The news that Emergent BioSolutions will offer Narcan, a nasal spray containing naloxone, over-the-counter, represents a major development in the continuing battle against the opioid crisis. Beginning next week, the medication will be advertised at multiple retailers, including Walgreens, Rite Aid, Walmart, and CVS. The Food and Drug Administration (FDA) in the US has approved the over-the-counter sale of Narcan.
Medical Experts Endorse Widespread Use
In the United States, opioid overdose fatalities have reached historic highs, making the timing of this announcement all the more foreboding. The increasing availability of synthetic opioids like fentanyl has exacerbated a serious problem. With its green light, the FDA hopes to increase access to the drug's key component, naloxone. Naloxone was formerly exclusively available via a limited number of organizations and pharmacies, and its use usually required a prescription or standing order.
Dr. Kevin Ban, Walgreens Chief Medical Officer, emphasized the broader implications of the FDA's decision. "We believe everyone should consider having this life-saving drug in their first-aid kit. Narcan can reverse an opioid overdose within minutes, potentially averting a tragedy," Ban said in an interview.
However, those who support the widespread use of naloxone are divided over the news. They contend that while it is a big step in the direction of greater accessibility, it is not a panacea for the opioid problem.
The majority of naloxone is purchased in bulk by governmental and non-governmental organizations, which subsequently distribute it to high-risk people, noted Maya Doe-Simkins, co-director of Remedy Alliance/For the People.. "Bulk distribution has an evidence-based track record for saving lives," she noted.
Moreover, Emergent BioSolutions has decided to reduce Narcan's so-called "public interest price," effective immediately. Community organizations, first responders, and local and state governments will be able to purchase two-dose cartons for $41. Although the company did not reveal the previous price, it was noted that when Emergent BioSolutions acquired Narcan in 2018, the price was $75 per two-dose carton.
Interestingly, another naloxone nasal spray, RiVive, received FDA approval in July. Produced by the nonprofit organization Harm Reduction Therapeutics, RiVive will be offered at a cost of $36 for a two-pack beginning in early 2024. Traditional injectable versions of naloxone are also available, but they are generally cheaper and require a prescription.
Barriers to Access Remain
Retailers are taking innovative approaches to prevent theft, which could be an unintended consequence of the drug's higher price point.
Walgreens, for example, will provide cards that customers can take to the register or pharmacy counter to purchase Narcan, a step intended to minimize the stigma often associated with asking for the medication openly. CVS has taken a multi-pronged approach, offering Narcan at both the pharmacy counter and the front of the store, with pickup and delivery options for those who desire more privacy.
While these developments are promising, Doe-Simkins cautioned that any extra steps required to obtain naloxone could act as barriers to access. "Every additional layer complicates the process and might discourage people from obtaining this life-saving medication," she said. Nonetheless, she also acknowledged that over-the-counter availability is a long-awaited development. "We've been advocating for this for well over a decade. It's high time this happened," she added.
The over-the-counter availability of Narcan represents a significant advance in public health policy, making a life-saving medication more accessible. However, it also highlights the complex challenges that remain in fully addressing the opioid crisis and the need for more integrated, multi-layered solutions.
