Estimates of first-year OTC naloxone sales in four U.S. states with high rates of opioid overdose deaths

Abstract

INTRODUCTION: In March 2023, the U.S. Food and Drug Administration approved naloxone nasal spray for over-the-counter (OTC) sale, creating a direct-to-consumer path that can increase access.

METHODS: We utilized weekly NielsenIQ (NIQ) retail sales data of OTC naloxone for local areas within Kentucky (KY), Massachusetts (MA), New York (NY), and Ohio (OH) during the week ending 9/9/2023 to week ending 4/27/2024, for sales occurring in physical stores (e.g., grocery, pharmacy). We analyzed the percentage of stores selling, average price per kit, and sales. We assessed patterns in local sales by a Social Deprivation Index accounting for poverty, housing, transit, education, and employment.

RESULTS: The brand Narcan made up approximately 99 % of all recorded OTC naloxone sales from September 2023 through April 2024. Weekly sales of OTC naloxone in KY, MA, NY, and OH spiked initially in September and October 2023, and stabilized through April 2024. The average price per OTC naloxone kit was $45 across states and brand. Between 5.0 % and 8.6 % of NIQ participating stores in each state sold OTC naloxone. A large proportion of local areas in three states demonstrated high social deprivation and low OTC naloxone sales.

CONCLUSIONS: OTC naloxone increases access, though the price may deter people with low income, as evidenced by our findings of lower sales among areas with high social deprivation, emphasizing the importance of naloxone access laws, opioid education and naloxone distribution programs, and Medicaid coverage. OTC naloxone creates a new channel for market penetration, satisfying a previously untapped demand, and supports naloxone saturation.