Naloxone Sales Show Initial Surge, Then Decline

Naloxone, OTC Naloxone, Opioid Crisis, Fentanyl Overdose, Overdose Prevention, Harm Reduction, Public Health, JAMA Internal Medicine, RAND Study, Opioid Deaths, Pharmacy Naloxone, Addiction Medicine, Health Policy, Substance Use Disorders, Emergency Medicine

Limited uptake raises concerns about accessibility and cost barriers

Naloxone Access Expected to Transform Overdose Care

Naloxone, a life-saving medication for reversing opioid overdoses, was approved for over-the-counter (OTC) sale by the FDA in September 2023. Public health experts hoped this move would improve access and reduce opioid-related deaths.

A new study by RAND, published in JAMA Internal Medicine, reveals that while OTC naloxone sales surged during the first month of availability, they dropped sharply and later stabilized at low levels. Even at its peak, OTC sales represented only 7.5% of naloxone distributed through prescriptions and free programs.

Lead researcher Dr. Bradley D. Stein noted that while naloxone is critical in preventing fatalities from fentanyl and other opioids, “limited uptake highlights ongoing barriers to access.”

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High Cost and Regional Disparities Impact Uptake

The analysis found significant state-by-state variations, with Western states recording higher sales. Nationally, the average was 396 OTC naloxone units sold per million residents over the first year.

Cost remains a major barrier, with the average price for a two-pack of naloxone nasal spray at $45. In comparison, free distribution programs and pharmacy-dispensed naloxone provided far greater supply, averaging 12,015 and 7,063 units per million residents, respectively.

Sales peaked at 22.5 units per million between mid-September and late October 2023 but dropped to 11–15 units per million through September 2024. A brief spike occurred in August 2024.

Dr. Stein emphasized, “The relatively high price is likely restricting broader adoption, limiting its impact on combating the opioid crisis.”

Addressing Barriers to Save Lives

Researchers suggest strategies to increase uptake, including requiring insurance coverage for OTC purchases and improving retail visibility.

Despite challenges, naloxone availability has contributed to a decline in opioid overdose deaths for the first time in years. Public health experts stress that wider access, affordability, and awareness are crucial to sustaining progress in the nation’s fight against opioids.