Naloxone OTC? What this might mean for patients and providers

In a move that could change the lives of millions, the FDA is now considering the choice to make Narcan – the naloxone nasal spray medication that reverses opioid overdoses – available without a prescription. This comes on the heels of a unanimous vote by FDA advisors in favor of the move and after overdose fatalities hit historic highs in 2021.

But beyond expanding access to the life-saving drug, what other impacts can making naloxone available over the counter (OTC) have on patients and providers? 

In this blog, we detail the scope of the opioid crisis and how pharmacists can leverage their prescribing authority and specialized medication knowledge to improve patient health outcomes at scale while supporting public health initiatives.

Pharmacists are on the front lines of the opioid epidemic

The opioid crisis has been the most pressing medical emergency in the US in recent years. Between 1999 and 2019, more than 500,000 people died from overdoses. And with the growing supply and popularity of synthetic opioid, fentanyl, that number continues to escalate at an alarming rate.

We’ve previously highlighted how pharmacists’ prescribing authority helps address the opioid crisis. And while regulating the prescription of opioids certainly helps limit overdoses, it’s an involved process that requires dutiful patient monitoring, extensive medication knowledge, and (most importantly) time.

In overstretched networks, availability is hard to come by – and even more difficult for providers to regularly carve out. And when providers are strapped for time, other strategies proven to reduce opioid abuse and the risk of overdoses (educating patients on risks, dispensing naloxone, using prescription drug monitoring programs, etc.) aren’t implemented as effectively.

This is where leaning on pharmacists – more specifically, technology-powered pharmacists – becomes a necessary component of any opioid-related care in the US.

OTC Naloxone won’t automatically grant patients easy access

Today, a critical strategy that pharmacists deploy in their efforts to reduce overdoses and opioid abuse is prescribing and administering naloxone. And even with the possibility of naloxone being available otc, that won’t change. Why? There are two key reasons:

  1. There still may be restrictions on a state-by-state basis. Though having Narcan approved for otc use will help increase access, it’s not a silver bullet. Protocols may vary between states. And while all 50 states currently ​​allow an individual to obtain naloxone without a prescription in some capacity, 14 states require cooperation between a prescriber and a pharmacist.
  2. Naloxone otc could be cost prohibitive to patients. Naloxone being available and being affordable are two different concepts. And naloxone’s otc availability doesn’t necessarily have any bearing on its cost. Low-income patients that want naloxone, whether for themselves or others, still may need assistance finding the most affordable options for the medication.

In both situations, technology-powered pharmacists can play a crucial role in expanding access to life-saving naloxone. For instance, say you’re a clinical pharmacist in rural Kentucky (one of the states that currently requires a prescriber and pharmacist to create their own standing order).

You have a patient who’s just undergone an invasive surgery and received a prescription for oxycodone from their provider. The patient wants naloxone as a cautionary measure. Of note, Kentucky doesn’t have a naloxone co-prescribing mandate, and this patient’s payer also doesn’t cover naloxone.

So you start the process of finding affordable naloxone for your patient. You first log in to your value-based pharmacy system where you message the patient’s provider and create a standing order for naloxone. You then start researching affordable ways for the patient to access naloxone (patient assistance programs, discount programs, etc.) which you can then share with the patient during a consult.

This comprehensive value-based pharmacy system also lets you monitor the patient’s medication regimen over time, which means you can deliver care with the most up-to-date information available. Whether your patients are renewing or finishing their oxycodone prescriptions, you have visibility. And that’s a key factor in improving health outcomes, not just at a patient-by-patient level, but also at scale.

Pharmacists and other providers will need to double down on educating patients

Though naloxone otc won’t guarantee access to every patient, it will increase access. And this gives pharmacists a unique opportunity to promote broader awareness and knowledge around naloxone and the opioid epidemic as a whole.

At first blush, it seems this responsibility falls on physicians. But physicians rarely have the flexibility in their schedules to consult with patients on their prescriptions for longer than a few minutes. Not only that, but physicians don’t always have a deep knowledge of opioids or related information (drug interactions, barriers to access, adherence hurdles, etc.).

Pharmacists, however, have that expertise. And if the clinical pharmacists on your team are already overloaded, you can tap into a fractional network of pharmacists to consult with patients who want to better understand their prescriptions, naloxone administration, and the opioid crisis.

Access to medication without education – even with a medication as safe as naloxone – lays the groundwork for public health problems down the line. Fortunately when it comes to anything medication-related, pharmacists are the best educators.

This is also why pharmacists are uniquely positioned to promote positive health outcomes and help curb opioid abuse more broadly in the US.

The pharmacist is a trusted partner – for patients and providers

Whenever discussing or dealing with an issue as serious as the opioid epidemic, people are inclined to refer to what they know. But if people’s knowledge is rooted in stigmas and inaccurate information, that exacerbates the crisis at hand.

Drugs like naloxone must be administered quickly for the recipient to benefit. If patients don’t know this, or how to administer naloxone, that’s a problem. And it ties back to education. The takeaway here: an educated public is a healthier, safer public.

Interested in learning how leveraging a fractional network of pharmacists or a comprehensive value-based pharmacy system can help you combat the opioid crisis? Shoot us a message.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.