Naloxone could be sold over the counter soon; experts say that's a good thing

ROCHESTER, Minn. — An opioid overdose reversal medication may soon be available for purchase over the counter across the U.S.

On Feb. 15, a Food and Drug Administration advisory panel recommended that naloxone hydrochloride nasal spray — known by the brand name Narcan — be made available for purchase over the counter. The FDA could approve the medicine for OTC use in the next few weeks.

It's a move that some experts say will be a step forward in addressing the opioid epidemic.
"I think anything we can do to get this into people's hands and more available is a good thing for people," said Dr. Casey Clements, a Mayo Clinic emergency medicine physician.

The drug naloxone has been in use since the 1970s in response to opioid overdoses. When a person is overdosing on opioids, symptoms include slow or absent breathing, sleepiness or unresponsiveness, slow heartbeat, and blue lips or nails. Clements said naloxone works by binding to the receptors in the brain that opioids attach to, alleviating those life-threatening symptoms.

Contributed / Mayo Clinic

"It directly binds to the receptor where opioids are and forces them off that receptor, so it undoes the action that opioids do in the brain, as well as other places in the body," Clements said. "It works very quickly, within about two minutes of administration, and it is a real lifesaver drug."

Though naloxone is a fast-acting agent that can reduce overdose symptoms, Clements said people should still call 911 or go to an emergency room right away.

"It doesn't last as long as the opioids do, some of the time," Clements said. "So it may need to be re-administered, or there may even need to be other medication given to keep that person safe."

Naloxone is available as an injectable medication and as a nasal spray. Under current Minnesota law, physicians and pharmacists can prescribe naloxone.

"You could walk into a pharmacy, say, 'I'd like to get prescribed naloxone,' a pharmacist can make that prescription and give it to you right there," said Alicia House, executive director of the Steve Rummler HOPE Network.

A box of Narcan containing two doses of naloxone can cost between $30 and $140, depending on where it is purchased and if the purchaser's health insurance covers it. Generic naloxone nasal spray is usually less expensive.

Naloxone is stocked by major retail pharmacy chains like Hy-Vee, Walgreens and CVS.

"Naloxone is currently available, without an individual prescription, at our pharmacy counters nationwide," a spokesperson for CVS said via an email statement. "We’re committed to expanding access to this life-saving opioid overdose reversal medication and are closely monitoring the FDA’s deliberations to make naloxone available over the counter."

The Minnesota Department of Human Services' Naloxone Finder map points out places where people can purchase naloxone or receive it for free through syringe service programs.

A common question: Who should carry naloxone? Clements said it is recommended that people who are prescribed higher doses of opioid pain medication have naloxone available in case of an accidental overdose. Friends and family members of people who use opioids, prescribed or not, can also carry it just in case.

But Clements also believes the general public should have naloxone on hand.

"It should be stocked in first aid kits or, a lot of times, along with an automatic defibrillator, for example, in schools, churches and public areas," he said. "Because having it on hand is both time-sensitive and can really be the difference between saving a life and not."

The possibility of naloxone nasal spray becoming an OTC medication comes as the United States faces an opioid epidemic. According to the FDA panel's Feb. 15 review, drug overdose is currently the leading cause of accidental death in the nation. In Olmsted County, per Minnesota Department of Health data , 32 deaths were attributed to drug overdoses in 2021, up from 18 in 2019. The majority of those overdose deaths (22) involved opioids.

Allie Halloran, director of health services for Zumbro Valley Health Center, said since the COVID-19 pandemic began, there has been an increase in interest for Zumbro Valley's mental health and substance use services.

Dené K. Dryden / Post Bulletin

"We've seen an increase just across the board for substance use services and programming ... and co-occuring services, so individuals coming in seeking both mental health and substance use services," Halloran said.

The opioid epidemic is intensified by stronger opioids, like fentanyl, being mixed with other drugs.

"They're very potent, and if there's too much of the fentanyl put into the drug, it can be highly, highly deadly," Clements said. "People might not even think that they're using an opioid medication, they may think that they're actually using something else, either a marijuana derivative or things like methamphetamine. Many of those things are actually tainted with opioids as well."

Making naloxone available over the counter can help reduce the financial and social barriers that come with accessing that medication.

"It's very different to be able to potentially go into a pharmacy or even a supermarket, if that's where these end up being on the shelves, versus having to go get in line at a pharmacy and then explain that you need to have Narcan because of X, Y or Z reasons to a pharmacist," Halloran said.

House added that there other naloxone nasal spray brands besides Narcan coming on the market, and that competition can help bring the price down.

Overall, House said OTC naloxone would be a great step toward not only responding to opioid overdoses, but also breaking down the stigma associated with naloxone and, more broadly, seeking help for substance use.

"I think when you have to have a prescription for it, there's still this misunderstanding and maybe this shame around it," House said. "Whereas if it's something that you can just go to the store and buy, that really destigmatizes it quite a bit. ... It's just like learning CPR or having an EpiPen on you — you just want to make sure that you're practicing public safety and being there in case of an emergency."

Clements said this change could help more people on their path toward recovery.

"I think this is a step toward being recovery-oriented for people who are struggling from addiction," Clements said. "I think the first step is saving that life so people have a chance to be in recovery."

Dené K. Dryden / Post Bulletin