Narcan, medication that can stop fatal opioid overdose now available without a prescription

Last month, drugstores and pharmacies nationwide began stocking and selling the country's first over-the-counter version of naloxone, a medication that can stop a potentially fatal overdose from opioids. It's sold as a nasal spray under the brand name Narcan.

Coming off a year with a record number of opioid-related overdose deaths in the United States—nearly 83,000 in 2022, according to the Centers for Disease Control and Prevention's National Center for Health Statistics—community health workers and addiction medicine experts were hopeful that the arrival of Narcan on retail shelves might make it easier for people to get the medication.

And, ultimately, prevent more fatal overdoses.

But it's unclear whether the move will actually expand access to Narcan. Experts worry that its unpredictable retail price, sporadic availability on store shelves, or general consumer confusion about potentially having to ask a pharmacist to retrieve it will mean that fewer people than expected will purchase Narcan to have it at the ready when an overdose occurs.

"It's not by any means a game changer," said Shoshana Aronowitz, a family nurse practitioner and assistant professor at the University of Pennsylvania's School of Nursing in Philadelphia. "I don't think it's a step in the wrong direction. I just think it's a tiny, tiny baby step that does not deserve a round of applause."

"We should not be under any illusion that this is going to meaningfully change things for a lot of people," she said. "But we need to be moving in this direction. We just need to be doing it faster and with an understanding that this is just way overdue."

The FDA approved over-the-counter marketing and sales of Narcan in March. Manufactured by Emergent BioSolutions, it started arriving in stores in early September.

Enduring barriers to access

As an over-the-counter product, Narcan ideally would appear on store shelves in the same way as ibuprofen and cough medication.

But at several drugstore locations in Philadelphia, "over the counter" means it is stocked and sold from behind the pharmacy counter. That requires people to wait in line and ask a pharmacist to buy Narcan.

"Having to go talk to the pharmacist who may or may not know you, it's not comfortable for people, and that's a barrier that this is supposed to eliminate," Aronowitz said. "It's counterintuitive. It needs to just be on the shelf, and someone can take it."

Keeping Narcan behind the counter will especially deter people who use drugs, said Lewis Nelson, chair of the Department of Emergency Medicine and director of the Division of Medical Toxicology at Rutgers New Jersey Medical School.

"For those who don't have substance use concerns, they might go in and just ask for the product and not be concerned about what the other person's thinking," he said. "But that's a mental state that's very hard for most of us to put ourselves into if we don't live the life of somebody with the stigma and the marginalization that is so associated with substance use."

Another potential barrier is related to affordability. Despite the suggested price of $44.99 for a two-dose pack, nothing is stopping individual pharmacies and other retailers from charging more. At least one drugstore in Philadelphia was selling it from behind the pharmacy counter for $72 a box.

"The higher the price, the fewer people who are going to splurge to have this with them in case somebody else needs it," Nelson said.

That's especially true for people with low incomes who are facing other daily financial challenges, Aronowitz said. Even $44.99 may be too steep for many consumers.

"That's a lot of money to be spending on something if you need food today, if you have a headache and need ibuprofen today," she said. "You think you'll probably need naloxone, but it's not a guarantee that you'll need today, so why spend the money?"

Generic brands of naloxone are also available at most pharmacy stores, but consumers need a prescription from a medical professional.

Most states have also adopted some kind of standing order, which authorizes pharmacists to dispense naloxone immediately to someone even without an individual prescription.

For some consumers, purchasing naloxone via prescription could remain cheaper than buying it over the counter. Many private health insurers—and public programs like Medicaid and Medicare—cover the cost of these prescription sales.

State officials in Pennsylvania, New Jersey, and Delaware confirmed to NPR and KFF Health News that their Medicaid programs, which offer health insurance to people with low incomes, will cover the cost of the new Narcan spray if a pharmacist puts the order through as a prescription.

In California, a bill is headed to Democratic Gov. Gavin Newsom's desk that would require health insurers—both public and private—to cover most of the cost of naloxone, and other FDA-approved opioid-overdose reversal drugs, in the nation's most populous state. The bill would allow insurance plans to charge a maximum copay of $10 per package, and it would sunset in five years.

Aronowitz predicted that if cost deters people from buying over-the-counter Narcan, it will fall upon nonprofit organizations and so-called harm reduction programs, which already distribute naloxone for free, to continue efforts to distribute it to a larger population of people.

Health departments try to do more

In Los Angeles County, health officials have launched a unique push to get Narcan into the hands of an overlooked demographic when it comes to the overdose epidemic: Latino immigrants.

The rate of fentanyl deaths among Latinos in L.A. County jumped by 748% in four years, according to the county Department of Public Health.

In 2016, 25 Latino residents died of fentanyl overdoses. By 2021, 551 Latinos had died. It's unknown how many of those people were immigrants because country of origin isn't a required data point in overdose reported data. Still, county health officials are proactively reaching out to immigrant communities with their harm reduction efforts.

While Mexico doesn't report an opioid use epidemic as severe and deadly as the one in the U.S., overdoses in that country are increasing—particularly in border communities—and there's a growing need for Narcan.

In Los Angeles, Martha Hernandez, a county community health worker, makes frequent visits to local consulates for Spanish-speaking nations, where she gives short, sharp demonstrations tailored to her audience, instructing them on how to effectively use Narcan.

Narcan is highly restricted in Mexico, so immigrants are unlikely to know much about it. But in the U.S., Narcan's new availability without a prescription, along with the ongoing surge in overdoses, has made consulates a new priority for enhanced outreach and training.

One common misconception Hernandez runs into surrounds Narcan's packaging, which says "nasal spray" in large letters on the box.

"People do mistake the fact that it's nasal [spray]; they think it's for allergies," she said. "That's where you see the necessity of educating our community because a lot of people will say, "Oh I need it, I have allergies.'"

Fake prescription pills are partially fueling the country's opioid crisis, especially in Western states. The share of overdose deaths involving counterfeit pills more than doubled comparing a three-month period in 2019 to the last quarter of 2021, and the percentage more than tripled in Western states, according to a new report from the CDC.

2023 KFF Health News. Distributed by Tribune Content Agency, LLC.