In 2020, the number of fatal opioid overdoses increased 30% over 2019, leaving 93,000 people dead. These people could have been saved, if naloxone (known by the brand name Narcan) was on hand and used alongside proper first aid methods.
What is naloxone? Naloxone is an antagonist at the mu-opioid, delta-opioid and kappa-opioid receptors in the brain. When it’s used on a person under the influence of an opioid, it immediately forces the opioids out of the receptors, jolting the overdosing person awake. Despite being awoken by naloxone, they still must be taken to the emergency room, where they will undergo a naloxone drip until it’s safe for them to leave.
Unfortunately, many of these patients end up overdosing again, requiring naloxone again.
But naloxone, despite the fact that it is an extremely important medication, is facing a critical shortage at a time where thousands of people are dying. Pfizer, one of the makers of naloxone, reports that its supply of the medication is depleted. Pfizer sold it at a discounted price to the Opioid Safety and Naloxone Network, who then provided various community-based harm reduction organizations injectable naloxone to people who needed it.
While this shortage does not extend to the nasal spray form — yet — it highlights that people living in addiction need this medicine. This shortage — along with shortages of other addiction-control drugs, methadone and buprenorphine (Suboxone, Subutex, Sublocade, Zubsolv) — have hit critical levels due to COVID. Drug manufacturers turned their attention toward the profits to be made off the epidemic, devoting fewer resources to the opioid epidemic Big Pharma helped create.
Some organizations that give away naloxone have had to hold back on distribution due to a depleted supply. This, while understandable, causes addicts to die while waiting for Pfizer to replenish its stock, which it has raised the price of. Emergent Biosolutions — makers of the name brand Narcan 4-milligram nasal spray — has emerged richer. So has the maker of Evzio — a name brand auto-injectable form of naloxone, Kaleo.
Organizations and individuals that work in the field of harm reduction have had to turn to these companies and either Narcan or Evzio, rather than Pfizer and its comparatively less-expensive generic injectable form of the drug. Emergent Biosolutions and Kaleo stand to make higher profits.
Hikma Pharmaceuticals stands to criminally benefit from the naloxone shortage and the opioid epidemic. They’ve formulated and patented Kloxxado, a new 8-milligram nasal spray, that may or may not even be necessary and that will definitely be harmful. What makes the higher dosage Kloxxado so dangerous is that it — like Narcan and the generic naloxone but at double the strength of Narcan — causes the person being revived to have unstoppable withdrawal-like symptoms. Nausea, vomiting, shaking, sweats and cramps — the works. No matter what they do, even if they use an opiate again, they cannot undo this experience.
Emergent Biosolutions, Kaleo and Hikma Pharmaceuticals are making money in the void that Pfizer left behind. And while Pfizer itself benefitted from the overdose epidemic; at the very least, the supply of its generic injectable naloxone could be managed better. The effects of withdrawal-like symptoms could be lessened with control over how much a person is given. It could be more affordable. With the notable exception of carfentanil, most overdoses only need a single vial or sprayer in order to revive an overdosing person.
It’s very difficult to fight the shortage caused by Pfizer or the companies stepping into Pfizer’s void, but we can be aware of it and act accordingly. Learn how to administer naloxone, stock up on it and carry it on you at all times. We need to be prepared for a year that follows one with the highest number of overdoses.