Narcan Now Available - Without Prescription

Retail Stores, Online Carry the Life-Saving Medication

In March 2023, the Food and Drug Administration (FDA) approved naloxone hydrochloride nasal spray for over the counter (OTC) nonprescription use. This was the first naloxone life-saving medication product approved for use without a prescription.

Naloxone – or more widely known by brand names Narcan, Evzio and Kloxxado - is a medication that rapidly reverses the effects of opioid overdose in minutes and is the standard treatment for opioid overdose.

Anyone who takes a prescription or non-prescription opioid is potentially at risk of experiencing serious, sometimes fatal side effects. An opioid emergency can happen anywhere but most often they happen at home and in front of a loved one. In the 12-month period ending in February 2023, more than 105,000 reported fatal overdoses occurred which were primarily driven by synthetic opioids like illicit fentanyl (Source: U.S. Food and Drug Administration - FDA).

"This approval from the FDA shows the progress that has been made by the Harm Reduction movement to chip away at the stigma that surrounds people who use drugs,” says Amanda Wroblewski, BCH’s PILLAR Program Coordinator.

The drug is just now arriving on store shelves and online at places like grocery stores, convenience stores and gas stations. Naloxone is covered by most insurance plans and available for free for some groups across Boulder County (such as University of Colorado students at Wardenburg Health Center and participants of The Works Program).

At Walgreens, a carton of two single-dose Narcan spray devices currently costs $44.99. Each device contains one dose of medicine. This price may still be a barrier for historically marginalized and underserved populations, and those in a lower socio-economic bracket, especially Medicaid patients.

There is a fatal overdose in Colorado every 4 hours, 45 minutes, and 9 seconds. (Source: StoptheClockColorado.org)

In Case of Opioid Overdose

Always dial 911 when administering the first dose of Narcan. Stay with the person until medical help is received.

Advice for Family Members & Friends

We asked Amanda Wroblewski: What can we do to help family members, friends, or neighbors who we know are using opioids?

• Don’t be afraid to purchase Narcan or to USE Narcan.
• Have honest conversations – but without judgment or punishment.
• Keep the Naloxone spray somewhere where everyone in your house knows where to find it and how to use it in the event of an opioid overdose.
• Naloxone is a stable medication, but it is also a liquid medication. Don’t keep it in your car because it could freeze overnight, rendering it useless. Frozen products can’t get up into the sinus cavity.

Additional tips from Wroblewski include:

• Know how to recognize an opioid overdose.
  • Slow, shallow, or no detectable breathing.
  • Unresponsive or unconscious.
  • Pale, blue, purple, or gray lips, face, and/or nail beds.
  • Loud snoring or gurgling noise.
  • Rigid arms and chest.
  • Slow or no pulse.
• Narcan is safe to use on someone even if they don’t have opioids in their system. You will not be prosecuted for saving someone’s life with naloxone.
• If you administer Narcan, stay with this person until EMS arrives.

“If we’re talking about a person who uses opioids regularly – always remember that they didn’t get to this place overnight,” says Wroblewski. “We shouldn’t be judging or trying to instill our personal bias onto them.”

Frequently Asked Questions

Q: Which formulation of naloxone is available for nonprescription use?

A: 4 milligram (mg) naloxone hydrochloride nasal spray (Approved March 2023) and RiVive, 3 milligrams (mg) naloxone hydrochloride nasal spray (Approved August 2023)

Other formulations and dosages of naloxone remain available by prescription only.

Q: Who can receive naloxone?

A: Naloxone can be administered to people of all ages, so it can also be used for suspected overdose in infants, children, and the elderly.

Q: What are additional tips for preventing overdose?

A: Don’t use alone. Start with a very small dose. Test drugs using fentanyl strips. If you are alone, call the Never Use Alone hotline at 800-484-3731.

Q: Will Medicaid pay for naloxone?

A: Only if Narcan is processed as a prescription by the pharmacy staff. Copays depend on the patient's setup with Medicaid.

Q: What is different about Fentanyl?

A: Fentanyl is contaminating all types of recreational drugs across Colorado. It’s an opioid that is 50 times stronger than heroin and 100 times more potent than morphine, making overdoses faster and more likely to be deadly. Drugs tainted with fentanyl make anyone vulnerable to an overdose. Test strips are available for checking fentanyl.

Q: Does naloxone work to reverse other drug overdoses?

A: Only opioids respond to Narcan. Xylazine, a non-opioid medication used as a sedative and muscle relaxant in veterinary medicine, is often being added to street drugs found in combination with fentanyl (a powerful synthetic opioid). Xylazine is often referred to as Tranq, which can increase the chance of an overdose.

Naloxone will not reverse the effect of Tranq. If you administer Naloxone to someone overdosing on opioids and Tranq, they may still be sedated after beginning to breathe again.

Q: What is Colorado’s 911 Good Samaritan Law?

A: Any person involved in a drug or alcohol overdose emergency who calls 911 for help is immune from arrest and prosecution for substance-related crimes. This rule applies to both the good Samaritan who dials 911 and the person suffering the overdose.

Q: Where to find local overdose prevention programs?

A: BCH’s PILLAR Program provides education to the Boulder community on the use/abuse of opioids and other substances, as well as chronic pain management. We act as a resource hub for substance abuse, mental health and medical support while also functioning as the bridge between provider, patient and referring agency.

The Works Program is a free, legal, and anonymous harm reduction program for people who use drugs and their friends and family in Boulder County.