Key takeaways:
Narcan (naloxone) nasal spray became available over the counter (OTC) in 2023. It’s still available with a prescription as nasal spray and injection.
The OTC price or copays may be a barrier for some, so it’s important for clinicians to know where and how to get free naloxone.
Free naloxone is available from clinics and pharmacies, through the mail, in vending machines, and at libraries. Harm reduction organizations and health departments provide free naloxone and remove barriers to access.
In some cases, having a prescription and coupon may help people pay less than the OTC price.
Opioid overdose deaths have decreased in recent years, but overdose is still a leading cause of accidental deaths in the U.S. With newer street drugs containing synthetic opioids, overdose reversal agents — such as Narcan (naloxone) nasal spray — remain important.
Broader access to these agents is becoming a reality in the U.S. Narcan and RiVive were FDA approved as over-the-counter (OTC) medications in 2023, and many organizations and government entities give it away for free to help save lives. Cities and states that have made Narcan more available have seen a decrease in opioid overdose deaths.
Clinicians can also play a key role in preventing overdose deaths through patient education. Encouraging anyone who takes opioids, or those who know someone with opioid use disorder, to keep naloxone at home is a critical step. But the reality is, the OTC cost or prescription copay cost may be a barrier for some.
Here are a few ways patients can access free or discounted naloxone.
Where is Narcan available for free?
There are several ways people may be able to get naloxone for free. They can:
Search the National Harm Reduction Coalition’s Naloxone Finder or check out their naloxone mailing program.
Inquire with local pharmacies, as many participate in free naloxone programs.
Check with local and state health departments to find out about naloxone mail order programs.
Look for a local safe syringe access program, as these typically have access to naloxone or know where to find it for free.
Keep an eye out for naloxone vending machines and public library distribution in many towns, cities, and college campuses.
Many cities and states have programs that provide free Narcan or naloxone to any resident who requests the medication. Here are some examples:
When in doubt, anyone can search online for their state or city and “overdose prevention” or “naloxone access” to find harm reduction organizations and programs that offer free naloxone in their area.
Other ways to save on naloxone
Making naloxone available OTC has improved access. But even so, the price tag (roughly $50 for OTC Narcan) can be a deal breaker for some.
One way patients can save is by using a GoodRx coupon for prescription naloxone (1 box of two nasal sprays). This may lower the price so it’s less than the OTC price. Just keep in mind that you’ll need to write a prescription for it in order for your patients to use a GoodRx coupon.
Do health insurance plans cover naloxone?
Most do. There are many options when it comes to prescription opioid antagonists (more on this below). So even if one medication isn’t covered, another might be. Many private health plans cover an overdose reversal medication, but there may be a copay. And they may not cover OTC naloxone. This varies by company and plan.
In most states and the District of Columbia, Medicaid covers at least one formulation of naloxone. Some Medicaid programs cover certain OTC medications if they are on formulary, and a prescription may be required.
Most Medicare plans will cover nalmefene and naloxone.
Can anyone get naloxone?
Yes, anyone can get naloxone, even if they’re not taking opioid medication. Prescribing naloxone to friends and families of people who take opioids is another way to be sure it’s readily available if needed. Third-party prescribing is permitted in all 50 states, allowing prescribers to make sure family and friends of people who use opioids have access to naloxone.
Naloxone options and alternatives
Naloxone is the most commonly available overdose reversal agent. There are several formulations to be aware of.
Naloxone | Dosage / Administration | Availability |
|---|---|---|
0.4 mg/mL and 1 mg/mL injection for intravenous, intramuscular, or subcutaneous use | Rx only | |
4 mg nasal spray | OTC Rx | |
Naloxone (generic for Narcan) | 4 mg nasal spray | OTC Rx |
3 mg nasal spray | OTC Rx | |
8 mg nasal spray | Rx only | |
5 mg injection (available as a single dose auto-injector) | Rx only |
Nalmefene is another opioid antagonist available for overdose reversal. It has a longer duration of action than naloxone. Formulations of nalmefene are only available with a prescription.
Information for patients
When prescribing nalmefene or naloxone to patients or loved ones, it’s important to make sure they know how to use it.
Fortunately, naloxone nasal sprays and Opvee were designed to be easy to use:
Peel back the package to remove the device. It's a small white spray bottle.
Lay the person experiencing an overdose on their back before giving them naloxone. With one hand, tilt the person’s head back and provide support under their neck with your hand.
