Narcan: Who Should Carry It and How to Buy It Easily From Popular Stores

For years there's been growing momentum to get naloxone -- the drug that blocks the effects of an opioid overdose -- into more people's pockets. But as the US has continued to grapple with an overdose crisis, stigma around drug use, and a lack of awareness about naloxone, may have contributed to fewer people having it on hand in a crisis. 

However, the idea of carrying Narcan, the brand name for a nasal spray version of naloxone, has recently moved closer to the mainstream and more into the public eye. This past week, major retailers including Walmart, CVS, Walgreens, Rite Aid and Target, started rolling out Narcan in-store and online, making it easier to buy and to have at the ready. This followed the US Food and Drug Administration's spring ruling that Narcan may be sold over the counter nationwide.

Narcan is a nasal spray that can be administered safely to someone experiencing signs of an opioid overdose. It's easy to use, which is why you don't have to be medically trained to use it on someone else. Carrying Narcan is similar to someone carrying an EpiPen in case they go into allergic shock. 

In about 40% of overdose deaths, someone else was present, according to the US Centers for Disease Control and Prevention. Deaths from opioid overdoses have surged in recent years, with deaths continuing to climb last year. 

Thanks to individual state laws put into effect in response to the country's opioid overdose epidemic, Narcan or naloxone should've already been available without prescription in many pharmacies. It's also been available for free through different community programs and harm-reduction sites. By having it available online and at more major pharmacies and stores like Target and Walmart, the hope is that people can find it easily and have it delivered or pick it up discreetly, and that more people will have access to it when it matters -- whether they use opioids or know someone who does. 

How to buy Narcan online, and how much it costs 

A box of Narcan, which contains two single-dose nasal sprays, costs $45 at all major pharmacies and retailers that carry it. How quickly you're able to buy it will depend on the pharmacy and its stock, but major retailers started rolling it out online this week.

Here are a few stores that have it in stock and ready to buy online: 

(Rite Aid is currently out of stock.)

If your preferred pharmacy is a smaller chain or a mom-and-pop shop, you can call to see if or when it plans to have Narcan in stock. If you choose to buy Narcan in person instead of online, it might be behind the pharmacy counter or another desk, or out in the aisles, depending on the pharmacy. It still will not require a prescription. 

If price is a barrier, there are ways to get free Narcan. You may find it through a community-based program, by calling or visiting your local health department and through syringe-exchange programs, according to the CDC.

Who should buy Narcan?

If you use opioids, whether it's a prescribed opioid like oxycodone or an illegal opioid like heroin, it's recommended that you carry Narcan or naloxone on you, similar to how someone with severe allergies carries an EpiPen in case they have a severe allergic reaction. The CDC recommends that if you take "greater or equal to 50 morphine milligram equivalents per day" of a high-dose opioid, you should carry Narcan. According to the Cleveland Clinic, overdoses happen if you take too much of an opioid but can also happen if it's combined with another substance, like a stimulant or alcohol.

About one-fourth of all opioid overdoses in 2020 involved prescription (legal) opioids.

You should also tell the people close to you that you carry it, since they may be the ones to give it to you in case of an emergency. (You can't give Narcan or any type of naloxone medication to yourself, unlike an EpiPen.)  

If you know someone who uses opioids (such as a friend or a family member), you may also want to carry it in case of an emergency. 

Each nasal spray cartridge of Narcan contains one dose, but it sometimes requires two doses of Narcan or naloxone to revive a person who is overdosing. Keep this in mind when deciding whether to carry the box or take the nasal sprays out individually. 

Signs of a drug overdose

If you think someone may be overdosing from opioids, it's important to first know the signs of an overdose. An overdose happens when the drug overwhelms the brain and disrupts the ability to breathe. According to the CDC, some signs of opioid overdose in a person are: 

• Small, constricted pupils.
• Loss of consciousness. (You can't wake someone up even after shaking or yelling at them.)
• Choking or gurgling sounds.
• Slow, shallow breathing.
• Limp body.
• Discolored or blue skin (especially in the lips or underneath the nails)
• Cold or clammy skin.

If you notice these signs, you should follow the next steps to adminster Narcan and call 911. Giving someone Narcan even if they aren't overdosing on opioids shouldn't hurt them, according to the FDA. So it's important to err on the side of caution and administer Narcan if you believe they may be overdosing. 

How to give someone Narcan 

According to information pulled from the CDC, the New York State Health Department (PDF) and the Narcan website, here are the steps for administering Narcan: 

• Check whether the person is responsive by shaking them, calling out to them and pushing your knuckles into their chest for five to 10 seconds.
• Lay the person on their back and tilt their head up.
• Take Narcan out of its package by peeling back the tab.
• Get a grip on the nasal spray by placing your thumb on the plunger and two fingers on either side on the nozzle. (Do not "test it" or push the plunger early.) 
• Insert the tip of the nozzle into one nostril and push the plunger firmly. 
• Remove it from the person's nose and wait two minutes to see if they respond. Call 911 during this time. 
• If the person does not wake up or respond to shaking, administer the second dose/second container of Narcan. 
• Roll them onto their side to prevent choking and stay with them until medical services arrive.

As the CDC notes, most states have laws that protect the person who overdosed or the person who called in the overdose from legal problems associated with drug use. Paramedics and health care workers have been using naloxone for decades, and adminstering it for a person who's overdosing can win them time to get to a hospital and potentially save their life.