Overdose Deaths Are Falling. So Why Aren’t OTC Narcan Sales Booming?

America finally has some good news on overdoses. The Centers for Disease Control and Prevention released data on Sept. 17, 2025 estimating 76,516 drug overdose deaths for the 12 months ending April 2025. That represents a 24.5 percent decline from the prior year, the sharpest drop of the modern crisis and a reason for cautious hope.

But here’s the puzzle: OTC Narcan, the best-known overdose-reversal tool, isn’t flying off store shelves. Researchers who analyzed the first year of retail sales found that OTC naloxone peaked early in fall 2023, then slid and stabilized at surprisingly low levels, far below the volumes moving through prescriptions or free community programs. At its peak, over-the-counter units represented only about 7.5 percent of prescription sales. Those findings appeared in a new study published in JAMA Internal Medicine.

What the numbers actually show

After OTC launch in September 2023, researchers tracked county and state-level sales across the country. The numbers tell a clear story. On average, states sold 396 OTC units per million residents during that first year. Compare that to pharmacies, which dispensed roughly 7,063 units per million by prescription, while community programs distributed about 12,015 units per million over similar periods. Translation: most naloxone still moves outside the consumer retail aisle, according to researchers at the RAND Corporation.

Price creates a significant barrier. The manufacturer list price for a two-dose carton of brand-name Narcan sits at $44.99. Studies peg the typical OTC two-pack between $44 and $45, a meaningful expense when you’re trying to keep emergency medicine on hand just in case. Some chains now sell store-brand naloxone for $34.99, but you won’t find that lower price everywhere. Emergent BioSolutions announced the $44.99 price point when the product launched over the counter.

Coverage compounds the problem. Unlike prescriptions, OTC products aren’t always covered by insurance or Medicaid. Many buyers end up paying full price, exactly the kind of friction that keeps a potentially lifesaving medicine out of shopping carts. Policy analysts have urged states to require or enable Medicaid coverage of OTC naloxone and work to lower retail costs.

Then there’s the matter of simple access. Surveys and spot checks reveal that many pharmacies don’t consistently stock naloxone on shelves for same-day pickup, or they place it where customers struggle to find it. Visibility (clear aisle placement, good signage) and reliable stocking vary widely depending on where you live.

Put the pieces together and you get a nuanced picture: overdose deaths are falling, and naloxone almost certainly deserves some credit. But price, coverage gaps, and uneven store access keep OTC sales modest while prescriptions and free programs carry most of the load.

Why OTC Narcan lags, and what could actually change it

Make it cheaper and get it covered. The Pew Charitable Trusts released a brief in September highlighting two key levers: reduce the retail cost and ensure Medicaid covers OTC naloxone. Some states have started negotiating bulk prices and allowing community groups to bill Medicaid, which helps stretch opioid settlement dollars further.

Stock it where people already shop. Policy can require or strongly encourage pharmacies to stock both prescription and OTC naloxone and put it on open shelves with clear signage, not locked behind the counter. When someone needs naloxone, seconds matter.

Send it home from healthcare settings. Co-prescribing naloxone alongside higher-risk opioid prescriptions helps. So does sending people home with naloxone after they’ve survived an overdose, and equipping people leaving jails, prisons, or treatment programs. These strategies show up in research as linked to lower overdose deaths.

Pair it with AEDs in public spaces. Stocking naloxone alongside automated external defibrillators at schools, libraries, gyms, and transit hubs makes bystander rescue more realistic.

Keep funding community distribution. The comparison in the RAND study makes one thing absolutely clear: free community programs still deliver the most naloxone to people at highest risk. Sustaining and smoothing those distribution pipelines remains vital while retail access catches up.

Local guide: where to get free or low-cost naloxone

Start with these resources, then dig into what’s available locally:

• Find harm reduction organizations near you using the National Harm Reduction Coalition’s resource map.
• Request mail-order naloxone (available in many states) through NEXT Distro’s free access program.
• Buy OTC Narcan using the brand’s store locator; some retailers now carry lower-priced store brands like Walgreens’ $34.99 option.
• Ask your pharmacy about getting a prescription, which may come with little or no copay under many insurance plans and Medicaid programs. Policies vary by state, so your pharmacist can walk you through what’s covered.
• Need treatment or more support? Call SAMHSA’s 24/7 national helpline at 1-800-662-HELP for referrals to services near you.

Bottom line: Overdoses are declining, which offers real hope. But people still need easy, affordable access to naloxone at the places they already go. Cutting the price, making insurance coverage routine, and putting it visibly on shelves could help OTC Narcan finally catch up to this crucial public health moment.

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