Lower OTC Naloxone Costs Fail to Ensure Equitable Access

Despite a drop in OTC naloxone prices, racial and geographic disparities in access to the overdose-reversing agent persist, according to a study in the Journal of Substance Use and Addiction Treatment (JSAT).¹

“Opioid overdose remains a significant public health issue in the US,” wrote the authors of the study. “While the CDC reported a notable decline in drug overdose deaths, the number of deaths still remained high in 2024 at approximately 80,000 deaths.”

Even as the price of OTC naloxone gradually declines, access remains far from equitable. Between September 2023 and November 2024, the average price of this lifesaving medication fell by about $0.49 per quarter while total sales simultaneously decreased by roughly 2% in the same period.

For pharmacists standing on the front lines of the opioid crisis, these findings suggest that mere availability and modest price drops are insufficient to overcome deep-seated structural and geographic barriers.¹

READ MORE: Naloxone Sales Highlight Limited OTC Use, Access Challenges

Why Low Costs Don’t Translate to Greater Access

The study utilized retail scanner data following the FDA’s landmark approval of OTC naloxone and highlighted significant disparities in how the medication reaches at-risk populations.

Sales were notably lower in nonmetropolitan areas and communities with higher proportions of Black residents. Even more concerning for public health advocates was the pricing variability, where areas with larger American Indian and Alaska Native populations faced estimated costs over $5 higher per unit than predominantly white areas.

These trends occur against a national backdrop where drug overdose deaths remain staggering and mortality rates continue to rise among Black, Hispanic, and American Indian populations, despite broader declines elsewhere.^1,2,3

Pharmacists are uniquely positioned to address this crisis because nearly 90% of Americans live within 2 to 5 miles of a community pharmacy.⁴ However, accessibility is often hindered by inconsistent stocking practices and the emergence of pharmacy deserts.¹

“In a case study exploring buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, 80% of pharmacies limited buprenorphine dispensing by refusing new patients, limiting dispensing to known patients/prescribers, or refusing to dispense buprenorphine due to lack of trust in buprenorphine and prescribers,” wrote the authors of a study in Substance Abuse and Rehabilitation.⁴

Research indicates that rural pharmacists are sometimes less likely to stock naloxone due to negative perceptions, and only about 58% of North Carolina pharmacies had the medication available for same-day pick-up shortly after the OTC transition.^1,3

Furthermore, even when stocked, naloxone is frequently kept behind the counter, requiring a potentially stigmatizing interaction that may deter individuals from purchasing it.^1,5 Stigma remains a fundamental hindrance to the response, existing not just among the public but within the profession, where some staff members still view substance use through a moral lens rather than as a treatable medical condition.^4,5

Although the shift to OTC status aimed to broaden reach, the average retail price of approximately $45 per 2-dose kit remains a substantial hurdle for low-income families.^1,5 In contrast, prescription naloxone covered by insurance can often be obtained for a much lower out-of-pocket cost, highlighting a significant affordability gap for those without coverage.^1,3

Addressing Persistent Gaps in OTC Naloxone Access

Policy experts suggest that states could bridge this gap by mandating that pharmacies in high-overdose areas maintain continuous supplies similar to models adopted in Massachusetts. Additionally, the widespread implementation of coprescribing mandates—requiring naloxone alongside high-dose opioid prescriptions—has been shown to significantly increase distribution in states like Virginia and Vermont, according to The Pew Charitable Trusts.³

To truly foster what the Robert Wood Johnson Foundation calls a “culture of health,” naloxone must be normalized as a routine first-aid tool akin to an EpiPen or defibrillator. This requires more than just shelf space; it necessitates cross-sector collaboration between pharmacies, public health agencies, and law enforcement.⁵

For the pharmacy profession specifically, the challenge lies in moving beyond the role of a passive dispenser to becoming an active advocate in the addiction treatment space.⁴ This involves eliminating stigma at the counter, ensuring equitable pricing in underserved regions, and viewing every patient interaction as an opportunity to prevent a fatal overdose.^4,5

“These differences could reflect structural factors that shape community-level access, such as pharmacy availability, transportation access, and poverty. These findings suggest that reduced cost alone may be insufficient to ensure equitable naloxone access in the retail environment,” concluded the authors of the current study.¹ “Future research should examine the broader health impacts of OTC naloxone availability and continue to monitor sales trends and pricing in order to support targeted policies and outreach strategies to ensure equitable access to OTC naloxone across all communities.”

READ MORE: OTC Resource Center

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REFERENCES

1. Johnson JM, Annis IE, Delamater P, et al. Over-the-counter naloxone sales and pricing variability in North Carolina following FDA approval. JSAT. 2026;185:209930. https://doi.org/10.1016/j.josat.2026.209930

2. Lifesaving naloxone. CDC. June 11, 2024. Accessed March 10, 2026. https://www.cdc.gov/stop-overdose/caring/naloxone.html

3. State policy approaches to expand naloxone access. The Pew Charitable Trusts. September 2, 2025. Accessed March 10, 2026. https://www.pew.org/en/research-and-analysis/issue-briefs/2025/09/state-policy-approaches-to-expand--naloxone-access

4. Kosobuski L, O'Donnell C, Koh-Knox Sharp CP, et al. The role of the pharmacist in combating the opioid crisis: an update. Subst Abuse Rehabil. 2022 Dec 28;13:127-138. doi: 10.2147/SAR.S351096.

5. Rangachari P, Tran A. Transforming opioid overdose prevention in the United States: leveraging FDA's Narcan approval to foster a culture of health. Risk Manag Healthc Policy. 2025 Jun 14;18:1935-1946. doi: 10.2147/RMHP.S521720.