It was a glimmer of hope amid America’s raging opioid epidemic. Narcan, the nasal spray that can almost instantaneously reverse a potentially deadly opioid overdose, was going to be available over the counter in stores, easy to find and easy to buy.
With the proliferation of fentanyl in the illegal drug supply, overdose deaths in the U.S. had reached alarming rates and most efforts to stop the crisis were failing.
Narcan needed to be more readily accessible for anyone who might need it to save a friend or even a stranger.
In a long-awaited move, the Food and Drug Administration cleared the antidote for over-the-counter use in March 2023, and in September the $45 two-dose boxes were shipped across the country. Prior to that, Narcan, or naloxone nasal spray, was distributed for free at community health centers and was also available via prescription.
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Has the rollout lived up to the early excitement?
NBC News visited 64 stores in 15 states and Washington, D.C., over three weeks in February looking for over-the-counter Narcan, including major chain drug stores, independent pharmacies, supermarkets, big-box chains, convenience stores and gas stations.
Stores around the country stocked the bright-pink Narcan boxes in different locations: on display on the pharmacy counter; in the pain medication aisle; behind the pharmacy counter; or behind the front register. Some were easy to spot and access. Other times, a customer would have to hunt or ask for help.
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In a CVS Pharmacy in a Target outside of Pittsburgh, Narcan was spotted in a locked case on a shelf marked “Covid tests.”
In a Walgreens in Atlanta, it was on the top shelf in a theft-resistant box, obscured by a large metal pole in the aisle.
At a Publix pharmacy in Chattanooga, Tennessee, a Narcan display sat on the pharmacy counter, but it was nearly obscured by a placard warning parents to lock up their medications and pamphlets advertising “Pet meds for less.”
Most major drugstores and big-box store pharmacies NBC News visited carried Narcan, but none of the convenience stores or gas stations did.
“There’s a real inconsistent rollout,” said Maya Doe-Simkins, the co-director of Remedy Alliance, a group that distributes naloxone, the generic version of Narcan, to harm-reduction groups across the country.
Dr. Maryam Jowza, a chronic pain expert at the UNC School of Medicine in North Carolina, said not selling Narcan in gas stations and convenience stores was “a missed opportunity.”
“If one can buy kratom at a gas station, why not Narcan?” Jowza said, referring to the unregulated herbal supplement often used for pain relief.
Jacob Abraham, a pharmacist at Mineral Springs Pharmacy in rural Mineral Springs, North Carolina, said he made sure to stock over-the-counter Narcan when it became available last fall.
“Then it sat on the shelf for so long, we had to send it back, because I have money sitting on the shelf,” Abraham said. Eventually, someone did come in and ask for it. Now, he said, “I keep one on the shelf just in case.”
Alicia House, executive director of Steve Rummler HOPE Network, a harm reduction group in Minnesota, acknowledged that the rollout has been bumpy and that “it’s probably going to take some time” for awareness about the over-the-counter version to build.
The need for Narcan on hand
When a person overdoses on an opioid, the drug slows down their breathing and heart rate. The person can fall unconscious, become unresponsive and go limp. Their lips, gums or fingertips may take on a blue tinge. It’s possible to choke on vomit, or to stop breathing entirely.
Narcan, when given soon after an overdose begins, reverses these effects rapidly: The person will usually wake up within one to three minutes, according to the FDA. Because the effects of Narcan do not last long, it’s essential to also call 911.
Dr. Steven Maher, an emergency medicine physician at the Mayo Clinic in Rochester, Minnesota, said that speed is important when it comes to administering Narcan.
"You start getting brain damage or brain injuries within six minutes of not breathing very well," Maher said. "So typically the sooner, the better."
Because of that, he added, already having Narcan on hand is key.
“Naloxone works exceptionally well,” said Dr. Scott Hadland, an addiction specialist at Mass General for Children in Boston, using the generic name for the drug. “It acts within minutes to reverse an overdose and save a life.”
But “we need to expand access, which means having it in more people’s hands,” Hadland said.
To be sure, Narcan is selling.
Since the launch of the over-the-counter version last fall, the drug can be purchased at more than 32,000 mass, drug, grocery and online retailers and e-commerce sites, Paul Williams, a senior vice president at Emergent BioSolutions, the maker of Narcan, said in a statement. In 2023, the company distributed more than 20 million doses of the antidote, both over-the-counter and prescription, in the U.S. and Canada, he said.
In the fourth quarter of last year, Emergent reported $111 million in Narcan sales, a 22% increase from the year prior. The increase was mainly driven by sales of the over-the-counter version, the drugmaker said.
Dennis Cauchon, president of Harm Reduction Ohio, a nonprofit group that distributes Narcan for free, said it’s still too early to gauge the impact the over-the-counter version is having on the opioid crisis.
Hadland knows of at least one case where a patient used Narcan bought over the counter to save a friend.
“People are recognizing it as something that everyone should consider carrying with them,” he said. “I think it will save lives.”
Matt Blanchette, a spokesperson for CVS Health, declined to share sales data for over-the-counter Narcan, but said the stores have “ample supply” of the product, located at the front store registers and near the pharmacy.
All CVS pharmacists, Blanchette added, are trained on how Narcan works and can provide counseling to people before they buy it. People can also buy the product at CVS.com.
Overcoming the stigma
For a product like Narcan, anonymity is part of access.
The stigma of walking into a brightly lit store and asking the pharmacist or another employee for Narcan behind the counter may be the biggest hurdle.
“They may ask all these invasive, detailed questions like, ‘What’s your name? What do you do? How old are you?’” House said. “Putting it out front, not having it being prescribed, is just taking down more of those stigmas and barriers.”
A Walgreens spokesperson said Narcan is placed behind the front register to ensure it is highly visible to customers. There are also pull cards on shelves in the pain relief aisle. The company, the spokesperson added, is “continually communicating with our field teams to ensure a consistent and proper placement of the product.”
At 16 Walgreens locations in 11 states plus Washington, D.C., NBC News spotted it behind the pharmacy counter, on display by the pharmacy and on the shelf in the pain relief aisle, in addition to behind the front register.
The cost barrier
Nearly all stores visited by NBC News priced over-the-counter Narcan at around $45, a lot for many people who use opioids.
As of late February, a handful of stores — including four Publix locations in Florida and one in Chattanooga, Tennessee — priced the product at $49.99. Two Walgreens locations, one in Maryland and one in Florida, sold Narcan for $49.99.
The Walgreens spokesperson said the company was communicating with stores about consistently pricing the product at $44.99.
Publix did not respond to multiple requests for comment.
Independent pharmacies may sell the drug at an even higher price, Cauchon said.
To really make a difference, the two-dose packs need to be priced at around $5, he said.
“There are very few reports of people going in and buying” Narcan in Ohio, he said.
“In theory, it’s good. In retrospect, we’ll be happy that this happened as an event in history,” Doe-Simkins said of Narcan’s arrival in stores. “Right now, it’s distracting.”
Hadland said he expects the people who will buy over-the-counter Narcan will be family members of people who use opioids.
“I’ve especially seen this among parents who increasingly want to keep Narcan at home, almost like a fire extinguisher in case of an emergency,” he said.
NBC Bay Area, NBC South Florida, NBC Connecticut and NBC affiliates KTAL (Shreveport, Louisiana), WBAL (Baltimore), WDTN (Dayton, Ohio), WFLA (Tampa, Florida), WIS (Columbia, South Carolina), WOWT (Omaha, Nebraska), WRAL (Raleigh, North Carolina) and WRCB (Chattanooga, Tennessee) contributed reporting.
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