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Nationwide naloxone shortage means higher costs in Michigan

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A nationwide shortage of naloxone is impacting the ability of community organizations and medical facilities to provide overdose prevention services to opioid users. It's caused concern in Michigan, where deaths due to opioid overdoses went up in 2020 as compared to the previous year.

Naloxone—also known by its brand name, Narcan—is the drug used to reverse the effects of opioid overdoses. This is most commonly done by injecting the medication directly into the muscle (also known as intramuscular naloxone). There are other ways of administering naloxone, such as a nasal spray (intranasal).

Red Project in Grand Rapids serves eight counties in West Michigan: Kent, Muskegon, Ottawa, Allegan, Lake, Mason, Oceana, and Newaygo. It's one of the groups impacted by the shortage, as it provides naloxone to the region, as well as safe syringe access services. In addition, Red Project also provides free HIV testing and HIV case management, among other services.

Steve Alsum is Red Project's executive director. He said the shortage we're experiencing is specifically of generic intramuscular naloxone.

"Recently, there’s been a number of new devices for administering naloxone that are FDA approved. As a result, companies still have patents on those new devices, so it’s extremely costly," he said. Among those are the nasal spray, which is not available in its generic form, making it significantly more expensive than the injectable.

This cost barrier also comes at a risk to smaller, grassroots organizations that provide overdose prevention services, Alsum said.

"It's really the only form of naloxone that's viable for a lot of grassroots organizations to provide access to," he said. "A lot of grassroots organizations are also the folks who have the best relationships with people who use drugs in the community, and so have the greatest ability to provide this medication to the people who need it."

Amy Dolinky is a senior opioids strategist for the Michigan Department of Health and Human Services. She agreed with Alsum, saying that the smaller organizations that are often the folks administering naloxone to community members will be the most impacted.

"It tends to be cheaper than the nasal spray and specifically with harm reduction organizations, the folks that are engaging in those services may have more comfort with that type of administration, whereas the general public would be more comfortable with that nasal spray," she said. "So we've seen some of those organizations who typically don't have extremely sustainable funding streams go with that intramuscular option."

The MDHHS has a portal where organizations can request naloxone for distribution in their communities. It doesn't distribute the intramuscular naloxone, just the nasal spray. She said those grassroots organizations can and should go through the state to get the intranasal naloxone, but says that if the shortage isn't remedied soon, it won't be enough for those organizations.

"There are so many people engaged in this work, some extremely small organizations to much larger ones, and they really are the front line able to meet individuals where they're at," she said.

Dolinky said the shortage of injectable naloxone is cause for concern among people who do harm reduction and work with people who use drugs, but it's certainly not the only source of uncertainty.

"I think there's always a concern around, 'can we continue providing the needed services to any community?' Which isn't just necessarily associated with the medication. Everything is contingent on funding. And most of these spaces and a lot of the work in the substance use and behavioral health field is grant-funded," she said.

Alsum said that 13,000 of the 20,000 doses they've distributed over the past six months have been intramuscular, and 7,000 have been intranasal. He also said the number of doses they've distributed in 2021 is the same number that they distributed in the entire calendar year of 2020. That, he said, is a good sign.

"I think it says a number of things, you know, for one, we're doing a better job each year of getting naloxone out into the community. We're also reaching more of the need in our communities," he said. "Even with our mortality rate being lower herein Kent County than it is elsewhere in the state, there's still way too many people dying every year of this preventable cause of death."

Both Dolinky and Alsum said naloxone is just one part of treating opioid addiction in Michigan. They said we have to treat addiction like a public health issue, and examine systemic factors like quality of life.

"Naloxone distribution is super important and it's literally life saving for thousands of people here in the state of Michigan. There's thousands of people who are alive just because of Red Project's program and all the other programs that exist in the state that provide access to naloxone. But, you know, in order to really have an impact on overdoses and opioid use, we've got to start thinking about some of those more system-wide interventions," Alsum said.

Caroline is a third year history major at the University of Michigan. She also works at The Michigan Daily, where she has been a copy editor and an opinion columnist. When she’s not at work, you can find her down at Argo Pond as a coxswain for the Michigan men’s rowing team. Caroline loves swimming, going for walks, being outdoors, cooking, trivia, and spending time with her two-year-old cat, Pepper.
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