Narcan Distribution: How the U.S. Is Making This Lifesaving Medication More Accessible

Naloxone, commonly known by its brand name Narcan, is a fast-acting medication that can reverse the life-threatening effects of an opioid overdose. To put it simply, easier access to Narcan saves lives. But only if it’s available when you need it.

In 2021, over 100,000 drug overdose deaths occurred in the U.S. This is the highest number ever recorded. And over 80% of these deaths involved opioids. The use of synthetic opioids in particular, like fentanyl, is the major reason for this spike in deaths. Fentanyl is more potent than most opioids.

In an attempt to curb overdose deaths, states and cities across the U.S. are finding unique ways to make Narcan more accessible.

How can you get Narcan (naloxone)?

There are many ways to get Narcan. Perhaps the easiest way to get Narcan nasal spray is over the counter (OTC) at your local pharmacy. Before September 2023, it was only available behind the pharmacy counter. But now, you can just grab it yourself; no prescription is needed.

But can anyone access Narcan? And what if your insurance doesn’t cover OTC Narcan? We’ll cover the answers to these questions below.

Can anyone get Narcan?

Yes. You may think that only people at risk of an opioid overdose, like people with opioid use disorder (OUD), need Narcan. But anyone can carry Narcan. For example, friends and family members of someone with OUD may want to have Narcan in case of an emergency. Or maybe your partner or child takes prescription opioids, and you want to keep Narcan on hand in case of an accidental overdose.

Even though Narcan is available OTC, your healthcare provider may still write you a prescription for you to pick up at your pharmacy (more on that below). Most states allow prescribers to write "third party" prescriptions for Narcan. With this law, friends and family members of someone who takes opioids can get a prescription for Narcan.

Keep in mind: If you administer Narcan to someone, you should call 911 to get emergency help. However, people who witness an overdose are often scared to call 911 out of fear that they will get in trouble with the police. Several states have passed “911 Good Samaritan” laws to encourage witnesses of an overdose to call the police. Even if the witnesses engage in illegal behavior, these laws protect them from being arrested for drug-related crimes or from being searched.

Is Narcan covered by insurance?

Many states require health insurance providers to play a role in making Narcan prescriptions more easily obtainable and affordable. Some states require that health insurance plans cover Narcan. Others forbid providers from requiring a prior authorization on Narcan. This means insurance companies can’t keep someone waiting for Narcan while they decide if it will be covered under insurance.

However, it’s unclear whether commercial insurance plans will cover OTC Narcan. Many insurance plans don’t cover OTC products. So check with your insurance plan to see if they cover OTC Narcan. If they don’t, ask if prescription Narcan is covered. Then, you can ask your healthcare provider for a Narcan prescription that can be used at any pharmacy.

What are Narcan (naloxone) distribution programs?

Even though Narcan is available OTC, some people may have trouble accessing it. The cost (about $45 for a package of two nasal sprays) may be too high if you don’t have insurance or if your insurance plan doesn’t cover OTC Narcan.

This is where Narcan distribution programs can be helpful. The programs help provide Narcan to opioid users and others who may witness an opioid overdose. They often provide Narcan for free, and train people how to use it. Some examples of these programs include:

• Project DAWN in Ohio was operating over 167 programs throughout the state as of June 2023. Their programs exist in many settings, from emergency departments to the prison system.

• DOPE (Drug Overdose Prevention and Education) Project is supported by the San Francisco Department of Public Health. One of their programs, the DOPE SRO Project, recorded over 9,000 instances of opioid overdose that were reversed by Narcan from their program.

• The Virginia Department of Health has a program that provides Narcan to businesses and nonprofits that wish to distribute Narcan to individuals.

• The People’s Harm Reduction Alliance in Washington will mail Narcan to anyone in the state for free.

What other creative solutions are expanding access to Narcan?

In cities across the U.S., community-based organizations and state governments are making Narcan more accessible. 

For example, states like Michigan, Kentucky, and California have installed vending machines that dispense Narcan for free. The machines are being placed everywhere, from outside police stations to college campuses. Having free Narcan available could be lifesaving, especially in cities like New York City, where someone dies from an overdose every 4 hours, and over 80% of these deaths involve opioids.

Another innovative way to distribute Narcan is happening in jails across the country. For example, people leaving state prisons in California receive free Narcan and training on how to use it. This is important because opioid overdoses are the leading cause of death in people leaving jail. From April 2020 to June 2022, more than 80% of people leaving state prisons in California left with Narcan and training on how to use it.

Why should Narcan be easy to access?

As Narcan becomes easier to access, there's been some debate about whether it's a good thing. Is making Narcan accessible really saving lives?

The short answer to this question is yes. Let’s examine a few reasons why making Narcan accessible is important:

• Having Narcan doesn't encourage people to misuse opioids. States that have laws making Narcan easier to get haven’t seen more people misusing opioids.

• Access to Narcan lowers the opioid overdose death rate. Laws making Narcan more accessible have led to fewer people dying of opioid overdoses.

• Narcan is safe. Narcan doesn’t usually cause serious side effects. It's unlikely that someone experiencing an opioid overdose will have a negative reaction to Narcan.

• Even if there are no opioids in your system, Narcan isn’t harmful. Narcan only reverses the effects of opioids, but it’s safe to receive even if you don’t have opioids in your system. If you see someone having an overdose and you don't know what caused it, it's safe to administer Narcan. If it turns out opioids were involved, Narcan could save their life. 

• When Narcan is easy to get, more people know how to prevent opioid overdose deaths. Just educating someone about Narcan can lower the risk of opioid overdose. And research shows that when Narcan is prescribed along with prescription opioids, overdose risks are lower even if the Narcan prescription isn’t filled. 

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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