Narcan is now available over the counter, but its price may be a barrier to access in WV

This month, for the first time, a version of the opioid overdose reversal drug naloxone is available over the counter in retail stores across the country.

The federal Food and Drug Administration earlier this year approved a 4-milligram nasal spray of Narcan to be sold without a prescription. Drug manufacturer Emergent BioSolutions has set its suggested retail price at $44.99. 

In West Virginia, which had the highest drug overdose death rate in the country according to 2021 data from the U.S. Centers for Disease Control and Prevention, some health workers say having Narcan on store shelves at that price may not help make it accessible for those most at risk of a drug overdose. 

Kathleen Maynard, a licensed therapist for the Division of Addiction Science at Marshall Health, said the price may be too high for people who need it most. 

“Most of the people who need it are people who are in active substance use,” Maynard said. “…they’re living day-to-day, and the ability to throw out $40 is not going to be something that they’re able to do on the regular, or probably even willing to do.”

Robin Pollini, a substance abuse and infectious disease epidemiologist and associate professor within the schools of Medicine and Public Health at West Virginia University, works with people who inject drugs through community-based research projects. Pollini said the suggested price is “very expensive” for people who inject drugs, who are most at risk of overdose.

“I can’t imagine under any circumstances, the folks that I work with going in and dropping $45 on a package of Narcan,” Pollini said. “So those folks will be largely unaffected.”

She added that community members and families of people who use drugs may possibly buy it over the counter.

“But in terms of it, increasing availability to people who are at highest risk, those distribution systems are sort of separate from the over the counter, and mostly those programs distribute injectable naloxone, which is not included in the over-the-counter designation,” she said. 

Narcan will be covered for Medicaid recipients

According to the state Department of Health and Human Resources, over-the-counter Narcan will be covered for West Virginia Medicaid recipients with a $2 copay. A prescription for the drug is required for Medicaid recipients, but can be written at the counter by the pharmacist under the state’s standing order, DHHR spokeswoman Jessica Holstein said. 

West Virginia, like many states, has already had a standing order prescription that allows residents at risk of overdose, their family members and friends to purchase naloxone at pharmacies. But that doesn’t always mean the drug is accessible. 

According to Pollini’s 2022 purchase trial of more than 200 local and chain pharmacies across the state, only 29% of purchase attempts were successful. Among successful sales, the median cash purchase price was $136. 

Fewer barriers 

While the price for Narcan may limit who purchases it, over the counter Naloxone will not have barriers of training and documentation required for prescription form of the drug. 

Under the state’s standing order, pharmacies and organizations that distribute naloxone in the community must counsel recipients about opioid overdoses, instructions for using the product and their responsibilities as an attendant to the administration of naloxone. 

Organizations must submit monthly distribution data to the state Office of Drug Control Policy.

Pharmacies distributing prescription naloxone are also required to report it to the Board of Pharmacy the same way they would a controlled substance, including the name of the person picking it up.

“The reason for that is not to track people, but more to track numbers of distribution and where in the state it’s being dispensed,” said Lindsay Acree, an associate professor at the University of Charleston School of Pharmacy. “But in the end, it still is on their Board of Pharmacy report.”

In Pollini’s study, pharmacies asked purchasers to see an ID 176 times out of the 200. 

Nonprescription Narcan will not require training but the packaging includes consumer-friendly labeling with key information about administering the drug. 

Acree said having the drug available over the counter will make it easier for community groups to purchase it with grant funds and distribute it without the need for counseling and without having to collect data. 

Less stigma, more availability

While advocates say distribution events like this month’s Save A Life Day have helped to lessen the stigma associated with naloxone, some health workers are hopeful having it available over the counter may help it lower it even more. 

Danni Dineen, quick response team coordinator for the city of Charleston’s Coordinated Addiction Response Effort, said having the drug over the counter may help to normalize it and further reduce the stigma.

“If you can buy something over the counter — like… you can buy Tylenol. That’s normal. Nobody sees the harm in that, and people regularly pick it up,” Dineen said. “I think that it’ll really go a long way for folks who aren’t necessarily using. It’ll help reduce stigma and normalize it.”

Dineen’s team responds to overdose events in the city, providing naloxone and opportunities for treatment. Having naloxone over the counter may help reach areas of the city the CARE team does not, CARE director Taryn Wherry said.  

“We do our best to hit every area code, every part of the city, but we’re not touching every person in every place all the time,” she said. “So just like you can buy NyQuil or something like that over the counter, this is something else that a whole lot more people have access to. 

“People can call us anytime and we will take them naloxone if needed, but I think if you can walk into Walmart and buy something over the counter, it just makes the availability that much wider,” Wherry said.

What would help lower the state’s overdose death rate

Pollini said in order to lower the state’s high overdose death rate, naloxone and fentanyl test strips should be distributed to people who are at the highest risk. 

“We can blanket our communities with naloxone, but if those people at highest risk and the people around them don’t have it, then we’re not going to make a dent in our overdose deaths,” Pollini said. “So it needs to be targeted.”

In addition, all formulations of naloxone available over the counter, and be pushed to programs that interact daily with people at highest risk, she said.

“There are limited opportunities for that in West Virginia, because our harm reduction programs are so restricted,” Pollini said. 

Maynard said in a perfect world, opioid reversal drugs would be available free, with vending units in high-risk areas such as homeless shelters and drop-in centers.

“My dream for where we need to be going is where it is free to access for those that need it most,” Maynard said. “Because individuals that are in active use are not afraid to carry it. They keep it, they are becoming more aware of the drug supply and the risk that’s out there, and they want to be able to make safe decisions. 

“The financial piece of potentially having to pay $44 for it over the counter may become a limiting factor,” Maynard said. “But it is a step in the right direction to make it accessible for all.”