The Food and Drug Administration has approved 4mg nasal spray naloxone (Narcan) for over-the-counter (OTC) use, the first naloxone product approved for use without a prescription. Naloxone rapidly reverses the effects of opioid overdoses.
CLAIRE ZAGORSKI; claire.zagorski@austen.utexas.edu
Zagorski is a paramedic and harm reductionist, supporting overdose response programming and research at the University of Texas at Austin College of Pharmacy’s PhARM Program.
On Twitter, Zagorski celebrated the OTC approval of Narcan. But there are also tradeoffs to the good news. She told the Institute for Public Accuracy: “When prescription drugs move to OTC, there’s [usually] a period” where the drugs remain expensive. In states like Texas, where Zagorski is based, “keeping [Narcan] prescription-only was confusing. It’s very reassuring and clarifying to organizations that may have been reticent to put [Narcan] out into the community without clinician oversight… We can say it’s safe as many times as we want,” but the public may remain fearful “as long as it’s prescription only.” Zagorski wrote: “As someone who’s worked to get naloxone distributed in a conservative state, the OTC approval is also going to be huge for the message it sends.”
“We need rapid movement” to make Narcan cheap and accessible, Zagorski added. “It’s cheap to produce and easy to show people how to use and administer it. So I’m very hopeful that the price will drop quickly.”
Zagorski has also critiqued some of the higher-dose naloxone products that remain on the prescription market. Higher-dose opioid antagonists often lead to a more rapid onset of intense withdrawal symptoms, known as precipitated withdrawal, like goosebumps, diarrhea, and chills. Zagorski noted that a 4mg dose is already a dose that is most often high enough to reverse respiratory depression (when breathing slows down).