The FDA has approved two brands of the opioid overdose treatment naloxone for sale without a prescription, clearing the way for the medication to be sold in grocery and convenience stores. As of September 2023, naloxone is officially available over the counter (OTC). 

Narcan, a naloxone nasal spray, is already available OTC, and a generic option will hit shelves in early 2024. The shift away from prescriptions should help make the lifesaving drug more accessible to the public at a time when opioid overdoses are at record highs

But there are still major barriers to getting naloxone to those who need it most. Here’s what you need to know about OTC naloxone.   

What is naloxone?

Naloxone is a medication that reverses overdoses caused by any opioid, including fentanyl. The drug is most commonly administered as a nasal spray but is also available as an auto-injector, similar to an EpiPen. 

When used correctly, naloxone reverses opioid overdose within minutes. The life-saving drug should keep an overdosing person stable until emergency medical staff arrive.

How to get OTC naloxone

Before the FDA’s approval, naloxone could only be purchased with a prescription through a pharmacy, although every state offered some means for pharmacists to dispense the medication without a prescription. Now, Narcan is available in all 50 states and D.C. at major retailers, like CVS, Rite Aid, Target, Walgreens, and Walmart. 

Two doses of the medication should cost no more than $45 at a wide range of retailers, including supermarkets, gas stations, and online drugstores. But whether these stores will actually stock the drug remains to be seen. 

Both nasal spray and injectable forms of naloxone are still available for free through various nonprofit organizations, like NEXT Naloxone, and government-run programs. The online resource site Get Naloxone Now recommends searching “city or county name + naloxone” on your web browser to find free naloxone near you.

What’s next

The change to OTC makes it easier for many people to keep naloxone on hand. But, at $22.50 per dose, the cost remains a barrier to access for many. 

However, a cheaper generic OTC option called RiVive is just around the corner. The medication is produced by the nonprofit organization Harm Reduction Therapeutics, which promises to keep the treatment low-cost or free. That could make a big difference for lower-income communities where opioid use is more pervasive.   

Expanding insurance coverage of OTC naloxone is another important step toward increasing access. Medicaid and Medicare may cover OTC naloxone, but coverage varies widely from state to state. Blue Cross Blue Shield of Massachusetts is the only major private insurer to commit to covering the medication. 

Finally, advocates are also working to ensure that OTC naloxone is not just accessible but also that people who need it actually keep it on hand. There are efforts nationwide to inform the public on how to administer naloxone and destigmatize the medication by normalizing its use and making it more widely available and accessible.