Over-the-counter Narcan will save lives — once we know how to use it

The FDA’s recent approval of the anti-overdose drug naloxone (brand name Narcan) as an over-the-counter medication has given us greater access to a powerful tool to save lives and is a step forward in fighting the ongoing opioid overdose epidemic ravaging cities across the United States. 

It also does not go far enough.

We echo arguments made by advocates quoted in this publication: Regulations may have made naloxone more available on paper, but in practice, having to purchase the medication at a pharmacy still poses a significant barrier. As one story said: “the people who need naloxone the most are also the least likely to go to a pharmacy and request it.”

That’s why opioid overdose prevention must include making naloxone widely available (at no cost when possible) and enabling regular citizens to administer this life-saving drug through education and training. Our own research found that, while we must make naloxone widely available, we must also address the stigma and concern about how to use naloxone correctly. The public is worried about causing harm, but proper education can help reinforce that administering naloxone can only help — it’s harmless if given to someone not experiencing an opioid overdose.

In this regard, New York State’s opioid overdose prevention program is an example of how to go further: naloxone is available at no cost through nearly 1,000 programs found across the state, alongside a required, but accessible, training module. In addition, insured individuals can get naloxone at no out-of-pocket cost at a participating pharmacy through the Naloxone Co-payment Assistance Program, though some worry about insurance-connected stigma for doing the right thing and carrying naloxone.

One population with tremendous potential to make an impact can be found on colleges and university campuses. In fact, New York is once again a leader in this area. Gov. Kathy Hochul (D) signed a law in 2022 requiring New York State Public College housing units to have opioid antagonists (i.e., Narcan) on hand in case of an overdose.

At Columbia, we’ve taken the findings of our research to heart. Given our highly mobile campus population of students, faculty and staff who live and work all around a city with high overdose prevalence (New York City) and who travel beyond state lines and abroad regularly, Columbia University became a Registered Opioid Overdose Prevention program in 2019. Through our program, we have trained more than 3,200 individuals who now can recognize the signs of opioid overdose and safely administer naloxone wherever they may be. We firmly believe that individuals carrying naloxone with them (compared to kits in buildings) is a better solution ensuring it is available where and when needed to save a life.

Our program outcomes support the idea that empowering and equipping individuals to carry naloxone facilitates greater access: Of the 13 reported lives saved so far, all the naloxone administrations were performed off-campus. In addition, the person administering naloxone was a Columbia community member but the person they were assisting was not Columbia affiliated. A person carrying naloxone can and does save lives.

An added benefit of community-based programs such as ours is its ability to address stigma and make the act of naloxone administration and the fact that overdoses happen part of the conversation. Comprehensive, no-cost programs are working to normalize the act of saving a life through naloxone administration and giving individuals tools to have critical conversations with individuals, loved ones and community members who use opioids. 

The opioid overdose epidemic is a complex, multi-layered public health crisis that won’t be solved by blanketing the country with naloxone. But it will help. Removing financial and geographical barriers to access and empowering millions of individuals to be part of the solution is the only way to realize the life-saving potential of naloxone.

Michael McNeil Ed.D. is the program director of the Opioid Overdose Prevention Program, a Mailman School of Public Health faculty member, and the associate vice president & chief of staff of Columbia Health, all at Columbia University. 

Melanie Bernitz MD is the medical director of the Opioid Overdose Prevention Program, a Vagelos College of Physicians & Surgeons faculty member, and the senior vice president of Columbia Health, all at Columbia University.