Treating Overdoses Over the Counter

America’s overdose crisis has prompted a significant shift in the war on drugs. Just last week, Narcan, a medication that stops opioid overdoses, became available nationwide without a prescription for the first time.

The change, which the Food and Drug Administration approved in March, is part of a growing acceptance of a strategy known as harm reduction. Under that approach, policymakers focus first on limiting the dangers of drugs, not necessarily getting users to abstain. Democrats and Republicans long shunned harm reduction as too radical, but many in both parties have reconsidered their opposition in response to the high death toll from overdoses.

More than 100,000 people in the U.S. die of overdoses each year, mostly from the synthetic opioid fentanyl. That is higher than the number of people who die each year from homicides and suicides combined, as this chart by my colleague Ashley Wu shows:

The policy shift seems to be producing results. Overdose deaths have plateaued over the past two years, after more than doubling from 2014 to 2021. Narcan has played a role, even when it required a prescription, and policymakers hope that making it more accessible will reduce deaths further.

Shifting policy

Naloxone, the key ingredient in Narcan, has been around for decades, but its use caught on in recent years in response to the overdose crisis. The F.D.A.’s approval of Narcan, a nasal spray, in 2015 made naloxone easier to administer. And serious side effects are rare. So police officers and other emergency responders started to carry it to reverse overdoses they would have been powerless to stop before.

But public health advocates have called for many more Americans to carry naloxone to try to stop overdoses. (Here is a video guide from The Times on how to use it.) Greater availability of the medication is one of the most effective interventions against the drug crisis, experts have said.

“Everyone should be thinking about putting this into their first aid kit,” Dr. Kevin Ban, Walgreens’s chief medical officer, told CNN. “It’s really unlimited in terms of the folks who should make sure that they get some naloxone in the off chance that they come across someone who was experiencing an overdose.”

Of course, the ideal solution is to get drug users into addiction treatment so they can stop using harmful drugs. But that is not possible if they are dead. Narcan, like other forms of harm reduction, can keep people alive until they are ready to get help.

Until now, however, access was limited without a prescription. State and local officials tried to get around that restriction by issuing what is called a standing order, allowing pharmacists to distribute naloxone without a prescription.

But few people knew about the orders. If they did, they might have been too nervous to ask a pharmacist for naloxone because of the stigma attached to drug use. Putting the medication on store shelves and letting people buy it online could both raise awareness and make people more comfortable getting it.

The over-the-counter version is not cheap. Each two-dose carton will cost about $45, a price tag that will put the medication out of reach for many who need it.

Still, some insurance programs, including several state Medicaid plans, will cover naloxone without a prescription. And now that the F.D.A. has approved an over-the-counter version, other drugmakers will likely try to compete with cheaper alternatives.

Limited impact

Every story about policy successes against the overdose crisis, like Narcan, comes with a caveat: This helps, but only somewhat. What the crisis calls for, experts say, is a layered approach that simultaneously tries to keep people alive, get them into treatment and reduce access to dangerous drugs. The strategy is often compared to stacking Swiss cheese, with each slice helping cover the others’ holes.

Naloxone is only one slice.

Related: In places with more overdose deaths, the job of restaurant workers now includes administering Narcan.

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