Naloxone ‘shortage’ made in Manitoba mistake

Opinion

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This article was published 09/06/2023 (822 days ago), so information in it may no longer be current.

Is it a supply shortage or a supply mismanagement issue?

Winnipeg Centre MP Leah Gazan sounded the alarm this week about a dangerous local shortage of naloxone kits, used to revive opioid overdose victims. Joined by the families that have lost loved ones to overdose, Gazan pleaded with Manitoba to ramp up its supply of the life-saving kits.

In response, a provincial government spokesperson said there was not a shortage of naloxone, per se; the medication is available, but the pre-dosed kits distributed to the public or to community groups have run short.

The shortage was caused by a “supply issue resulting in a delay on the shipping of some orders.”

The spokesperson said the province is scrambling to acquire more kits, which are expected to arrive next week.

This is no small concern. North America continues to suffer through a severe opioid crisis that is claiming hundreds of thousands of people every year.

In Winnipeg, drug overdoses — many of them related to opioids — have reached epidemic proportions.

Research consistently shows opioids — drugs such as morphine, heroin, codeine, oxycodone, hydrocodone and fentanyl — claim lives across the socio-economic spectrum, with many people dying in their homes and not alone on the street.

When abused or when they are cut with more dangerous drugs, opioids lead to severe drowsiness, confusion, nausea and diminished respiratory function that can lead to cardiac arrest.

While there are no perfect solutions, naloxone has been proven to be effective in reviving overdose victims once they have stopped breathing.

However, is a supply issue really at the heart of the shortage?

Notwithstanding the lingering global supply chain problems that started during the COVID-19 pandemic, Manitoba appears to be among the only jurisdictions in North America experiencing a shortage of naloxone kits.

Currently, no other city of similar or larger size in Canada has reported a shortage of naloxone, either as an injectible medication or administered via nasal spray. In fact, when community agencies in Manitoba started to run short of kits, they were able to get emergency supplies from agencies in Ontario and British Columbia.

Further complicating the province’s claim is the fact the City of Winnipeg is not currently reporting a shortage of naloxone, which is used by the Winnipeg Fire Paramedic Service and trained staff at civic facilities (such as libraries).

The true irony is a city official confirmed Winnipeg gets its supplies of naloxone from Shared Health and the Winnipeg Regional Health Authority — both provincial agencies. The city official confirmed, “We have never had a shortage of naloxone.”

When you start to add up all of the circumstantial evidence, the province’s claim some vaguely defined “supply issue” has caused the shortage begins to look very tenuous.

If it wasn’t the supply chain, then what?

Opioids present an extremely fluid public health challenge.

Different types, formulations and combinations of drugs can produce dramatically different outcomes. Illegally manufactured variations of fentanyl, in particular, are extremely volatile; some formulations used to cut other more traditional opioids are deadly even if an overdose victim receives naloxone.

As the global opioid crisis worsened through the COVID-19 years, there were times when naloxone was in short supply. However, in the last year, it seems governments, public health agencies and community partners have become better at anticipating demand and, thus, managing supply.

It is that last point — anticipating demand — where Manitoba may have failed.

The community groups that raised the shortage alarm this week said they are being forced to administer as many as seven doses of naloxone to revive overdose victims. The need to administer greater amounts, combined with an increase in opioid potency and a rise in the total number of people abusing opioids, all add up to a problem growing in size and scope.

The big question is whether the provincial government decided to hold off on ordering more to keep down overall costs.

A government spokesman said the province is acquiring and distributing more kits: 2,000 last week, with another 9,000 coming in the next week or so. However, the PC government refused to say how much it was spending on kits, nor the cost per unit.

The refusal to provide these numbers is no coincidence; without them, it’s impossible to tell whether the Tories have underfunded the naloxone program.

It’s also worth noting this government has a limited appetite for harm reduction, having rejected supervised consumption as one of an array of services for those suffering from addiction.

The awful truth for the Tories is when you have a spotty record on harm reduction, it’s going to be hard to convince people the “shortage” of naloxone kits was someone else’s fault.

dan.lett@winnipegfreepress.com