Editor’s Note: Dr. Scott Hadland is a pediatrician and addiction expert. He is the chief of Adolescent Medicine at Mass General Hospital for Children and Harvard Medical School, and spoke at the February US Food and Drug Administration advisory committee meeting on Narcan. Follow Dr. Hadland on Twitter, Instagram or LinkedIn. The views expressed here are his own. Read more opinion on CNN.
The first time I watched Narcan save someone’s life was after I administered the medication just outside my home in Boston, acting not as a doctor, but as a neighbor. It was 2016, the national overdose crisis was worsening, and because I worked as an addiction doctor for teens, I carried Narcan — an easy-to-use nasal spray that reverses an opioid overdose within minutes — wherever I went (and still do).
Walking home from work one evening, I found a neighbor slumped over, non-responsive and blue. I reached into my bag, pulled out Narcan, sprayed it in my neighbor’s nostril and called 911. Within minutes, he was awake, talkative and thankful. My neighbor was one of the now 5.6 million Americans who live with opioid addiction. He had used heroin that unbeknownst to him had been laced with fentanyl, a highly potent and lethal drug. The paramedics soon arrived and took my neighbor to our nearby emergency department, where he was offered further care, including the opportunity to start addiction treatment.
Last month, the US Food and Drug Administration (FDA) made the historic decision to make Narcan available to everyone over the counter. Starting this summer, anyone will be able to purchase Narcan directly from drug stores — as well as supermarkets, convenience stores, gas stations and vending machines.
The FDA’s decision comes amid a national overdose crisis. More than one million Americans have died of an overdose since the turn of the 21st century, and death rates are worsening. In 2021 alone, the US recorded nearly 107,000 fatal overdoses, the equivalent of an American dying every 5 minutes. Overdoses are becoming more commonplace because fentanyl has flooded the illicit drug supply, including in counterfeit pills made to look like real prescription medications such as oxycodone or Xanax. Fentanyl is also commonly a contaminant in other drugs like cocaine.
While the FDA’s move is a critical step to addressing our opioid crisis, this policy change alone will not be enough. Each of us will need to take action to capitalize on this important moment and ensure that the FDA’s move saves as many lives as possible. First, every one of us — as everyday citizens and members of our communities — should be prepared to address an overdose. Second, we must hold our policymakers accountable for ensuring that Narcan is affordable and accessible.
Being prepared to address an overdose requires having Narcan nearby. Even before it becomes available over the counter later this summer, each of us can request Narcan from a pharmacy now through a “standing order,” which allows pharmacists to dispense Narcan to anyone without a doctor’s prescription. If you have health insurance, it’s likely your plan will pay for all or most of the medication.
I recommend everyone consider keeping Narcan at home and carrying it with them in public. Opioid poisonings and overdoses are rising in unexpected populations. As a pediatrician, I’ve watched in shock as deaths among children and teens have skyrocketed. Toddlers can inadvertently ingest fentanyl through unexpected exposures to counterfeit pills at home or in public spaces. Adolescents might try a tainted pill they bought on social media. Most overdoses happen at home where someone could intervene, but unfortunately, in most cases, most children and teens who die do not receive Narcan and are pulseless by the time paramedics arrive.
Narcan is safe to use in people of all ages, including infants, children and adolescents. Keeping Narcan at home — much like having a fire extinguisher in case of an emergency — gives families the tool they need to respond to an overdose, when every second matters.
Next, we must demand that our lawmakers ensure that Narcan is affordable. To date, Narcan’s manufacturer has not publicly stated how much it will cost. The current out-of-pocket cost of a Narcan prescription without insurance is often at least $50 or even $100. Many of the families I care for who have insurance still struggle to pay even a $10 copay. Through regulation and in partnership with Narcan’s manufacturer, state and federal governments can help ensure that Narcan is as inexpensive as possible so that people actually buy it.
We should also make certain that policymakers fund programs to make Narcan widely available in our communities and schools. Many local health departments and other organizations currently distribute Narcan free of charge in their communities. After a string of teen overdoses, the Los Angeles Unified School District recently made Narcan available in all its schools. Such programs are publicly funded, and even after Narcan is available over the counter, lawmakers should continue to support them to get the medication to people who cannot afford it and in places where it is needed.
Some have argued that making Narcan widely available will encourage people to use more drugs — that if they know their overdose can be reversed, they will take more risks. This type of argument is common in public health debates about safety and is continually proven wrong. For example, in the 1980s, critics argued that mandatory seatbelt laws would lead people to drive more recklessly, an assertion that has been clearly disproven. Research shows that when Narcan is readily available, deaths decline and drug use does not increase.
With a simple intervention — little more than using a nasal spray and calling 911 — any of us can be a hero. The FDA’s decision to make Narcan over the counter gives us all a new way to access this lifesaving medication. But amid one of the greatest public health challenges of our time, we need to ensure that each of us is prepared to use it, and that we hold our lawmakers accountable for making it affordable and accessible.
