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Opioid overdose nasal sprays available over the counter

Local community health centers applaud increased access

Avery Bleichfeld
Opioid overdose nasal sprays available over the counter
PHOTO: COURTESY DISTRO UNSPLASH

Local community health centers are celebrating the federal government making Narcan, a nasal spray medication used to treat opioid overdoses, available over-the-counter nationwide for the first time last week, after approval earlier this year by the U.S. Food and Drug Administration.

The switch means the Narcan-brand nasal spray formulation of the drug naloxone can be sold in pharmacies to any patient, without a prescription. Naloxone can be administered to an individual who has overdosed on opioids to counteract the drug’s effects.

Opioid-related overdose deaths in Massachusetts rose in 2022 from the year prior, according to data from the Massachusetts Department of Public Health.

Stephen Wright, medical director at Whittier Street Health Center, said, “Every opportunity to save lives is a great opportunity. I think, with Narcan being available over the counter like this, it hopefully will move the needle in the right direction [in treating opioid-related overdose deaths].”

Renee Crichlow, chief medical officer at Codman Square Health Center in Dorchester, said she thinks Narcan could become part of the first aid available in the public arena. She compared knowledge of how to administer the medication to knowing how to give someone CPR.

“We have emergency response equipment in public,” Crichlow said. “This should be a part of emergency response equipment in some way. … It’s really about the risk potential; it’s the EpiPen of overdoses.”

For some community health centers, offering Narcan to anyone who wants it isn’t new. Wright said at Whittier Street Health Center, staffers have been offering Narcan to everyone for as long as he can remember.

“We have a number of patients who are maybe on opiate medications to treat their chronic pain, and it’s always a safety net to have something like Narcan,” he said.

Wright said anyone can carry Narcan, but it is especially useful for people who are taking opioids for chronic pain or after surgery ,as well as family members and friends of people who take opioids.

“I think it really crosses the gamut,” he said. “If you’re going to be on opiates, you should have it on hand. That’s just in case—we never know how a person is going to react to a medication.”

Diana Sención, manager of the Day Engagement Center at the Whittier Street Health Center, said it’s important for community members to know how to use the drug. The Engagement Center, which serves patients experiencing homelessness, offers training every six months for clients and staff on how to administer Narcan.

Sención said she thinks there’s a need for greater education around the drug.

“There should be a billboard that says, ‘Pick up Narcan, save a life,’” she said.

The Day Engagement Center, which is located next to the Whittier Street Health Center’s main building on Tremont Street in Roxbury, offers Narcan for free. Sención said that anyone can walk in and ask for it and staff at the center give it out without asking any questions.

As pharmacies begin to make it available over the counter, questions remain about how the change will increase access. While the switch will mean more people will be able to get Narcan, over-the-counter medications are not generally covered by insurance, and a high price point could limit its actual availability, Crichlow said.

“It’s definitely something that we still want to be able to prescribe and supply for patients at risk, but if insurance coverage in some way is compromised, then that would be a really big concern,” Crichlow said.

Narcan has a suggested retail price of $49.99.

The U.S. Food and Drug Administration first cleared Narcan for over-the-counter sale in March, the first naloxone nasal spray product it has approved for nonprescription use. The agency approved a second naloxone nasal spray, RiVive, in July, which is expected to be available in pharmacies in 2024.

At the time of its approval, FDA Commissioner Dr. Robert Califf said general access to Narcan would help address “evolving complexities” in the opioid overdose crisis.

“Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country,” Califf said in a March 29 news release.

Community health centers say access to the drug is important to address the opioid overdose epidemic in Massachusetts, which has been growing in recent years. According to data released by the Massachusetts Department of Public Health in June, there were more than 2,300 confirmed and estimated opioid-related overdose deaths in the state in 2022, a 2.5% increase from the previous year. Rates among Black people made up the largest increase.

Naloxone was previously made available to Massachusetts residents without a prescription. In July 2022, to increase accessibility, the Department of Public Health issued a statewide standing order that allowed retail pharmacies to dispense naloxone to anyone.

The standing order will continue to allow pharmacy patients to obtain prescription formulations of naloxone without patient-specific prescriptions, according to a Department of Public Health spokesperson. The state will also continue managing its existing bulk-ordering system for qualified organizations that provide free naloxone to communities in need.

Narcan, opioid, Opioid-related overdose