• Posted September 16, 2025

Over-The-Counter Sales Of OD-Reversal Drug Have Been A Bust

Over-the-counter sales have tanked for the overdose reversal drug naloxone, likely due to its high price, a new study says.

Naloxone (Narcan) is a nasal spray that rapidly reverses an overdose by blocking opioid receptors in the body. It has been a key weapon in fighting America’s opioid drug crisis.

To that end, regulators in September 2023 made naloxone available without a prescription, hoping to get the medication into more hands and potentially save more lives.

Sales peaked during the first month of availability, but then dropped off rapidly, researchers reported Sept. 15 in JAMA Internal Medicine.

Worse, peak over-the-counter sales for naloxone only reached about 7.5% of the quantity sold by prescription, results showed.

The average cost for a two-pack of naloxone is nearly $45 over-the-counter, researchers noted.

“It’s likely that the relatively high cost of over-the-counter naloxone has contributed to the limited sales,” said lead researcher Dr. Bradley Stein, a senior physician policy researcher at RAND, a nonprofit research organization.

“That cost is likely going to limit over-the-counter sales of this important medication in the fight against the nation’s opioid crisis,” he said in a news release.

The number of Americans who died from opioid ODs declined in 2023 for the first time in many years. Experts attribute this in part to the increased availability of naloxone.

However, Americans typically obtained naloxone either through a prescription or from a free distribution program, until policymakers approved its over-the-counter sale.

For the new study, researchers analyzed sales information for over-the-counter and pharmacy-dispensed naloxone in 2023 and 2024.

They found that an average 396 over-the-counter packs of naloxone were sold per million U.S. residents between September 2023 and September 2024.

By comparison, pharmacies dispensed an average 7,063 units of naloxone per million in 2023 between August 2022 and August 2024, and free distribution programs an average 12,015 per million.

Biweekly over-the-counter naloxone sales peaked at about 22.5 units per million between Sept. 16 and Oct. 21, 2023, then fell to about 15 units per million in early December 2023, results showed.

Sales have since hovered between 11 and 15 units per million.

“While the FDA’s approval of over-the-counter naloxone was intended to facilitate access to this life-saving medication, we found there was only limited uptake for over-the-counter sales,” Stein said.

More research is needed to better understand the factors influencing demand for over-the-counter naloxone, researchers said. Promoting visible placement in retail pharmacies and groceries or requiring health insurance to cover over-the-counter naloxone might boost sales, they added.

More information

The U.S. Centers for Disease Control and Prevention has more about naloxone.

SOURCE: RAND, news release, Sept. 15, 2025