Narcan is on its way to stores: what you need to know

Narcan, the first opioid overdose drug approved for over-the-counter purchase, is being shipped to drugstore and grocery chains nationwide, the maker said on Wednesday. Major retailers including 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 access to the drug, which they say is a crucial weapon against rising overdose rates. There have been more than 100,000 opioid overdose deaths in the United States in each of the past two years.

Narcan is already a staple for emergency responders and street operations. Now scientists and public health officials alike are hoping that at some point Narcan will become commonplace in public libraries, subways, dormitories, delis, and street vending machines.

They also reckon it could become a staple in medicine cabinets as more people realize that illegal recreational drugs like cocaine and fake Xanax pills may be laced with the deadly opioid fentanyl.

Here's what you need to know about buying this life-saving drug.

Narcan is a nasal spray version of the drug naloxone that blocks the effects of an opioid on the brain, saving a person suffering from drugs like fentanyl, heroin or oxycodone.

A person may have overdosed if their breathing slows or stops and the pupils of their eyes constrict with pinpoint accuracy. Naloxone is generally considered so safe that experts say that in the event of a possible overdose, it's better to risk than procrastinate.

Each carton contains two palm-sized flasks, each filled with four milligrams naloxone. The rescuer inserts the spray tip into the patient's nostril and depresses the plunger.

Usually one dose is enough to reverse an overdose within two to three minutes. However, addiction specialists have reported that in areas where fentanyl supply is quite heavy, a second dose may be needed.

Cost is likely to determine the scale of Narcan adoption. Manufacturer Emergent BioSolutions suggests $44.99 as the price for the two-dose box.

“People with some money and motivation will go for this product, which is fantastic,” said Brendan Solaner, an addiction policy expert at the Johns Hopkins Bloomberg School of Public Health. “This can also include concerned family members.”

But those who need Narcan most may not be able to afford it, he added, saying, “That includes people who are homeless or financially insecure and who are at greatest risk of an overdose.”

When Narcan was only available by prescription, it was easily covered by public and private insurance companies. However, these plans typically limit coverage for over-the-counter drugs.

Some state Medicaid programs have already announced that they will cover Narcan once it becomes available over the counter. These states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.

Emergent said prices would be lower for wholesale sales to public advocacy groups and state health departments, who in turn would distribute Narcan to local outreach organizations and clinics.

Retailers often place more expensive or stolen products behind the counter or in a locked box. But behavioral health experts say customers may be reluctant to ask store employees about Narcan for fear of raised eyebrows and dismissive comments — signs of the pervasive stigma surrounding drug use and addiction.

Through a spokeswoman, Rite Aid said Narcan is available at the pharmacy counter and pain departments. Many stores, including CVS, also offer it at the checkout. Rite Aid, Walgreens, Walmart and CVS also said Narcan will be available to purchase through their online sites next week, offering more privacy.

“Stigma will always be there, but I think over the last decade there has been a fundamental change in the way the public perceives naloxone and a lot more people are willing to wear it,” said Dr. solan.

Though Narcan is the first overdose drug sold over-the-counter, the field is likely to be crowded with less expensive competitors soon.

A generic naloxone spray from Teva Pharmaceuticals is still available by prescription, which means it's usually covered by public and private health insurance plans. In most states, pharmacists rely on “standing order” for the spray, meaning they don't need a doctor's prescription to dispense it. For a person with Medicaid or commercial insurance, generic naloxone could well cost less than $10.

CVS encourages customers to ask about Narcan at the pharmacy counter “so our pharmacy teams can review a patient's insurance plan for potential savings on prescription naloxone products,” a spokesman said.

Earlier this summer, the Food and Drug Administration granted over-the-counter approval for RiVive, a naloxone spray expected in early 2024. RiVive, manufactured by Harm Reduction Therapeutics, is intended primarily for outreach groups as a cost-effective product.

Other forms of naloxone, including some at higher concentrations and some that come in syringes, are already available by prescription.

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