More Michigan pharmacies may soon carry Narcan, which can reverse opioid overdoses, following federal action to increase access to the drug earlier this year.

Addressing an opioid epidemic that killed 83,000 people nationwide in 2022, the U.S. Food and Drug Administration in March approved Narcan, made with the drug naloxone, for over-the-counter use.

Emergent BioSolutions, which manufactures Narcan, expects that the emergency medicine will be available by September. The company has already shipped thousands of kits, which are expected to hit the shelves soon.

“Early fall this year is when you’re going to start to see more over-the-counter naloxone,” said Jared Welehodsky, senior analyst for the Michigan Department of Health and Human Services

Nearly 50% of Michigan pharmacies have sold Narcan since 2017, after the Legislature passed a standing order that allowed people to buy it without a prescription,

Now that the medicine has become more accessible, all pharmacies can sell it over-the-counter.

Narcan is only effective on overdoses caused by opioids such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine, codeine and synthetic fentanyl.

In Michigan, overall drug overdose deaths fell 4% last year to 2,993. Nationwide, some 80% of overdoses involve opioids, and life-saving actions were present in 60% of drug overdose cases, according to the U.S. Centers for Disease Control and Prevention.

How it works

Narcan usually takes 2 minutes to 3 minutes to work. Each dose contains 4mg of the medicine, but multiple doses may be needed. The effects can last for as little as 20 minutes or up to two hours.

The three major signs of an overdose are very slow, irregular, or no breathing; blue, purple, or green lips and fingernails; and unresponsiveness to pain, said Gina Dahlem, a University of Michigan clinical associate professor of nursing who works with Opioid Prescribing Engagement Network Statewide initiative.

“Other signs can include tiny pupils, choking sounds ,or snore-like gurgling noises,” she said.

After taking the medication, side effects include nausea, diarrhea, vomiting, chills, muscle aches, and increased agitation, which is why it is for “emergency accidental overdose situations” and not for regular use, Dahlem said.

Where to find it 

Narcan was approved for over-the-counter sales in 50 states, the District of Columbia and Puerto Rico by the U.S. Food and Drug Administration, but it is more likely to be found in national pharmacy chains like CVS, Walgreens and Rite Aid, which also offer them online.

Narcan kits also increasingly are available for free in vending machines statewide, as part of an effort by health agencies and nonprofits to address the epidemic.

CARE of southeast Michigan, like many other advocacy groups, offers free Narcan kits along with resources to anyone who needs them. “In the state of Michigan, nobody should have to pay for it,” said Mark Kilgore, coordinator for Project Vox, CARE’S recovery advocacy group.

People feel more comfortable coming into the office to get Narcan because it is a judgment-free zone, he said.

“We don’t ask a bunch of questions,” Kilgore said. “We treat them with respect and dignity.”

How much will it cost

Emergent BioSolutions suggests $44.99 as the retail price, but the company notes that ultimately, individual retailers set the price.

Medicaid will cover over-the-counter Narcan but federal rules still require a prescription in order to receive that coverage. Medicaid will cover the costs only for recipients with a prescription.

Narcan is not covered under Medicare (Part D), which by law can’t cover over-the-counter medications, but some exceptions apply.

“We are concerned that there is the potential for patients to no longer receive insurance coverage and or have to pay out of pocket in full and if so, the cost could become prohibitive for many,” said Chad Brummett, co-director of the Opioid Research Institute at the University of Michigan.

On the other hand, Brummett points out that people will no longer have to disclose their need for Narcan now that it is available over-the-counter.

Other medications

In July, the U.S Food and Drug Administration approved a second naloxone spray, RiVive, a 3 mg nasal spray, for over-the-counter use.

Harm Reduction Therapeutics, the nonprofit pharmaceutical company that makes RiVive, said it will be available primarily to treatment centers and state governments in early 2024, “for costs lower than other opioid antagonist nasal sprays.”

In the same month, the agency also approved the first generic version of Narcan for over-the-counter use, made by the company Padagis.