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As opioid epidemic rages, an overdose antidote is in short supply

Pfizer says manufacturing issue led to problems producing injectable Narcan

Injectable naloxone, which is used to reverse opioid overdoses, is in short supply in Rhode Island because of a manufacturing issue at Pfizer.Travis Dove/NYT

PROVIDENCE — Rhode Island is facing a shortage of lifesaving overdose reversal treatments, even as the opioid epidemic continues to surge.

The issue is with naloxone, a treatment that quickly reverses opioid overdoses and saves lives. Outreach organizations in Rhode Island have been able to get it in injectable form through a national consortium called the Opioid Safety and Supply Network Buyer’s Club, which in turn has a deal with pharmaceutical giant Pfizer.

But Pfizer said in a statement the company has run into production issues with this particular type of naloxone and doesn’t expect to ship any more of it until the fall. It will still take some time to ramp back up, and the company may not be back to uninterrupted levels until February 2022.


The supply issues are already showing up in very real ways: Last year, a program through the Miriam Hospital in Providence called Preventing Overdose and Naloxone Intervention distributed 11,000 naloxone doses in injectable form for people to have on hand in case of an overdose. This year they’ve distributed 8,000 — but they are now depleted and likely won’t have more access through the buyer’s club.

“This puts everybody in a really difficult situation,” said Michelle McKenzie, director of the Miriam program.

The shortage is playing out nationally: According to an article in Filter magazine, the buyer’s club represents 108 organizations in 39 states, distributing 1.3 million doses of naloxone in 2020. The article described the shortage as the worst since 2012. Overdoses have surged in the years since.

Pfizer acknowledged in a statement that its single-dose vial format of naloxone is temporarily out because of a manufacturing issue it’s already addressed. The company has been in communication with the US Food and Drug Administration about it, Pfizer said. The supply issues have nothing to do with its work on COVID-19 vaccines, according to Pfizer.


Pfizer isn’t the only company that makes this treatment, even in this particular single-vial format, but it was the main avenue for organizations working through the buyer’s club. The program through the Miriam is one of those organizations. The Miriam’s program is not the only one in the state that distributes naloxone, but it was at one point the biggest supplier here.

To get the treatment at retail would cost significantly more than the deal the hospital had with Pfizer, McKenzie said. And naloxone in spray form — easier to use, especially for people who don’t have experience injecting drugs — is even more expensive. The Miriam program has a “shoestring” budget and can’t afford these higher prices, McKenzie said.

The state Department of Health and Department of Behavioral Healthcare, Developmental Disabilities and Hospitals also work to get naloxone. BHDDH just got 2,374 kits of Narcan spray, three times what the department usually buys a month, according to spokesman Randal Edgar.

“BHDDH, RIDOH, and our partners inside and outside state government are working on solutions to ensure robust naloxone access at the community level,” Edgar said. “As always, BHDDH encourages people to obtain kits at CVS and Walgreens, where Medicaid insurance covers the kits in full and other insurers may cover a portion of the cost.”

The need, though, has never been greater. Last year, 384 people died of accidental drug overdoses in Rhode Island, the most on record. That came after years of decline. Overdoses are high again this year. This January and February, the only two months so far with full data, had more fatal overdoses than last January and February. This January, 34 people died of accidental drug overdoses, compared to 30 last January. This February, 38 people died of accidental drug overdoses, compared to 33 last February.


Rhode Island has done “amazing things” to address drug overdoses, but one thing it hasn’t done is build dedicated funding for naloxone, McKenzie said.

“Year after year we’ve relied on whatever becomes available,” McKenzie said. “We need a very reliable source of funding so we don’t run into this issue.”

Already, outreach workers say they’re feeling the pinch. Project Weber/RENEW, a harm reduction organization, is rationing its supply of naloxone.

“With supplies being reduced we will undoubtedly see people dying preventable deaths, and this is unconscionable,” the group’s executive director, Colleen Daley Ndoye, said in an e-mail.

Ashley Perry, who manages the group’s Pawtucket program, called it a “double emergency: the pandemic that everyone knows about, and the epidemic not enough people know about.”

“As both an addict and a person who works with addicts everyday this national shortage on Narcan is just another slap in the face that says our lives are not worth it,” she said in a written statement. “How many of us have to die to be worth it?”

Brian Amaral can be reached at Follow him @bamaral44.