The Life-Saving Overdose Treatment Narcan Is Now Available Over the Counter—Here’s What You Should Know
So the recent news that the Food and Drug Administration just approved one of the manufacturers of the medication Naloxone, also known as Narcan, for over-the-counter purchase was greeted by many with cheers. Previously, the life-saving, overdose-reversing medication had only been accessible via prescription or through harm-reduction programs and participating pharmacies. Now, anyone who wants to have some on hand will have access, no questions asked.
- Kelly Johnson-Arbor, MD, medical toxicologist and co-medical director of the National Capital Poison Center
- Stephen Gilman, MD
What is Narcan?
This medicine is an antidote that can reverse an opioid overdose and restore breathing in a previously unconscious or non-breathing person in two to three minutes, according to the Centers for Disease Control (CDC).
“Opioids, including morphine, heroin, and fentanyl, cause pain relief as well as sedation and a slowed or absent respiratory rate,” says Kelly Johnson-Arbor, MD, an emergency medicine physician and medical toxicologist, and co-medical director of the National Capital Poison Center. Narcan prevents opioids from binding to receptors, which can reverse the effects of opioid overdose, including life-threatening respiratory depression.
However, it's not absorbed effectively when taken by mouth, Dr. Johnson-Arbor explains, which is why it is most commonly available to consumers as a nasal spray. It is also sometimes given as an injection in medical settings.
How can Narcan help with the opioid crisis?
Though they have a purpose in setting medical settings, opioids are highly addictive, and the opioid crisis in the country has increased rapidly in the last two decades. In particular, fentanyl, a highly potent opioid that can cause an overdose with a drastically smaller portion, has been the main driver of more recent overdose stats: There was nearly a 7.5-fold increase in fentanyl-related deaths from 2015 to 2021.
One study found there was a bystander present in about one-third of opioid overdose deaths—which is why Narcan is such an important medication to have access to. Many harm reduction efforts have targeted both education around the use of Narcan for reversing an overdose, and the distribution of test strips for recreational drugs, since many overdoses occur because individuals aren’t aware that their drugs have been cut with fentanyl.
How do you use Narcan?
When you buy Narcan, the instructions will indicate exactly how to administer the medicine, and when to do so for someone who may be experiencing an overdose. You can also take a training class, either online with a harm reduction or public health education organization or at a community organization near you.
“Intranasal Narcan is easy to use: Remove the device from the package, place and hold the tip of the nozzle in the nostril of an affected individual, and press the plunger to deliver the Narcan into the nose,” says Dr. Johnson-Arbor. The person does not have to be breathing normally in order for intranasal Narcan to work.
“The effects are short-acting, and multiple doses may be needed to establish normal breathing in a person affected by opioid overdose,” says Dr. Johnson-Arbor. "Of course, anyone receiving an emergency dose of Narcan should also be given emergency medical care by calling 911."
One thing to keep in mind: The medication also does not have any negative effects on a person if they are not experiencing an overdose, since its sole purpose is binding to opioid receptors in the brain. There's no need to be worried about using it if it's unclear whether someone is overdosing.
Most adverse events associated with Narcan are related to its ability to cause opioid withdrawal symptoms. (Emergency medicine physicians sometimes recommend stepping away from someone after you've administered Narcan—they may be angry or violent when revived.) While withdrawal may be unpleasant, symptoms are rarely life-threatening and often resolve within hours, Dr. Johnson-Arbor explains.
To be clear: Narcan does not increase opioid use
Harm reduction organizations and activists have been fighting for Narcan access to expand since it is such a simple and life-saving tool in the fight against the opioid epidemic. Still there’s a lot of stigma surrounding harm reduction efforts with regard to addiction, unfortunately.
“Some believe that by giving someone who is actively addicted to opioids Narcan that they will simply continue to volitionally use opioids,” says Stephen Gilman, MD, an addiction psychiatrist in New York City. “There are also false misconceptions that increasing access to Narcan will increase people’s use of opioid drugs.” These are categorically false, Dr. Gilman firmly states. “The availability and the use of Narcan does not increase the incidence of opioid dependence and does not increase the 'recreational' use of opioids."
With the current opioid epidemic, the widespread availability of Narcan is essential to minimize the increasing risks of opioid overdoses and subsequent deaths.
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