Narcan becoming available over the counter is definitely an important development in the evolution of how we can address the opioid epidemic.

Vinod Rao, MD, PhD
Medical Director, West End Clinic, Department of Psychiatry, Mass General

The opioid epidemic is wide-reaching. Over 150 thousand people have died of an opioid overdose in the last two years, 29 million people are struggling with opioid use disorder, and 43 million Americans are impacted by a close friend or family member’s use — those this last figure is thought to be underreported.  

Earlier this year, the Food and Drug Administration (FDA) approved the first over-the-counter naloxone nasal spray, Narcan, and it is expected to be available in store shelves this month, which is also National Recovery Month. In July, the FDA approved a second naloxone nasal spray for over-the-counter use as well. With the approval, this mitigating tool is in nearly everyone’s reach.

“The US is not the first country to make naloxone available over the counter,” says Vinod Rao, MD, PhD, Medical Director of the West End Clinic in the Department of Psychiatry at Massachusetts General Hospital. “The FDA approving Narcan for over-the-counter sales is a piece of the puzzle when it comes to doing everything we can to address the opioid crisis.”

How does naloxone work?

An overdose of opioids, especially in combination with alcohol, blocks the activity of the brainstem, which normally keeps us breathing without us having to think about it — and that’s when an overdose can occur. Naloxone is nasally administered, providing a direct and quick route to the brain to knock opioid molecules off the receptors in the brain to restart breathing. It temporarily reverses the overdose, giving time for medical care and saving lives.

Who should carry Narcan?

With Narcan becoming available for over-the-counter sales, anyone could purchase it at a pharmacy and carry it. It may be more likely that a person who uses opioids or the friends and family of someone suffering from opioid use disorder carries Narcan on a regular basis. Emergency personnel always carry it in the case that someone calls 911 to report a possible overdose they can respond and administer it quickly.

Individuals can carry and administer Narcan, there’s no special training needed and instructions for how to do so are widely available. Narcan won’t harm someone who isn’t overdosing, but of course, people can always dial 911 instead of administering it themselves. Most states (including Massachusetts) have ‘Good Samaritan’ laws in place that prevent a person from being prosecuted when administering Narcan in good faith to someone appearing to have overdosed.

“Most people need to cope with stress at some point or another in their life and we cope in a variety of ways, some people turn to opioids, others drink, others run, the list goes on and on,” says Dr. Rao. “There’s a large biological component to substance use disorder, but I’ve found in my work that people come to cope from an honest place, seeking support in a time with more social challenges and less social supports. Empathy is critical.”

Substance Abuse Resources and Action Steps

What should I do if I suspect a friend or family member is struggling?

There are a lot of different approaches depending on individual preferences and styles. Families and friends can engage and encourage treatment while also keeping themselves safe. Below are some different resources and approaches for handling this topic with your loved one:

  • Community Reinforcement and Family Training (CRAFT) aims to reduce harmful use, engage with the person to help them find treatment, and increase family quality of life 
  • Al Anon and Nar-Anon Family Groups provide support to the friends and families of people struggling with addiction to alcohol and drugs 
  • The Mom of an Addict provides education and support to families and friends (not just moms) who have been affected by a loved one's substance use 
  • The West End Clinic at Mass General offers couple and family therapy options open to family members and close friends of patients undergoing treatment at the West End Clinic. Research has shown that supportive significant others (SSO) involvement can help improve treatment outcomes 

I’m ready to seek treatment. What now?

Congratulations. This is an important first step in your path to recovery. There are resources below to help guide your immediate next steps.

  • The Mass General Substance Use Disorder Bridge Clinic offers walk-in and appointment-based services including addiction pharmacotherapy, peer support and groups, treatment/resource coordination, mental health care, and safe use/harm reduction education. It is intended to provide initial engagement and stabilization and transition to long-term care in the community. 
    • Clinic hours are Monday-Friday from 9 am - 5 pm 
    • It is located on the Mass General Main Campus at 55 Fruit Street in the Cox Building, 1st Floor, Suite 110  
    • Phone number is 617-643-8281 
  • The West End Clinic at Massachusetts General Hospital offers long-term treatment to patients with substance use disorders, commonly with co-occurring mental health needs. Services include psychopharmacology and group, family, and individual psychotherapies. Patients must have established treatment with a longitudinal Mass General provider (e.g., a primary care physician) to be eligible for care.  
    • It is co-located with the Bridge Clinic the Mass General Main Campus at 100 Blossom Street in the Cox Building, 1st floor, Suite 110 
    • Ask your Mass General PCP to place a referral order to MGH West End Clinic 
  • The Massachusetts Substance Use Helpline is only statewide, public resource for finding substance use treatment, recovery, and problem gambling services. Helpline services are free and confidential. Our caring, trained specialists, available 24/7, will help you understand the treatment system and your options. 
    • You can call (1-800-327-5050), text HOPE to 800327, or complete this form to get a list of programs or services in your area