Opinion | A conversation with Leana Wen: Should everyone buy Narcan now?

March 30, 2023 Staff Reporter 2088 Views 0 Comments

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The Food and Drug Administration announced Wednesday that Narcan, the nasal spray that can reverse an opioid overdose, will be available over the counter. The decision was years in the making and should have happened long ago.

Now that this essential drug will soon be more accessible, we had a discussion on how best to make use of it and save lives. Our conversation is below:

Robert Gebelhoff: So the big picture first. How big of a difference will this make in addressing America’s overdose epidemic?

Leana Wen: I think it’s a major step, but perhaps not for the obvious reason.

America is in a crisis, with record numbers of people — including teens — dying from preventable opioid overdoses. Naloxone, also known as the brand-name Narcan, can revive someone who has stopped breathing and would otherwise die within minutes.

For years, I and many other advocates have been trying to make naloxone available without a prescription. Getting it over the counter removes one barrier to access, but many others — most notably the cost — still exist.

The biggest benefit of making it available alongside first aid kits and cough and cold medicines, I believe, is that it normalizes naloxone. It sends the crucial message that addiction is a disease and that people overdosing deserve our care and compassion.

Gebelhoff: So, do you think everyone should have naloxone on hand, like Tylenol? Should we all go to the pharmacy and buy it?

Wen: Yes. Everyone should have naloxone in their homes or medicine cabinets. And those who are around people at high risk for overdose should carry it in their pockets and purses.

Gebelhoff: How can we get this drug to as many people as possible?

Wen: Even before the FDA issued its decision, all 50 states and the District passed laws that allow any person to obtain naloxone without a prescription from their physician. In theory, anyone should already be able to walk into any pharmacy and get this antidote.

But this isn’t well understood. Many pharmacies don’t even carry naloxone, and people might not know to ask for it.

Public-health officials and harm-reduction advocates have been trying to bypass these barriers by directly purchasing naloxone and dispensing it to people who are at highest risk. It’s common for local health departments to provide naloxone free of charge to people actively using drugs. Many community hubs such as schools, libraries, parks and shelters carry naloxone and help distribute it to residents.

We need to keep funding these programs. We must also urge everyone to carry naloxone. And naloxone should be accessible in all public spaces, much like defibrillators.

Gebelhoff: Let’s talk about price. As you’ve written, Narcan has cost as much as $75 a dose in the past. That could be a big barrier. So if I’m a person struggling with addiction or a parent of a teen using drugs, what would be your advice on accessing naloxone?

Wen: You’ve just named my major concern. Over-the-counter drugs are often not covered by insurance, and the company that makes Narcan, Emergent BioSolutions, has yet to announce a price for the medication. If the price is too high, this policy change won’t do much good.

My advice for people who want naloxone is to first see if you can get it for free from your city or county health department.

Next, ask your local pharmacies if they carry naloxone. The FDA just issued its ruling, so they probably won’t have it over the counter yet. But most states’ standing orders should allow you to get naloxone if they have it in stock. If they do, ask them how much it is with and without insurance. It might be that obtaining naloxone through the standing order is cheaper than getting it over the counter.

Gebelhoff: Is there any reason to be nervous about this broader availability?

Wen: No study that I’m aware of has ever shown that naloxone leads people to use more drugs.

Right now, we have a tragedy of people taking fentanyl-laced pills and dying. Many are young people who aren’t aware that what they are taking contains this extremely potent opioid that can kill them. Prompt naloxone use can reduce the lives lost to these poisonings.

Gebelhoff: What would you like to see happen next to make naloxone even more accessible?

Wen: First, I want to see over-the-counter Narcan fully covered by Medicaid, Medicare and private insurance so it can be purchased for at most a few dollars.

If this is not possible, then injectable naloxone should be considered for over-the-counter status, too. As I have written, that formulation is much cheaper and has been used safely for decades.

Second, I’d love to see legislation mandating that every public space, from schools to stadiums, carries naloxone.

Third, every pharmacy should be required to dispense naloxone. Every time someone is prescribed an opioid, they should be given the antidote. And there should be a major national campaign urging everyone to carry naloxone, because we can all can save lives.

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