Narcan, the first opioid overdose reversal drug approved for over-the-counter purchase, is being shipped to pharmacies and grocery chains nationwide, its manufacturer said Wednesday. Big-box outlets like Walgreens, CVS, Walmart and Rite Aid said they expect Narcan to be available online and on many store shelves by early next week.
Public health experts have long called for greater accessibility to the drug, which they describe as a critical weapon against rising overdose rates. There have been more than 100,000 opioid overdose fatalities in each of the last two years in the United States.
Narcan is now a staple for emergency personnel and street outreach teams. Now scientists and health officials hope Narcan will become commonplace in public libraries, subways, dorms, corner delis and street vending machines.
They also predict it could become a fixture in medicine cabinets, as more people become aware that illicit party drugs like cocaine and fake Xanax pills can be laced with the deadly fentanyl, an opioid.
Here’s what you need to know about buying this life-saving drug.
How Narcan Works
Narcan is a nasal-spray version of the drug naloxone, which blocks the effects of opioids on the brain, saving someone who has been overcome by drugs like fentanyl, heroin or oxycodone.
An individual may overdose if his breathing slows or stops, and the pupils of the eyes narrow to a pinpoint. Naloxone is generally considered safe with experts saying that, when faced with a possible overdose, it is better to risk using it than to hesitate.
Each carton contains two palm-sized plunger devices, each filled with four milligrams of naloxone. The rescuer will place the spray tip in the patient’s nostril and press the plunger.
Usually one dose is enough to reverse an overdose within two to three minutes. But addiction specialists report that in areas where the supply of fentanyl is relatively strong, a second dose may be necessary.
How Much Does It Cost?
Cost will likely dictate the extent of Narcan procurement. The manufacturer, Emergent BioSolutions, suggests $44.99 as the price of a two-dose box.
“People with a little money and motivation are going to find this product, which is amazing,” said Brendan Solaner, an addiction policy expert at the Johns Hopkins Bloomberg School of Public Health. “That may include concerned family members.”
But the people who will need Narcan the most may not be able to afford it, he added, saying “this includes people who are homeless or financially insecure and are at the greatest risk of overdose.”
When Narcan is only available by prescription, public and private insurance readily covers it. But those plans typically restrict coverage of prescription drugs.
Some state Medicaid programs have announced that they will cover Narcan when it becomes available over the counter. Those states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.
Emergent said prices will be lower for bulk sales to public interest groups and state health departments, which in turn will distribute Narcan to local outreach organizations and clinics.
How Can I Find Narcan in Stores?
Retailers often put more expensive products or those that are likely to be stolen behind a counter or in a locked case. But behavioral health experts say customers may be reluctant to ask store workers for Narcan, fearing raised eyebrows and snide comments — marks of widespread stigma surrounding drug use and addiction.
Through a spokeswoman, Rite Aid said Narcan is available over the counter in its pharmacy and in pain-care aisles. Many stores, including CVS, will also have it in front of the register. Rite Aid, Walgreens, Walmart and CVS also said Narcan could be purchased next week through their online sites, which offer more privacy.
“Stigma will always be there, but I think there’s been a big shift in how the public perceives naloxone over the past decade, and more people are willing to take it,” said Dr. Solaner.
What next?
Although Narcan is the first overdose reversal drug sold over the counter, the field will likely soon become crowded with cheaper competitors.
A generic naloxone spray by Teva Pharmaceuticals is still available by prescription, which means it is usually covered by public and private insurance policies. Pharmacists in most states rely on a “standing order” for the spray, which means they don’t need a doctor’s prescription to dispense it. For someone with Medicaid or commercial insurance, generic naloxone can be less than $10.
CVS encourages customers to request Narcan at the pharmacy counter “so that our pharmacy teams can assess a patient’s insurance plan for potential savings on prescription naloxone products,” a spokeswoman said.
Earlier this summer, the Food and Drug Administration granted over-the-counter approval to RiVive, a naloxone spray expected in early 2024. RiVive, made by Harm Reduction Therapeutics, is intended as an inexpensive product mainly for outreach groups.
Other forms of naloxone, including some with higher concentrations and some that come in syringes, are available by prescription.
