Harm reduction

Naloxone is about to be easier to get — what does this really mean for harm reduction?

Here’s what you need to know about the challenges of making naloxone widely available and where we’re headed in light of the FDA’s recent OTC approval.

Ophelia team
Narcan nasal spray distribution
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Fact checked by
Arthur Robin Williams, MD

This content has been reviewed and updated on 3/31/2023.

As the opioid epidemic rages on, doctors and advocacy groups are pushing to increase access to naloxone. The reason is simple: naloxone saves lives and should be available where and when people need it. Also sold under the brand name Narcan®, naloxone is an opioid antagonist that binds to the brain’s opioid receptors and forces true opioids, like heroin and fentanyl, out. This allows naloxone to reverse the respiratory depression caused by overdoses, ultimately saving lives.

The FDA approved an over-the-counter (OTC) version of naloxone in late March, meaning it will be available in pharmacies, convenience stores, grocery stores, and online retailers. Increasing naloxone distribution will help save lives and keep opioid users safe, but there are still questions about what this newly expanded access means. Here’s what you need to know about the challenges of making naloxone widely available and where we’re headed in light of the FDA’s recent OTC approval.

How can you get Narcan?

Naloxone regulations in the U.S. have been changing recently, but they haven’t quite caught up with the level of need. Let’s start with the good news. This life-saving drug is available through prescription as an injection, auto-injection (similar to an EpiPen®), or intranasal spray—and having options for delivery makes the medication more user-friendly. Many doctors are also encouraged to provide a prescription for naloxone alongside any opioid prescription for pain, such as after surgery. However, naloxone prescriptions are still vastly outnumbered by opioid prescriptions. 

Before the FDA approved naloxone for OTC sales, most states passed legislation allowing pharmacists to dispense it at their discretion, especially when dealing with patients who are at higher risk of overdose. This approach was sometimes easier said than done because some pharmacists are not well-versed in the current regulations and may have refused requests for legal Narcan distribution. Other times, patients seeking Narcan reported being required to provide identifying information and extensive paperwork in order to receive the drug. 

When going to a pharmacy wasn’t an option, harm reduction and advocacy groups were often the best way to access this important medication. And we expect these organizations to play a valuable role in this expansion of access to naloxone and the overall public health crisis of drug misuse. These groups seek to prevent overdose deaths and other drug-related problems by enabling safer use. This includes providing safe use sites, organizing needle exchanges, helping with access to medical care, providing drug testing strips, and distributing Narcan to opioid users and those likely to encounter someone experiencing an overdose. 

Harm reduction groups often also give courses on how to administer naloxone to someone experiencing an overdose. Making these courses widely available can make people feel better about purchasing naloxone as a basic safety measure, even if they don’t anticipate needing it.

Can you get naloxone OTC?

The FDA’s approval of Narcan is big news, but it will take time before it’s officially sold alongside other OTC pharmaceuticals. The agency’s announcement indicates that the timeline will be set by the manufacturer, and formulations and dosages other than this specific form of Narcan will still be prescription-only.

Since the manufacturer is taking the lead on this rollout, there are still questions about what this means for consumers–especially those wondering about the potential out-of-pocket cost. A two-pack of intranasal Narcan costs over $100, and injectable naloxone can cost thousands of dollars per dose. Currently, many people use insurance coverage to control costs. Making the drug available over the counter could cause insurance companies to stop covering it—and this increases the risk of naloxone becoming unaffordable.

At the same time, many people already struggle to afford naloxone with insurance. Introducing it in OTC and generic forms may instead make it easier for some individuals and harm reduction groups to acquire this important drug and distribute it to those in need. Harm reduction groups with more buying power due to private donations or state and federal grants could become critical sources for individual doses of naloxone.

Wider access, even at higher costs, may ultimately lead to more Narcan making it into the hands of those most likely to use it, whether for themselves or to help someone else. 

Because bystanders and friends are likely to arrive at the scene of an overdose before medical personnel, higher rates of naloxone distribution in the community is sure to save lives and decrease the number of fatal overdoses the U.S. experiences each year.

Communities are starting to get creative, too. In New York City, the Office of Nightlife and Department of Health are joining forces to stock Narcan rescue kits in bars, clubs, and restaurants and train venue staff to provide emergency intervention.

There has been much research into the use and distribution of Narcan, and the scientific evidence is clear: more access means fewer deaths. While naloxone itself won’t solve the opioid crisis, there is no doubt it can save lives while policymakers tackle other measures at the state and federal levels.


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