The opioid crisis is a major public health concern in the United States, where over 100,000 people die of opioid overdose each year (3). One of the key strategies to reduce opioid overdose-related deaths is to increase the availability and accessibility of naloxone, a medication that reverses the effects of an opioid overdose (3). To that end, in March 2023, the Federal Food and Drug Administration approved the naloxone nasal spray Narcan for over-the-counter use, changing the status of Narcan from a prescription drug to an OTC drug (2). FDA approval to change the status of Narcan to an OTC drug could increase access to naloxone and reduce the stigma around opioid addictions, helping to reduce the number of deaths due to overdose each year (2). 

Data from the CDC demonstrates that deaths related to opioids are continuing to grow (6). While earlier waves of the opioid epidemic were driven by heroin and prescription pain medications, this third wave of the opioid epidemic has been overwhelmingly driven by fentanyl (4). Fentanyl is a synthetic opioid that can be packaged into pressed pills with other drugs, such as Xanax or Adderall (4). As a result, individuals can become accidentally exposed to fentanyl when they buy prescription drugs through illegal means (4). 

Naloxone is a medication that blocks the effects of opioids on the brain and reverses the depression of the central nervous system and respiratory system during an overdose (5). Historically, naloxone has only been available by prescription or through emergency medical services in some areas. To address this barrier, in March 2023, the FDA approved Narcan—a 4 milligram naloxone hydrochloride nasal spray—for OTC use (2). The approval of OTC nasal spray products will allow consumers to purchase naloxone directly from places like drug stores, convenience stores, grocery stores, and gas stations, as well as online, without needing a prescription from a healthcare provider (2). Naloxone could also be kept in public areas for quick access when someone is having an overdose, much like the way AEDs are stored for treating cardiac arrest (5). 

Like other forms of harm reduction, carrying Narcan is one of the most effective interventions against the overdose crisis (3). Harm reduction strategies aim to reduce the dangerous effects of drugs instead of solely focusing on getting drug users to abstain from using (3). The change of Narcan’s status from a prescription drug to an OTC drug reflects an ongoing shift in attitudes toward harm reduction and substance use disorder. 

Making Narcan available without a prescription and allowing people to buy it online could raise awareness about naloxone and reduce the stigma around substance use disorders (3). However, Narcan access is just one part of the “layered approach” that is necessary for addressing the opioid crisis (3). Addressing the overdose crisis requires primary prevention strategies to reduce exposure to unnecessary and illicit drugs, educating communities about harm reduction, and the continued development of evidence-based treatments for substance use disorders (2). 

References 

1. Bennett, Alex S, and Luther Elliott. “Naloxone’s role in the national opioid crisis-past struggles, current efforts, and future opportunities.” Translational research : the journal of laboratory and clinical medicine vol. 234 (2021): 43-57. doi:10.1016/j.trsl.2021.03.001
2. “FDA Approves First Over-the-Counter Naloxone Nasal Spray.” FDA, March 29 2023, FDA Approves First Over-the-Counter Naloxone Nasal Spray | FDA 
3. Lopez, German. “Treating Overdoses Over the Counter.” New York Times, Sept 11 2023, Treating Overdoses Over the Counter – The New York Times (nytimes.com) 
4. “Over-the-Counter Narcan: A New Weapon in the Fight Against Opioid Overdose Deaths.” Weill Cornell Medicine, June 1 2023, Over-the-Counter Narcan: A New Weapon in the Fight Against Opioid Overdose Deaths | Patient Care (weillcornell.org) 
5. Perkes, Courtney. “What OTC naloxone means for the opioid crisis.” UCLA David Geffen School of Medicine, Jan 27 2023, What OTC naloxone means for the opioid crisis | UCLA Med School 
6. “Why you should carry naloxone (Narcan) to combat opioid overdoses.” UC Davis Health, August 2 2023, Why you should carry naloxone (Narcan) to combat opioid overdoses (ucdavis.edu)