How to Get Narcan for Free
The prescription drug naloxone can reverse an opioid overdose and save lives, but access can be difficult for the uninsured. Here’s how to get this lifesaving medicine.
Between May 2022 and April 2023, more than 80,000 Americans are thought to have died from an opioid overdose, according to preliminary data from the Centers for Disease Control and Prevention (CDC). That grim statistic is actually estimated to be much higher — more than 84,000 — because this early data reflects incomplete and underreported estimates, according to the CDC. The numbers also show that most of the opioid overdose deaths were caused by synthetic opioids, such as fentanyl, a drug that can be up to 50 times stronger than heroin and 100 times stronger than morphine.
Because the opioid crisis doesn’t appear to be stopping, public health leaders are pushing for easier access to medication that can save someone’s life by reversing an opioid overdose.
Naloxone, which is sold in the United States under the brand names Narcan and Zimhi, is a nasal spray or injection that stops an opioid overdose once it’s in progress. In March 2023, the U.S. Food and Drug Administration (FDA) approved an over-the-counter (OTC) version of Narcan nasal spray that can be bought without a prescription, and in July 2023, the agency approved another OTC nasal spray, called RiVive. The type of naloxone that’s available to the public is almost always a nasal spray. (Prior to these OTC drugs, in response to the opioid epidemic that has gripped the nation over the past several years, the federal government made it legal for pharmacies and healthcare facilities to distribute naloxone without a prescription — called a standing order).
Unfortunately, the out-of-pocket price of naloxone for people who are uninsured remains a key barrier. An investigation by the RAND Corporation, an American nonprofit research organization that develops solutions to public policy challenges, determined that the out-of-pocket price of naloxone has gone up significantly since 2014, while the price for some insured people has gone down.
The report, published in August 2022 in JAMA Health Forum, found that in 2014, the average out-of-pocket cost per naloxone prescription among all insured people was $28, compared with $35 for people who were uninsured. But, by 2018, the average out-of-pocket cost for the uninsured had jumped nearly sevenfold, to $250. That same year, the average cost was cut by almost 26% for insured people, to just $18. (Note: This was due to a large drop in cost for Veterans Affairs/Tricare beneficiaries. People with private insurance or Medicaid saw a rise in their average cost from 2014 to 2018).
And, while the federal approval of OTC naloxone has the potential to make the drug more widely available, there are several real-world barriers that may hamper widespread access, according to KFF, a nonprofit foundation engaged in research, journalism, and communications programs that focuses on healthcare issues. These hurdles include the lack of awareness about the drug; the fact that pharmacies may not want or be financially able to carry the drug; and the cost of OTC Narcan — about $45 for two doses (4 mg) of nasal spray, making it too expensive for many individuals and loved ones who may want to carry the medication as a precaution.
Although buying naloxone from a pharmacy remains expensive without insurance, even with coupons from companies such as SingleCare and GoodRx, many state governments and harm reduction organizations — groups that focus on minimizing the impacts of drug use when a person is using — have programs that allow people to access naloxone for free or at a very low cost. You just need to know where to look.
“In an environment where opioid overdoses are the leading cause of accidental death, making an antidote to an overdose much easier to access is a no-brainer. It will save lives,” says Andrew Kolodny, MD, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management in Waltham, Massachusetts.
Dr. Kolodny adds that better naloxone access alone will not be enough to get the epidemic under control. “We really have to do a much better job of treating people who are addicted to opioids.”
Before accessing naloxone, it’s important to follow one key safety rule: Never use drugs alone, says José Martinez, a harm reduction associate at the National Harm Reduction Coalition, which works to provide educational information about safer drug use, increase access to naloxone, conduct overdose prevention trainings, and more. That’s because a person who is overdosing cannot administer naloxone to themselves.
If it’s not possible to have someone present while using, Martinez recommends calling Never Use Alone Inc., a free national hotline for people who are using to make sure they have someone who will call for emergency medical assistance if they are suspected of having an overdose.
“Volunteers talk to them while they are using, and they will come to an agreement, like, ‘I’m going to call your name out, and if you don’t answer by the third time, I’m going to call EMS,’” Martinez says.
Another safety concept to understand before administering Narcan nasal spray, according to Michael Litterer, a certified prevention specialist and vice president of prevention and recovery at RWJBarnabas Health Institute for Prevention and Recovery in Eatontown, New Jersey, is that a person who overdoses but receives naloxone still needs emergency medical assistance.
“The half-life of naloxone is much shorter than the half-life of opioids, so they can go into an overdose again,” he says.
Because laws and government-funded programs for harm reduction vary not only by state but also by city and county, it can be difficult to figure out where to find naloxone for free. Below are the best places to start when searching for free or low-cost Narcan nasal spray close to you.
NEXT Distro is probably the most comprehensive resource for naloxone and the organization that all of the experts recommend first. The website has a searchable database that organizes resources by state and gives a brief explanation of the laws around Narcan in each state.
Just click on the state you live in and follow the links to harm reduction clinics, hospitals, and other places in your area where you can pick up a low-cost naloxone kit. If there aren’t any in your area, you can request that NEXT Distro send you naloxone in the mail. This isn’t available in every area, but NEXT Distro makes it clear whether or not you’re able to access a medication kit by mail.
Litterer recommends doing a quick internet search for harm reduction organizations in your area. You can also check the National Harm Reduction Coalition’s website to see if there are any organizations near you. Many have naloxone on hand that they can give away to people who think they may be at risk of an opioid overdose.
Many state health departments have created initiatives that provide people with Narcan nasal spray for free, but these can be a bit difficult to find and navigate. NEXT Distro lists state websites in its database, but you can also search for your state and “free naloxone program” or “opioid harm reduction program” to start. You might also try the same search using your city or county instead of your state, says Martinez.
Finally, you can check for free or low-cost naloxone at local hospitals, says Litterer. Some hospitals, including RWJBarnabas Health in New Jersey, have implemented programs that allow the hospitals to keep naloxone on-site to be distributed to patients. There may be stipulations on who can access it, such as only people who have been admitted to the emergency department because of an overdose. Making a quick call to local healthcare facilities and hospitals could end up putting naloxone in your hands faster than getting it by mail.
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