Over-The-Counter Narcan Will Not End The Opioid Epidemic In America

On March 29, 2023, the FDA approved an Over-The-Counter (OTC) nasal spray known as Narcan, a drug that reverses the effects of an opioid overdose. This is the first drug of its kind to be available for the treatment of opioid overdose without a prescription, representing a major breakthrough in its potential to dramatically reduce the risk of death from overdose. This could be a gamechanger since synthetic opioids were responsible for 66% of the 106,699 drug overdose deaths amongst Americans in 2021, a dramatic rise since only 6% of drug overdose deaths were attributable to synthetic opioids in 2012.

Because Narcan will eventually be available OTC, this means Americans will most likely need to pay for it out of pocket as public and private insurance companies will not cover it as part of their plans. It remains to be seen how accessible the drug will be and how many Americans will actually purchase the drug. The actual cost of the drug has not been determined, but current speculations from a recent New York Times podcastestimates a price on the order of $40 for manufacturers to have a reasonable profit margin. According to a study in the American Journal of Public Health, individuals recently released from prison are 40 times more likely to die from opioid overdose than others. Will these recently incarcerated individuals be able to afford Narcan if they need it?

Besides cost, additional barriers to obtaining Narcan could also be the well-known stigma associated with purchasing a substance used to treat drug overdose. Even if certain patients can afford Narcan, they may not be willing to purchase it because of the social stigma or fear of being judged at the checkout counter for having an opioid use disorder. Both cost and the stigma of being labeled a “druggie” or “substance abuser” are real and powerful barriers that could significantly affect how accessible Narcan becomes to the general American public. Affordability and decreasing social stigma surrounding the purchase of Narcan must be public health priorities in order to realize the benefits of having an OTC drug to fight opioid overdoses.

Although the emergence of Narcan should represent progress towards America’s fight against the opioid epidemic, there remains more work to be done. Having an OTC drug does not address the root causes for the opioid epidemic in America. Per the CDC, most cases of Fentanyl (a synthetic opioid that is 100 times more potent than Morphine) related overdoses are associated with the illegal manufacture of fentanyl through illegal drug markets. Federal funding and intelligence are necessary to halt major drug trafficking organizations to put an end to the illegal manufacturing of opioids.

In addition, physicians and providers must be held accountable for prescribing opioids at high rates. Although the national opioid dispensing rate has declined significantly in recent years, the rate in 2020 was 43.3 prescriptions per 100 persons, a rate that should be considered unacceptable- accounting for more than 142 million opioid prescriptions. Continued prescription drug monitoring programs coupled with federally enforced guidelines limiting the prescription of opioids could help in keeping physicians honest in the fight against this deadly epidemic.

Finally, treatment of opioid overdose, dependence, and use should be promoted and made readily available to as many Americans that need it. The Affordable Care Act helped expand Medicaid, which is the single largest payer of opioid use disorder services. There remains work to be done as 10 states have still not expanded Medicaid under the Affordable Care Act.

The United States will celebrate Fentanyl Awareness Day on May 9, 2023; and this serves as a gentle reminder for us to reflect on the many thousands of deaths lost each year due to opioid overdoses. This has resulted in loss of loved ones for thousands of Americans, not to mention the related issues of homelessness, job insecurity, and family disruptions that often occur secondarily from opioid use disorder. A concerted effort amongst government officials, policymakers, healthcare personnel, educators, and the general public will and must be necessary to turn the page on the opioid epidemic in America.