It’s been a banner day for the effort stop opioid overdoses: the U.S. Food and Drug Administration announced that it has approved Narcan, a nasal-spray form of the opioid-overdose-reversing drug naloxone, for over-the-counter use without a prescription. The change is widely expected to save lives at a time when opioid overdose deaths, (largely driven by the infiltration of the highly potent drug fentanyl into the illicit opioid market), have risen as high as 80,000 per year in the U.S.

Narcan is sometimes called a miracle drug because it can essentially bring someone back to life after they’ve stopped breathing following an opioid overdose, and it’s about as easy to use as a nasal spray for allergy symptoms. At the same time, however, advocates and health care workers emphasize that there are still barriers that could prevent many people from having access to Narcan.

Chelsea Shover, an epidemiologist and assistant professor at the University of California-Los Angeles, told me that as exciting as the FDA’s news is, other steps are still necessary to make sure Narcan is widely available:

• It must be affordable at retail locations. Without insurance, Narcan can be costly; over $100 for two doses of brand-name medication at some pharmacies, according to GoodRx. Shover notes that many of the people she’s provided Narcan to—including teenagers and people living in street encampments—wouldn’t be able to afford it on their own.
• Organizations must still be able to give it out for free. Though there is no reason to believe this will change, it's important to keep an eye on, as spaces like community groups and clinics have been instrumental in getting it directly to drug users.
• Insurance must still cover Narcan if it’s over the counter. OTC drugs are not subject to the same federal rules as prescription drugs in terms of insurance coverage. “Narcan was covered by many kinds of insurance at no or very low cost to the consumer. Now that it’s available over the counter, I worry about losing that coverage,” says Shover.

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