Brand-name naloxone spray will cost Winnipeg police up to 5 times more than locally made alternative

Winnipeg police will pay four to five times as much for naloxone after the College of Pharmacists of Manitoba pulled its approval for a local pharmacy to make the opioid antidote.

Instead of paying $20 per kit for Tache Pharmacy to make the nasal spray, used to help people overdosing on opiates like fentanyl, the Winnipeg Police Service will pay $80 to $100 for the brand-name Narcan spray, manufactured in the United States.

WPS Chief Danny Smyth said he was "really impressed" with Tache Pharmacy's product, but now that there is a commercially available alternative, the pharmacy has been directed to stop making it.

The pharmacy started making naloxone kits for police in Winnipeg and around Manitoba in December 2016, after police started encountering people who had overdosed on powerful opiates like fentanyl and carfentanil.

At the time, the nasal sprays were only available through the Special Access to Drugs and Health Products program, which provides access to non-marketed drugs for patients with life-threatening conditions, said Gregory Harochaw, manager at Tache Pharmacy.

The Narcan spray received approval for sale from Health Canada in June.

"The College has therefore determined that given the availability of a Health Canada-approved naloxone nasal spray, Tache Pharmacy must discontinue production of naloxone nasal spray as a compounded product," College of Pharmacists registrar Susan Lessard-Friesen said in an emailed statement.

Pharmacies can get authorization from state bodies to compound small amounts of a product, but manufacturing larger amounts requires authorization from Health Canada. The college was concerned the volume of product the pharmacy was making crossed over into manufacturing, Harochaw said.

"Because we're experts at making compounded products, we were able to make a product that we felt was better and cheaper for the Winnipeg police," he said.

'We had a superior product'

The college also thought the Narcan kits were safer, Harochaw said, although he disagreed. Commercial manufacturers do stability testing of their products at room temperature, but police officers wear their kits on their bodies, so the product doesn't remain at room temperature, Harochaw said.

"We send our product off for six-month stability testing to show that it is safe and still as potent after six months at 37 degrees Celsius as room temperature," he said.

Harochaw also said his pharmacy's kits deliver a larger volume of the product, coating the nasal cavity better and giving the spray a better chance of being absorbed and having the desired effect.

"That was my biggest reason for being disappointed, because I really thought we had a superior product to what the commercial brand was making."

With a local pharmacy making the kits, Harochaw said police could also easily adjust the dosage in the naloxone kits as they encounter people with more opiates in their system, something that is not possible with a commercial manufacturer, Harochaw said.

The college says it advised Tache Pharmacy that it can apply through Health Canada to manufacture a naloxone nasal spray if it wants to.

That's not likely to happen, Harochaw said, because even if the pharmacy gets approval from Health Canada, it could find itself in a legal battle with the maker of Narcan, Adapt Pharma. 

"And they have much bigger pockets than we do," he said.

Although he's disappointed with the college's decision, Harochaw said he must respect it.

Police Chief Smyth said the service has been ordered to return all the naloxone kits purchased from Tache Pharmacy. WPS has not yet bought any Narcan kits, he said.