With your other hand, place and hold the tip of the nozzle in a nostril until your fingers touch the base of the person's nose.
Press the plunger firmly, and the dose will release into the person’s nose.
Remove the spray bottle and turn the person on their side. You may start chest compressions while waiting for an ambulance to arrive.
There’s only one dose per bottle, so you only need to spray into one nostril. If the person isn’t responding after 2 to 3 minutes, give another dose with a new spray bottle.
Zurnai and Zimhi come in pre-filled, single-dose injectors, similar to EpiPens. Instructions are clearly printed on the labels of the injectors. Naloxone injections must be drawn up with a needle and syringe.
For patients:
In this article, we detail what to do in an opioid overdose, including how to recognize one and steps to take.
If you administer naloxone or nalmefene to someone, you should call 911 to get emergency help after giving the first dose. Several states have passed “911 Good Samaritan” laws to encourage overdose witnesses to call the police without fear of being arrested for drug-related crimes or from being searched.
What are the side effects someone should expect after receiving naloxone?
After receiving a dose of naloxone, it’s normal to feel some side effects, such as:
Headache
Muscle aches or spasms
Nasal congestion or swelling
Higher blood pressure
If a person is physically dependent on opioids, a dose of naloxone can also cause withdrawal symptoms. So they should always get medical attention after receiving it.
How quickly does it work?
Narcan should work within 2 to 3 minutes. But some people may need a second dose. Either way, everyone who receives Narcan should get medical attention.
Narcan’s effects can wear off in about 30 to 90 minutes, and breathing problems may return. This is especially possible if a person took a long-acting opioid that can stay in their system for hours. A risk of overdose symptoms returning is why medical staff should monitor the person after receiving Narcan.
Does Narcan expire?
Yes, check your package of Narcan for an expiration date. It’s ideal to use naloxone products that are not expired, if possible.
However, studies suggest that you can use expired Narcan safely, and it may be just as effective. Expired Narcan is better than no Narcan.
The bottom line
Naloxone (Narcan, RiVive) is available over the counter (OTC), so people don’t need a prescription to get it. Private insurance plans, Medicare, and Medicaid may cover the cost of OTC naloxone. Also consider that the cost may be lower with a prescription and a GoodRx discount. Free naloxone is available through many health departments and overdose prevention organizations near you.
Why trust our experts?
References
Amerisource Bergen. (2025). Naloxone hydrochloride spray [package insert]. DailyMed.
Bell, D. (2026). U.S. cities installing Narcan vending machines. USA Mobile Drug Testing.
Denver Public Library. (n.d.). Community resources.
Emergent Devices Inc. (2026). Narcan- naloxone hydrochloride nasal spray [package insert]. DailyMed.
Feltus, S. R., et al. (2025). Medicaid managed care naloxone coverage and management. JAMA Network Open.
Fresenius Kabi USA, LLC. (2025). Naloxone hydrochloride- naloxone hydrochloride injection, solution [package insert].
Garnett, M. F., et al. (2026). No. 549 drug overdose deaths in the United States, 2023–2024. National Center for Health Statistics Data Briefs.
Harm Reduction Therapeutics, Inc. (2026). Rivive- naloxone hydrochloride spray [package insert].
Hikma Specialty USA, Inc. (2025). Kloxxado- naloxone hcl spray [package insert]. DailyMed.
Knoa Pharma LLC. (2026). Zurnai- nalmefene hydrochloride injection, solution [package insert]. DailyMed.
Lieberman, A., et al. (2024). Legal interventions to reduce overdose mortality: naloxone access laws. The Network for Public Health Law.
Mann, B. (2026). Historic decline in U.S. overdose deaths threatened by changing street drug supply. NPR.
McClellan, C., et al. (2018). Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors.
Medicare.gov. (n.d.). Opioid use disorder treatment services. Centers for Medicare & Medicaid Services.
National Institute on Drug Abuse. (2022). Naloxone DrugFacts. National Institutes of Health.
Next Distro. (n.d.). 911 good samaritan drug overdose laws.
Pruyn, S., et al. (2019). Quality assessment of expired naloxone products from first-responders’ supplies. Prehospital Emergency Care.
Saunders, H., et al. (2023). Will availability of over-the-counter Narcan increase access? KFF.
U.S. Food and Drug Administration. (2023). FDA approves first over-the-counter naloxone nasal spray.
U.S. Food and Drug Administration. (2023). FDA approves second over-the-counter naloxone nasal spray product.
