Narcan, a nasal spray that reverses opioid overdoses, will be available for purchase without a prescription at any pharmacy in the United States starting this summer. The Food and Drug Administration (FDA) announced the measure on Wednesday (28), raising hopes that the widespread and easy availability of the medication will help reduce the alarming drug-related mortality rates in the country.
Narcan is a nasal spray version of the drug naloxone, which blocks the effect of an opioid in the brain. As the overdose crisis worsens, with over 100,000 drug-related deaths in the United States in each of the last two years, millions of doses have been administered by community workers, health professionals, and emergency teams.
But for people who use drugs, as well as their friends and family, immediate access to prescribed medication has been difficult.
Access laws for naloxone in all states allow pharmacists to prescribe the medication or a generic brand to anyone who requests it. However, many pharmacies choose not to prescribe the nasal spray without a prescription as a way to avoid encouraging illicit drug use. Of the nearly 17 million doses of naloxone distributed in 2021, only 2.64 million came from pharmacies, according to a recent report.
Currently, a package of two prescription doses of Narcan is generally free for people covered by Medicaid or any private insurance, and has a co-payment of $10 or less. But public and private health plans do not cover most over-the-counter medications. It is still unclear whether an exception will be made for Narcan.
The company that manufactures Narcan, Emergent BioSolutions, has refused to disclose the price it plans to set for the over-the-counter version of Narcan. This month, a major pharmacy in Manhattan was charging $98 for a box of two doses of the spray for uninsured customers. Another pharmacy chain in New Jersey was charging $73.
What You Need to Know About Narcan
What’s in the Narcan box?
A box contains two palm-sized nasal spray devices, each with four milligrams of naloxone.
How should I use it?
Gently tilt the person’s head back. Insert the tip of the spray into one nostril until both fingers are against the nose. Push the plunger to release the full dose.
Shouldn’t I call 911 first?
Call 911 after using the spray. This is an emergency, but it can take precious minutes for help to arrive.
What do I do after applying the spray and calling 911?
Make sure the person’s airways are clear. Roll the person onto their side, supporting their head with your hands. Bend their knees to prevent them from rolling onto their stomach or back. Stay with the person for a few hours or until help arrives.
The kits have two doses. Should I use the second?
Usually, one dose will be enough. But if the person doesn’t start to wake up after two or three minutes, administer the second dose in the other nostril, especially if you know a stronger opioid like fentanyl may have been used.
Will the spray be harmful if used by someone who is not overdosing?
No. Unless someone is allergic to naloxone, which is rare, the safest bet is to use the spray if you are unsure whether it is an overdose.
How can I tell if someone is overdosing?
Breathing is slowed, with gurgling sounds, or completely stopped. Pupils may be constricted to a pinpoint, lips or nails may turn blue or purple. Skin may feel clammy to the touch. Even shaking the person and shouting, you cannot wake them.
Are there side effects?
Narcan can cause withdrawal symptoms, including vomiting. Airway must be kept open to prevent choking.
Other withdrawal symptoms include: diarrhea, body aches, increased heart rate, fever, chills, sweating, and irritability. Remember that while opioid withdrawal creates a sad scenario, you are saving a life.
Who should carry a box of Narcan?
According to reports from the Centers for Disease Control and Prevention, in 2021, bystanders were present in 46% of fatal opioid overdoses. If they had been carrying naloxone and knew how to use it, many lives could have been saved.
If you know people who use drugs, even casually, or if you use opioids yourself, there’s no downside to carrying Narcan. If you work in a company that has a first aid kit on hand, why not keep a naloxone spray in it? Parents of teenagers or young adults, how about having a box in the medicine cabinet? College dorms? The school infirmary? Libraries?
Source: The New York Times