A nationwide shortage of the anti-overdose drug naloxone has put pressure on Maine providers struggling with the continuing rise in opioid overdoses and deaths during the COVID-19 pandemic.

Also known by the brand name Narcan, naloxone can reverse overdoses by blocking opioid receptors. The pandemic has caused disruption to pharmaceutical supply chains and overloaded drug production capacity, creating what some experts say is a “perfect storm” that could leave users and health providers unprepared to respond to overdoses even as they are on the rise nationwide.

U.S. overdose deaths reached a record 93,000 in 2020, a 29 percent increase over the 72,000 in 2019, which was the previous high.

In Maine, there were 310 fatal overdoses from January to June, a 21 percent increase over the same period in 2020, according to the Margaret Chase Smith Policy Center. In June, there were 60 suspected or confirmed fatal overdoses in the state, the most for any month this year, the center said.

And there were at least 3,759 non-fatal overdoses from January to June, the center said, and 815 in June alone. Those were reported by hospital emergency rooms and emergency medical responders. In many cases, naloxone was used to reverse the overdoses and save lives, the June report said.

Naloxone can be injected or administered through a nasal spray. The shortage of naloxone is most pronounced in the drug’s injectable form.

Pfizer, which manufactures naloxone, said a production issue forced it to stop making single-dose injectable versions of the drug in April, the Washington Post reported.

The company said it may not be until February that it can ramp production back up to meet demand. Pfizer sells the drug at a discount to a national buyers’ club made up of harm prevention programs, the Post said, and some have been seeking donations to buy naloxone at market prices to make up the shortfall.

Nasal Narcan is most popular among the public – primarily family members of drug users or people in community groups that respond to overdoses – because of the ease of use, said Zoe Brokos, director of operations for the Church of Safe Injections. However, she prefers to use injected naloxone because the dose can be controlled better, leading to fewer side effects in recovery.

Health Equity Alliance, a Maine nonprofit that serves people battling addictions and HIV/AIDS, has had to tell clients that its supplies of naloxone are limited, an official with the group said.

“We at certain times have had to set limits as to how many doses of naloxone we can give out to people at a time, which is really tough, because we want to be giving people what they need,” Jill Henderson said.

Part of HEAL’s strategy to deal with the shortage, Henderson said, is to work on the other side of the coin: preventing overdoses. HEAL workers encourage people who use drugs to also use fentanyl test strips that can warn them if a substance they’re about to consume contains the dangerously powerful opioid.

“Knowing if there is fentanyl in their supply before they choose to partake in that is really huge in preventing overdoses,” Henderson said. “So that’s kind of the flip side to it, which is knowing beforehand.”

Experts in Maine and around the nation cite the pandemic’s isolation and disruption to social and work lives as major contributors to the increase in substance use and overdoses.

“COVID has rippled through every part of society, (and) all of the factors that increase usage of drugs, substances are in play with COVID,” Henderson said. “Whether it’s people’s work life, social life, isolation, mental health, all these things COVID has exacerbated and made worse for the most marginalized and vulnerable communities.”

Brokos, with the Church of Safe Injection, said her organization had to cut back on public outreach programs during the pandemic, unintentionally preserving its supply of naloxone. The substance has a long shelf life, she said, so the supply is safe as the group ramps up distribution efforts.

“It ended up feeling like a blessing in disguise,” she said, because the organization now has ample supplies of both nasal and injected naloxone. Brokos said she hasn’t had to reorder yet but recently spoke to her distributor, who didn’t indicate that they would have to wait for an order to be filled when they do try to get resupplied.

“We have an adequate supply,” Brokos said. The group plans to give out naloxone at the end of the month in Bangor at an event marking International Overdose Awareness Day.

Staff Writers Diego Lasarte and Edward Murphy contributed to this article.

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