FDA approves opioid treatment Narcan for over-the-counter

Narcan is currently in use by medical professionals and first responders but the recent FDA approval would allow for it to be purchased in stores.


© David Tucker / USA TODAY NETWORK

Michael Feldbauer, president of the Flagler County Drug Court Foundation, holds a Narcan nasal spray and the demonstration device, Saturday February 4, 2023 during a training session at Iglesia Pentecostal Ebenezer de Bunnell Church. Narcan reverses drug overdoses caused by opioids. Dtb Flagler Narcan 9

Archie Wagner, News Reporter

The access to use and training to administer the opioid-overdose antidote naloxone, also known by brand name Narcan, is expanding for Johnson County residents, law enforcement, and emergency responders.

The U.S. Food and Drug Administration announced its approval of naloxone for over-the-counter use on March 29, with the rollout expected later this year. The approved medication will be available in a naloxone hydrochloride nasal spray.

The Iowa City Police Department patrol officers have carried naloxone since fall 2020, Iowa City Public Safety Information Officer Lee Hermiston wrote in an email to The Daily Iowan.

Iowa City law enforcement saved 10 lives in 2021, six lives in 2022, and six lives so far in 2023, Hermiston wrote.

“Equipping our officers with Narcan has allowed us to save lives and will give us the vital opportunity to help others in the future,” Hermiston wrote.

Alisia Meader, education supervisor for Johnson County Ambulance Services, has been in the emergency medical services field since 2008. Meader said naloxone has always been in ambulances as advanced life support providers.

Johnson County Ambulance Services first responders were recently trained how to administer naloxone to increase the number of first responders certified to carry it, Meader said. She said the training highlights signs and symptoms of an overdose, what a patient will experience when given naloxone, and the risks for the patient if they don’t go to a hospital.

“I know it’s over the counter now, and you can walk into a pharmacy and get it, which is good, but also it’s important for us to have more availability of Narcan as well within our community,” Meader said.

Chantal Rozmus, who sits on the Board of Directors for the Iowa Harm Reduction Coalition, said she is excited about the FDA’s approval of naloxone for over-the-counter sale.

The Iowa Harm Reduction Coalition is a community-based nonprofit, which aims to create health equity in Iowa communities.

“I want more people to be able to have Narcan in their hands,” Rozmus said. “I think it would be amazing if people could just go into Walgreens or go into their pharmacy and ask for it over the counter and be able to buy it.”

Having more naloxone accessible to people will result in a greater reduction and reversals of drug overdoses, she said.

Rozmus said the Iowa Harm Reduction Coalition sends out free naloxone to people on request, and with the over-the-counter accessibility, it might lengthen their supply for those who can’t afford it.

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In addition to serving on the board of directors, Rozmus said she is a child and adolescent psychiatry fellow, and she works in a medication-assisted treatment clinic.

“I can prescribe Narcan if I have a patient who is actively using or even if you go have surgery and you get pain medications afterward. Oftentimes, the doctor will write a prescription for Narcan just to be really safe,” Rozmus said. “But insurance covers it. With this going over the counter, my fear is that insurance won’t be able to cover it.”

Thomas Romano, a University of Iowa Carver College of Medicine third-year student, said the approval of naloxone for over the counter is likely to increase its accessibility.

“Previously, you needed a prescription. The prescriptions were, in theory, widely available,” Romano said. “But there’s still a lot of barriers. You still need to go speak to a health care professional, have it run through your insurance, and go to a pharmacy to pick it up.”

Romano said many people are discouraged from trying to get naloxone because of the challenges of obtaining it.

“A lot of people are treated poorly when they go and ask for these things, which is unfortunate because it’s a literal antidote for fentanyl poisoning,” he said.

When opioids enter the body, Romano said, it activates opioid receptors on the surface of the cells. When these receptors are activated, that’s when the side effects, including euphoria, respiratory depression, and slower breathing, occur.

When Narcan is utilized, it binds strongly to the receptors and prevents them from being activated, Romano said.

“So, whatever opioids are floating around the system cannot actually interact with the body, which is why they work so well for every single opioid out there, from fentanyl to morphine,” he said.

With a half-life of 90 minutes, naloxone doesn’t last as long as opioids do, which is why multiple doses of naloxone are usually given to people, Romano said.

“This is definitely a really big important step forward,” Romano said. “It looks like it might be about $50 still for like two doses, which is a lot.”

In addition to being out of reach for some financially, Romano said he also isn’t sure how many pharmacies will stock it.

“We see that with other harm reduction supplies like syringes, sometimes stores just won’t stock them,” Romano said. “They feel like, by selling syringes, they’re supporting drug use, or because, you know, it’s not making them money.”