Is Naloxone (Narcan®) Sold Over-the-Counter?

A Q&A about what to know & how to access the opioid overdose drug

The widespread crisis of opioid addiction has become one of the deadliest epidemics in the United States – and with this surge has come a scary flood of overdose incidents.

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Opioids make pain signals to the brain less intense. And while they’re powerful tools for reducing pain when used properly, they’re often highly addictive if abused.

Some organizations now recommend that people at risk of an overdose – or even family members or those who live in at-risk communities – should consider carrying a medication that can reverse the effects of opioids.

The medication, naloxone, is often sold under the brand name, Narcan®.

“Most people know someone who’s been impacted by an opioid overdose,” says registered pharmacist Matthew Soder, RPh. “Having this medication available and knowing how to use it can save someone’s life.”

Here’s everything you need to know about naloxone – the opioid overdose reversal drug.

What is naloxone and how does it work?

Naloxone is a drug that reverses the effects of opiates such as fentanyl, oxycodone, heroin and codeine.  It’s used for treating an opioid overdose and works by blocking the opioid signals to the brain through receptors. This rescue medication can quickly restore normal breathing for a person who has slow breathing or stopped breathing altogether because of an opioid overdose.

Naloxone typically works within a few minutes and is very safe to use.

How is it administered?  

Naloxone can be given three ways:

  • Through a nasal spray, such as Narcan.
  • Injected into a vein (like through an IV).
  • Or through an autoinjector, which is a spring-loaded syringe similar to an EpiPen.

Typically, naloxone injections are used in hospital settings or by emergency dispatch because it requires trained professionals to administer it. The most common form of naloxone is the nasal spray, which involves inserting a nozzle into the nose and pumping medicine up into the nasal area. Most nasal sprays come with two doses per package.

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The naloxone autoinjector is often thought of as “buddy administration” because it’s easier for another person to give it rather than doing it yourself. The autoinjector can be given through clothing into the muscle of the person overdosing. 

Is naloxone sold OTC and can anyone get it?

Every state has different laws, but traditionally naloxone can only be dispensed with a prescription or by a pharmacist under a pharmacy specific protocol. In other words, you can’t just go in and purchase it over-the-counter like you would with cold medicine or vitamins.

Many pharmacies now have set protocols that allow pharmacists to dispense naloxone to those who are at-risk and for family members or friends of those at-risk of overdosing.

The protocol typically requires that the pharmacist provide in-person training and written educational materials to the individual prior to dispensing the medicine. Training typically includes strategies to prevent overdose, information on risk factors, signs of overdose, steps in responding to an overdose, procedures for administering naloxone and proper storage.

“For the most part, naloxone is widely available. Most pharmacies have a protocol in place to dispense it to those who need it,” says Soder. “My biggest recommendation is to call your pharmacy and ask to speak to the pharmacist about the requirements for getting naloxone. The pharmacist can also discuss your insurance coverage with you.”

Typically, pharmacies will dispense the naloxone nasal spray, but it’s at the discretion of the pharmacy and its protocol.

Is naloxone covered by insurance and how much does it cost?

Although Medicaid, Medicare and many private insurance companies may cover the cost of naloxone, the law does not require that insurers do. You should verify coverage with your insurance provider.

The average out-of-pocket cost of naloxone nasal spray (Narcan®) is approximately $140. The naloxone autoinjector (Evzio®) out-of-pocket cost is approximately $4,000. And although naloxone is available as an injectable solution, it’s typically not offered as a prescription from the pharmacy.

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Can naloxone be used for an overdose from other drugs or alcohol?

Naloxone is not effective against medications and drugs such as cocaine, benzodiazepines, Xanax® and alcohol.

How should naloxone be stored?

The autoinjector should be stored at room temperature in the outer case provided. Naloxone nasal spray should be stored at room temperature and protected from light.  Avoid storing it in the car during hot summer days or cold winter days.

Also be sure to check and keep an eye on the expiration date, which is on the label.  

Can naloxone ever be harmful?

While naloxone is considered safe, it can result in sudden withdrawal in opioid-dependent people. If someone’s going through sudden withdrawal, you’ll notice symptoms like increased heart rate and blood pressure, sweating, nausea, diarrhea, vomiting, irritability and fever.  

Getting help for addiction

“You never know what you might walk into – a friend or acquaintance that’s struggling from an overdose,” says Soder. “These are safe products to have on hand just in case.”

If you or someone you know is struggling with addiction, talk to your doctor or to theirs.

And remember, no one intends to become addicted. But if you or someone close to you is experiencing the loss of control that comes with opioid addiction, you need to reach out for help.

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