Naloxone is an opioid overdose reversal drug. It’s classified as an opioid antagonist, also known by the brand name Narcan. When naloxone is administered during an overdose, it can reverse life-threatening central nervous system depression and restore normal breathing. Naloxone can only work to reverse opioid overdoses — not overdoses from other substances. Naloxone doesn’t have any abuse potential and it’s not a controlled substance. There is a growing push for increased access for it due to the opioid epidemic.
U.S. Naloxone Dispensing Statistics
Different states have varying naloxone access laws, but most states have in recent years made naloxone more available to friends, family, and other people who could be likely to witness an overdose. All 50 states, as well as the District of Columbia, Guam and Puerto Rico, certify emergency medical services providers to administer naloxone.
Additionally, there are at least 46 states — as well as D.C. — that have enacted what are called naloxone good Samaritan laws. While naloxone laws by state vary, good Samaritan laws allow private citizens to administer it without legal liability. According to the Network for Public Health Law, all but four states require pharmacies to provide naloxone to anyone who wants it without a prescription. Some states are also requiring doctors to offer or give it to patients who are taking high-dose opioid pain medications.
Where to Get Naloxone
Despite the fact that many states are working to make it easier to access naloxone, there are still barriers to access according to the Centers for Disease Control and Prevention (CDC). Common questions people have are can they get it over-the-counter and, if so, where to get it.
While the CDC says retail pharmacies dispensing of naloxone went up steadily from 2012 to 2018, pharmacies still only dispensed an average of one prescription for naloxone for every 69 prescriptions of high-dose opioids. This ratio is in spite of the CDC’s recommendation that naloxone be co-prescribed with all high-dose opioids.
As far as people getting naloxone without a prescription, many retail pharmacies do offer it over-the-counter. For example, at most CVS retail pharmacies, it is available without a prescription, although it can vary depending on the state. Walmart and Sam’s Club now dispense it as well without a prescription in states where they legally can. Naloxone is available without a prescription in all Kroger stores. More than 8,000 Walgreens locations offer it without a prescription, and Rite Aids in 19 states do the same.
Despite the availability of naloxone without a prescription at many retail pharmacies, there are still barriers, one of which is the cost. A syringe of brand-name Narcan can cost more than $150, although health insurance will usually cover it. Generic naloxone is cheaper, but still is around $30 or more in most cases.
- Pros and Cons of Pharmacy-Based Naloxone Distribution Programs
Retail pharmacies are just one of the places it is available, and understanding the different types of naloxone distribution programs can help save lives. It’s important that naloxone is in the hands of the people who need it most, and these aren’t necessarily the people who are prescribed opioids, but rather people who abuse opioids, such as fentanyl and heroin.
While the biggest pro of naloxone distribution programs at a pharmacy is that most people know where a retail pharmacy is, there are quite a few possible obstacles. For example, receiving naloxone from a pharmacy can include not only the possible cost barriers but fear of stigma, dealing with insurance and a lack of pharmacist knowledge about the reversal medication.
- Pros and Cons of Health Center Naloxone Distribution
There are community health centers and health departments that will hand out naloxone for free. The biggest pro of this form of naloxone distribution is, of course, the fact there is no cost, and you don’t have to navigate the complexities of insurance to access it.
The big downside of health center naloxone distribution is again the possible stigma people might feel about going into a center and asking for it. This form of naloxone distribution also requires people to visit a health center, which they may not be willing or able to do.
- Pros and Cons of Community Naloxone Distribution Programs
Increasingly, community organizations are working to distribute naloxone in the streets. The idea is that people who are at the highest risk of overdosing or witnessing an overdose are not engaging in traditional healthcare or pharmacy environments. With distribution programs, there isn’t the need to get people into pharmacies or clinics, and there’s not the fear of stigma.
Some opponents of community naloxone distribution programs feel it encourages abuse, but most say that’s not the case and all it does is reduce potential deaths.
Barriers to Naloxone Access
People often wonder how they can get a naloxone kit and if they can get it for free. The following are key aspects to know about getting naloxone:
- Cost: The cost of naloxone can vary depending on where someone is buying it and insurance. According to the CDC, the out-of-pocket naloxone cost can run anywhere from $0.01 to $50 on average at a retail pharmacy, but without insurance, this cost can be higher — brand-name Narcan can be as much as $150 for a kit with two doses.
- Distribution point: Most people who need naloxone the most aren’t in health clinics and pharmacies, so while many states have expanded their laws for access to naloxone, they’re working on improving how it gets into the hands of the people who need it most.
- Prescription requirement: It’s important for people to realize that anyone can buy naloxone or Narcan from a pharmacist without a prescription as long as the pharmacy stocks it. People see the need for a prescription for naloxone as a barrier to receiving it, but it’s not.
Recognizing the Signs of Opioid Overdose and When to Use Naloxone
While increasing the accessibility of naloxone is important to reduce overdose deaths, it’s also essential that people who are most likely to witness an opioid overdose know how to recognize the signs that it’s occurring and when to use naloxone.