Over-the-Counter Naloxone: A Turning Point in the Opioid Crisis

The opioid epidemic has taken a devastating toll on communities across the country. However, a major shift in public health occurred when the FDA approved Narcan nasal spray for over-the-counter use. This change means anyone can now walk into a local pharmacy, buy this life-saving medication, and be prepared to reverse an overdose.

What is Over-the-Counter Naloxone?

Naloxone is a medication designed to rapidly reverse an opioid overdose. It is an opioid antagonist. This means it binds to opioid receptors in the brain and blocks the effects of drugs like heroin, fentanyl, oxycodone, and hydrocodone. When a person is experiencing an overdose, their breathing slows down or stops completely. Naloxone restores normal breathing within two to three minutes.

In March 2023, the U.S. Food and Drug Administration (FDA) made a historic decision. They approved Narcan, a 4 milligram naloxone nasal spray manufactured by Emergent BioSolutions, for over-the-counter (OTC) use. A few months later in July 2023, the FDA also approved RiVive, a 3 milligram OTC naloxone nasal spray made by Harm Reduction Therapeutics.

Before these approvals, getting naloxone required a prescription or a specific standing order from a pharmacist. Now, you can buy it straight off the shelf.

Where to Buy Narcan and How Much It Costs

You can find Narcan nasal spray at major retail pharmacies, grocery stores, and online retailers. Companies like CVS, Walgreens, Rite Aid, and Walmart stock the medication in their aisles. It is often located near the pain relievers or pharmacy counter.

Pricing is a critical factor for accessibility. A standard box of OTC Narcan contains two single-dose nasal sprays. At most major retailers, this two-pack retails for about $44.99. Some independent pharmacies may price it slightly higher, pushing it to around $49.99.

While the $45 price tag is a barrier for some, many state health departments and harm reduction programs still distribute free naloxone. Programs like NEXT Distro allow people to request free naloxone by mail in certain states. RiVive, the other approved OTC spray, is primarily distributed to harm reduction organizations at manufacturing cost to help keep free distribution programs afloat.

Why Widespread Availability Matters

The current drug crisis is largely driven by illicit fentanyl. Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin. According to the Centers for Disease Control and Prevention (CDC), the United States has seen over 100,000 drug overdose deaths annually in recent years, with synthetic opioids causing the vast majority of these fatalities.

Fentanyl works incredibly fast. When someone overdoses, permanent brain damage from a lack of oxygen can occur within minutes. Emergency medical services (EMS) do incredible work, but ambulances cannot always arrive in three minutes. Bystander intervention is the absolute key to preventing fatal overdoses. When everyday people carry Narcan in their bags or glove compartments, they become immediate first responders.

Putting naloxone on store shelves also helps reduce the stigma surrounding opioid use disorder. Buying it is now as routine as purchasing allergy medication or bandages. This normalizes the conversation around overdose prevention and encourages more families to keep the medication in their first-aid kits.

Recognizing an Opioid Overdose

Having Narcan is only half the battle. You also need to know when to use it. An opioid overdose looks different from simply falling asleep. If you suspect someone has taken drugs, look for these specific signs:

• Breathing issues: Their breathing may be very slow, shallow, or completely stopped.
• Unusual sounds: You might hear deep snoring, choking, or a gurgling sound.
• Skin color changes: Their lips and fingertips may turn blue or gray (depending on their natural skin tone).
• Unresponsiveness: They will not wake up if you shout their name or vigorously rub the center of their chest with your knuckles.
• Pinned pupils: The black circles in the center of their eyes will be incredibly small.

How to Administer Narcan Nasal Spray

Using Narcan is very simple. The device is designed for anyone to use under extreme stress. It does not require any medical training.

First, check for a response. If you cannot wake the person up, call 911 immediately.

Next, lay the person on their back. Take the Narcan device out of the package. Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Do not press the plunger yet, or you will waste the dose.

Tilt the person’s head back slightly. Gently insert the tip of the nozzle into one nostril until your fingers touch the bottom of their nose. Press the plunger firmly to release the dose into their nose.

After giving the first dose, turn the person onto their side. This is called the recovery position, and it prevents them from choking if they vomit. Watch them closely for two to three minutes. If they do not wake up or start breathing normally, give them the second dose in the other nostril using a new device.

What Happens After Reversing an Overdose

Naloxone is temporary. It usually wears off in 30 to 90 minutes. However, opioids like fentanyl or methadone stay in the body for much longer.

This means a person can slip back into an overdose once the Narcan wears off. This is exactly why calling 911 is a required step. Medical professionals need to monitor the individual and potentially provide more doses of naloxone.

When a person wakes up from an overdose after receiving Narcan, they may feel terrible. The medication instantly puts them into opioid withdrawal. They might feel confused, agitated, or physically sick. Stay calm, reassure them that they are safe, and let them know that an ambulance is on the way.

Good Samaritan Laws Protect Bystanders

Many people hesitate to intervene in a medical emergency because they fear legal trouble. They might worry about doing it wrong or getting arrested if illicit drugs are present.

To solve this problem, nearly all 50 states and the District of Columbia have passed Good Samaritan fatal overdose prevention laws. These laws provide legal protection to the person who calls 911 and the person experiencing the overdose. They protect individuals from arrest and prosecution for minor drug possession charges. Furthermore, medical liability laws protect you if you administer naloxone in good faith to someone you believe is overdosing.

Frequently Asked Questions

Can you use Narcan on someone who hasn’t taken opioids? Yes. Naloxone only targets opioid receptors. If you give it to someone who is having a heart attack or a diabetic emergency, it will not hurt them. If you are unsure why someone is unconscious, it is always safer to administer Narcan just in case.

Does naloxone expire? Yes. Most naloxone products have a shelf life of three to four years. The FDA recently extended the shelf life for certain Narcan products from 36 months to 48 months. You should store the spray at room temperature and keep it out of direct sunlight. While it is best to use unexpired medication, health experts agree that using expired Narcan is better than using nothing at all during an emergency.

Is over-the-counter Narcan covered by health insurance? The over-the-counter version is usually an out-of-pocket expense. However, many insurance companies, including Medicaid and Medicare, will cover the cost if a doctor writes a prescription for it. If you have insurance, ask your doctor for a prescription. You might be able to get it at the pharmacy counter for a $0 copay.