Narcan, a medication that can reverse an opioid overdose within minutes, will imminently be available over-the-counter in drugstores.
First approved by the Federal Drug Administration for over-the-counter purchase in March, Narcan has been shipped to mass drug, pharmacy, and grocery stores, such as Walgreens, CVS, Walmart, and Rite Aid, as well as online retailers, and is expected to hit shelves in September, its manufacturer, Emergent BioSolutions, said.
Walgreens announced it would stock Narcan online as soon as September 5, with nationwide availability on September 7. Emergent BioSolutions’s suggested retail price is $44.99 for two doses.
Narcan — also known in its generic form as naloxone — is the first opioid overdose reversal medication to be sold without a prescription, providing greater accessibility for a drug that has been shown to reduce opioid deaths nationwide. More than 80,000 Americans died from an opioid overdose in 2021, up from 68,630 in 2020.
“Seeing it there on the shelf really helps remind us that the opioid crisis affects every county in the country,” says Shawn Westfahl, the overdose prevention and harm reduction coordinator at Prevention Point Philadelphia, a non-profit organization that works to reduce the harms associated with drug use.
Previously, naloxone was available at pharmacies without a prescription for anyone who asked for it, but not every pharmacy carried it. As Vox’s Dylan Scott reported, this required people to ask the pharmacist directly for the medication. The difference is that soon, consumers will be able to pick the drug off the shelves themselves (or grab a ticket for the drug to bring to the counter for retrieval and purchase).
Most of the 17 million naloxone doses distributed in 2021, however, were not sold in pharmacies, but instead administered by hospitals, doctors, health departments, harm reduction groups, first responders, schools, and community health organizations, Scott reported. Local non-profits, like Prevention Point Philadelphia, and harm reduction organizations also offered, and will continue to offer, free naloxone kits.
There’s no shortage of need. During Prevention Point Philadelphia’s fiscal year ending July 31, 2023, the non-profit distributed 95,644 doses of the drug, triple the number of doses distributed the prior year. “I believe that naloxone becoming over the counter is going to hopefully reduce some of this stigma around opioid use and buying or possessing naloxone,” Westfahl says.
How does Narcan work, and who does it help?
Naloxone works by blocking the effects of opioids — including heroin, fentanyl, and prescription opioid medications — on receptors in the brain. Opioids can dangerously depress a person’s breathing during an overdose, and the drug restores normal breathing within two to three minutes of being administered.
Through previous efforts, access to naloxone has increased nearly 785 percent between 2016 and 2021, but research suggests that to meet the present need, naloxone access must be much more prevalent. In-store presence in major drugstores helps ensure the wider population is aware of and has access to naloxone. Nearly half of overdose deaths in 2021 occurred while another person was nearby. Many fatalities can be prevented if bystanders have naloxone on them.
While it’s difficult to estimate how many lives could be saved with greater access to naloxone, Westfahl says making the medication easier to access will limit fatalities. Anyone who uses opioids or knows anyone who does stands to benefit from readily available naloxone in drugstores.
Who should carry Narcan?
Westfahl says everyone, even if you don’t think of yourself as being near drug users, should carry naloxone and know how to use it. The signs of an opioid overdose include symptoms like an extremely pale or clammy face, limp body, blue or purple fingernails or lips, vomiting or gurgling noises, slowed or stopped breathing, or an inability to speak or be awakened.
To administer naloxone, tip the person’s head back and insert the tip of the spray in either nostril until your fingers are touching their nose. With your thumb, press on the plunger firmly. Make sure the dose hasn’t passed the expiration date. However, research shows expired naloxone may still be effective years after expiration, so if an expired dose is the only thing you have, it’s better to use it than nothing at all.
Naloxone is incredibly safe and will not have any adverse effects on people who are not overdosing on opioids. “Naloxone will not do anything to them good or bad,” Westfahl says. “In fact, sometimes we’re giving naloxone to somebody who’s unresponsive to rule out an opioid overdose.”
The Centers for Disease Control and Prevention likens carrying naloxone to carrying an EpiPen: The life-saving medication should be available if needed.
Accessibility still remains an issue
Increasing Narcan’s visibility is a welcome step toward addressing the opioid crisis, but a number of factors still make it difficult for people to access. The $45 price tag can be prohibitive, Westfahl says, especially for those who are unhoused or financially insecure. Westfahl hopes vouchers or coupons could be distributed to customers to help lower the cost.
Due to the current price tag on Narcan, it’s imperative that local harm reduction programs continue to distribute free naloxone to vulnerable communities.
“It is extremely important that the existing methods of naloxone expansion — including community distribution models and insurance coverage — remain in place to ensure as much access as possible,” says Elizabeth Salisbury-Afshar, an addiction medicine physician at UW-Madison School of Medicine and Public Health. “Many community distribution programs have been able to strategically focus on getting naloxone to the people and communities most impacted by overdose, which needs to remain central to our strategy.”
Presentation in the store can be a deterrent as well. Customers may be turned off if Narcan is locked behind a display in a drugstore, requiring a worker to open the case. Walgreens says it will not stock Narcan in locked cases, but instead will require customers to retrieve a card for Narcan from shelves in the store and to bring it to the register or pharmacy for purchase. Other drugstores said Narcan will be available in pain care or over-the-counter medication aisles or at the pharmacy counter, as reported by CBS News.
Another concern is future coverage of Narcan by insurance companies. “Sometimes when a medication is over the counter, insurance stops covering that medication,” Salisbury-Afshar says. “We are waiting to see what approach insurers will take to naloxone now that it is over the counter. I am hopeful that they will [cover] naloxone … despite there being an over-the-counter option.”
What comes next
Earlier this summer, the FDA approved another emergency treatment for opioid overdose for over-the-counter use: RiVive. The medication’s manufacturer, Harm Reduction Therapeutics, expects RiVive will be available by early 2024. RiVive will reportedly be sold for $36 for a two-pack, according to CBS News. A second, cheaper, opioid overdose treatment may ease concerns of cost and accessibility.
“I’m excited for naloxone to be available over the counter,” Westfahl says. “It’s long overdue. I believe that with access to naloxone more easily available, that we will hopefully start seeing a more drastic reduction in the numbers of fatal overdoses.”
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