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As Overdose Rates Climb, Community Groups Face Naloxone Shortage
With overdoses soaring across the United States, groups that distribute the opioid overdose-reversal medication naloxone say they are struggling to maintain an adequate supply, and Pfizer, which offers the medication at a discount to a national buyers club of harm reduction programs, said it could take until February for it to catch up to demand, according to a recent report by the Washington Post.
Pfizer’s production of single-dose injectable naloxone was paused in April because of a manufacturing issue. The company told the Post that the issue was unrelated to production of its COVID-19 vaccine, but did not offer any additional details.
The Opioid Safety and Naloxone Network Buyers Club, a national consortium of more than 100 harm reduction programs, accounted for 1.3 million doses of naloxone in 2020 and was on pace for 1.5 million doses of the overdose-reversal medication for 2021 prior to the Pfizer shortage. Maya Doe-Simkins, one of the buyers club’s organizers, tells Addiction Professional that the club is currently facing a 250,000-dose backorder that could result in up to 12,000 to 18,000 opioid overdose deaths, based on the club’s calculations.
“Naloxone is an essential tool to address this overdose crisis and we need it in as many hands as possible to make sure it’s available when it’s most needed,” Sheila Vakharia, PhD, LMSW, deputy director of the Drug Policy Alliance’s Department of Research and Academic Engagement, said in an email to Addiction Professional.
“Unfortunately, while access has grown across the country in recent years, we know barriers remain in various parts of the country due to limited availability, expense, and other reasons. Taken together, the current naloxone shortage couldn’t be happening at a worse time, and it is likely that we lose many more people before the supply chain is fully resumed.”
Vakharia noted that while shortage impacts only injectable naloxone, and not Narcan nasal spray, many people prefer the injectable formulation because the dose can be titrated, which helps individuals avoid going into more severe withdrawal. Doe-Simkins adds that the nasal spray formulation is also significantly more costly than generic injectables.
Some community programs that acquire naloxone through the buyers club have taken to accepting donations to buy naloxone at market price or from locations where the drug is in lesser demand. The scarcity has put some programs in the difficult position of determining locations where they will stop stocking naloxone.
“Who do you stop supplying? Who do you stop prioritizing? Who do you stop making sure has naloxone?” Utah Naloxone founder and medical director Jennifer Plumb said to the Post.
Doe-Simkins says one issue is that a significant amount of government funding for naloxone distribution, which in itself was a non-starter until 2017, has gone toward “ancillary groups and venues,” such as libraries, police and social workers, leaving the buyers club’s members, which deal more directly with more vulnerable individuals who are actively using drugs, scrambling for funding.
“Federal and state funding entities need to absolutely revisit the ways populations are getting prioritized in the context of any type of scarcity whatsoever, be it funding or product,” she says. “The only way to follow the evidence base is to ensure we have sufficient [supplies] for people who use drugs, and then move on to friends, families and loved ones, and then summoned responders, such as police and non-EMS fire. That’s the only way to follow the evidence base and expect an overdose reduction the way evidence shows it’s possible. State, federal and, frankly, philanthropic funding entities need to reprioritize.”
Last month, the National Alliance of State & Territorial AIDS Directors’ Drug User Health Team, in collaboration with harm reduction consultants, produced a recommendations and strategies document on how federal partners and health departments can support syringe service programs and harm reduction partners experiencing naloxone supply disruptions. That document is available for download on the NASTAD website.
