Naltrexone shortages impact the United States according to social media users unable to fill their prescriptions. As of one month ago users on Reddit and other social media platforms, such as X (formerly Twitter), report being unable to fill their naltrexone prescriptions. Some individuals cite supply chain issues as their primary concern. As of March 12, 2024 pharmacies across the United States report naltrexone shortages. These prevent patients from filling prescriptions at CVS, Walgreens, regional grocery store pharmacies, some local pharmacies, and mail-order pharmacies.

Supply Chain Issues

Temad, Sanofi, LGM Pharma, Pluviaendo, Euroapi, Jai Radhe Sales, Noramco, Veranova, Aspen API, Deccan Neutraceuticals, Midas Pharma, Siegfried AG, Sun Pharmaceuticals Industries Limited, and Mallinckrodt Pharmaceuticals manufacture naltrexone for the United States markets. Production of naltrexone requires a precursor compound, thebaine. Thebaine is used in the manufacturing of a large number of opioid-related products including naloxone – the life-saving overdose intervention drug.

Thebaine is derived from poppy straw (Papaver bracteatum) produced primarily in Australia, Spain, and France. By 2017 the total production of thebaine dropped to approximately 2 metric tonnes, down from 146 metric tonnes in 2012. In 2022, the Food Standards Australia New Zealand issued national recalls of poppy seed products due to unusually high concentrations of thebaine resulting in the hospitalization of individuals consuming the raw seeds. This came after a 2020 report found Johnson & Johnson had been growing a highly potent poppy variety in Tasmania. Reduction in the global supply of the FDA-approved manufacturing process precursor has resulted in an overall reduction in the supply of opioid pharmaceuticals and pharmaceuticals used for substance abuse disorders, such as alcoholism and opioid addiction.

Impacts Of Shortage

Naltrexone is a unique medication due to its lack of euphoria when taken and being used to reduce or eliminate euphoric effects from other drugs. Off-label it is prescribed for weight loss, inflammatory diseases, chronic pain, HIV, and cancer. Individuals across the United States report being unable to fill medications. This negatively impacts individuals across multiple indicated medical conditions and increases susceptibility for relapse in those using naltrexone for the treatment of substance abuse disorder.

So what should those adversely effected by the shortages do? Users on Reddit recommend “white-knuckling” through, reminding those facing substance abuse disorder of the negative impacts of relapse. Another user mentioned using acamprosate as an alternative for helping maintain abstinence from alcohol. Unfortunately, this option does not assist those facing opioid addiction, nor does it assist those prescribed naltrexone off-label.

With the current status of the opioid epidemic, naltrexone shortages impact the United States. A decrease in accessibility of supply could result in relapses and decreased quality of life for those living with cancer and HIV. Additional concerns arise regarding the illicit fentanyl and counterfeit drug market capitalizing on thebaine shortages by taking advantage of alternate non-FDA-approved synthesis pathways. The average retail price of naltrexone is approximately $110 per month without a prescription discount program or insurance, coming out to just over $3 per pill; more expensive than $0.50 per illicit fentanyl pill in Washington state, and $1-3 per illicit fentanyl pill in Arizona. Hopefully, support networks will be in place for the upcoming effects of this shortage.

If you, a family member, or a close friend are impacted by the naltrexone shortage or shortage of any other medications impacted by supply chain issues, please do not hesitate to reach out for support. SAMHSA has a free, confidential 24-hour helpline available by calling 1-800-662-HELP (4357). For those in need of treatment options, please visit FindTreatment.gov.