In September, Narcan — the first over-the-counter naloxone nasal spray approved for use by the Food and Drug Administration without a prescription — was rolled out to pharmacies and drugstores across the United States with a retail price of $44.99 for a pack of two devices. Experts have already hailed the widespread availability of the medication, which quickly reverses the effects of an opioid overdose, as a "lifesaving" tool amid alarming rates of drug overdose deaths. In 2021, more than 75% of those deaths involved opioids, with fentanyl contributing to more than 77% of adolescent overdose deaths that year. Indeed, New York City's Department of Health and Mental Hygiene issued an advisory this week urging New Yorkers to "carry naloxone and know how to use it," noting that fentanyl was detected in 81% of the city's drug overdose deaths in 2022.
But do enough Americans know enough about Narcan, the brand-name nasal spray form of naloxone, and how to use it to make a difference? According to a new Yahoo News/YouGov poll, just 28% of respondents said they had heard "a lot" about Narcan; a further 43% had a "little" awareness about the over-the-counter medication. And 29% of those surveyed reported hearing "nothing at all" about it. Broken down by age, respondents ages 18 to 29 were least likely to be informed about Narcan, which is credited with saving pop star Demi Lovato during a 2018 overdose; 50% in that demographic had heard "nothing at all" and just 17% had heard "a lot."
The poll — which was conducted by YouGov using a nationally representative sample of 1,636 U.S. adults interviewed online from Sept. 14 to 18, 2023 — also found that just 7% of respondents had purchased Narcan, and only 8% had been trained to administer it in the event of an emergency.
As experts and health officials encourage the public to have naloxone on hand, just 20% of those surveyed said they would consider purchasing it, compared with 60% who had no interest in purchasing it and 21% who were unsure. Young adults (25% of 18- to 29-year-olds) were most likely to consider buying the nasal spray; respondents ages 65 and older (13%) and those who identified as politically independent or conservative (16% and 17%, respectively) were least likely.
What's stopping them? While experts have expressed reservations about the $44.99 retail cost set by manufacturer Emergent BioSolutions, only 1% of those who ruled out buying Narcan cited its cost as a deterrent. The main hesitation? Most people don't think they will ever have cause to use it. "I don't think I will need it," 43% of those surveyed responded when asked why they wouldn't consider adding it to their shopping basket.
According to Dr. Jennifer Plumb, pediatric emergency medicine physician, professor in the University of Utah department of pediatrics and medical director of Utah Naloxone, there are some issues in how the dialogue about naloxone access is framed.
"Do I think everyone should have naloxone? I actually do, because you just never know," she tells Yahoo Life. But the initial push for easier access to the medication, she tells Yahoo Life, was led by community-based organizations focusing on harm reduction and working to remove barriers for those who need it most, including those who don't have a doctor to prescribe it. "In my perspective at least, it wasn't as much about every single human being able to walk into Walgreens or Walmart to be able to get it," Plumb says.
Having naloxone available over the counter is a "barrier removal," she concedes, but the nearly $50 price tag still puts it out of reach for many. "Of course I like naloxone access anywhere, and I'm glad it's available, but the majority of people who are truly at risk are not going to have access via this route," she says.
But Plumb, whose own brother died of a heroin overdose, is cautiously optimistic that having naloxone more widely available will eventually result in the nasal spray becoming more affordable and accepted.
"I do wonder if it's going to take a trajectory kind of like what Plan B did," she says, referring to the emergency contraceptive. "Plan B similarly was very expensive when it first came on the market over the counter. In fact, it was so expensive they were keeping it behind the [pharmacy] desks still because ... they didn't want it to be stolen. And now it's much more affordable. So will naloxone do the same thing? I guess I can hope, right? That the more people see it, hear about it, know that it's OK for them to have it — it doesn't mean they're admitting they're any type of 'scary person,' that someone in their family or someone in their life or someone in their neighborhood might need naloxone — maybe it'll be that sort of trajectory."
The 'I don't think I will need it' assumption
For now — as this poll makes clear — most people assume that they won't need naloxone. Plumb calls that "evidence of a failure of our health care system." While the vast majority of naloxone reversals among "laypersons" involve drug users, prescription opioids — to treat pain, for example — can be found in many medicine cabinets and also pose a risk that is commonly downplayed.
"Anyone who is prescribed an opioid or has an opioid in their life around them could potentially have an overdose, or someone around them could have an overdose," Plumb notes. That includes small children, who she has treated previously after, say, a parent accidentally left medication out, or a grandparent receiving end-of-life cancer care dropped a pill. "They're oral explorers. Everything goes right in their mouth."
Alicia Kowalchuk, associate professor of family and community medicine at Baylor College of Medicine, agrees, expressing a similar sentiment in a recent interview with Yahoo Life. "It is a great idea for anyone concerned about a loved one's or their own risk of overdose to have naloxone on hand," she said. "For example, a parent or grandparent who has prescription opioids can also have naloxone on hand just in case their young child or grandchild accidentally takes it or their teen decides to 'experiment' with it and overdoses."
Medical professionals who prescribe or dispense opioids should be more transparent, she says, about the risks — both of becoming dependent on the medication and of overdosing. "People saying 'I don't need that' is a reflection of what little the health care system has told them about opioids."
People with pharmaceutical opioids also need to move past that "not me" mentality, notes Plumb.
"If you have opioids in your home, period, you should have naloxone — whether it's for you, whether it's for a visitor, whether it's for a kid, even a dog," she says. "Honestly, you should have it there. And the number of people who have opioids that say, 'Oh no, I would never misuse my prescriptions" — it doesn't matter. It's not a judgment thing; it's just these are dangerous substances. They can do things no matter who it is. And that's maybe part of the messaging that we need to work on out there. Not just, 'hey, naloxone is an important thing,' but more importantly 'opioids are a risky, potentially dangerous thing,' and we're still not talking about that enough."
For myriad reasons, there's still a lack of awareness about naxalone and who might benefit from having it. But it has only been on the market as an over-the-counter option for weeks. Ultimately, the biggest issue is ensuring that those most at risk can access the lifesaving nasal spray.
"I don't see that the general public hasn't fully lit up to the fact that it might be something smart for them to have around as any sort of a condemnation on where we are with naloxone," says Plumb. "I just think they really haven't thought about it yet. And on some level that's OK. Like, I would like us to keep working on them, but they're not the focus."