone, anywhere to access naloxone without a prescription. By entering basic prescription information, a patient (or loved one) is prompted to watch a training video prior to completing the transaction. The purchase is then executed by our partner pharmacy within the state, and naloxone is then delivered directly to any consumers home or address.

We feel that innovation that removes barriers to accessing life-saving services is necessary to save lives. We will continue to innovate and execute in our social venture. Thinking differently about this problem has so far been our key to success.

This venture has been extremely challenging. There are so many barriers to providing thoughtful, and sustainable solutions in healthcare, and I find that very unfortunate. Regardless of the challenges, I’m dedicated to working through each of them as they come, and inspired by the hundreds of text and emails I’ve received giving me stronger ideas, and offering me inspiration to try to save lives.