Over-the-counter naloxone availability: Insights from rural community pharmacists in the Southern US.

Background: Previous work has found that naloxone availability without a prescription in the Southern United States is highly varied, with 37% of Mississippi pharmacies and 53% of North Carolina pharmacies having naloxone available without a prescription in 2022 and 2024, respectively.^1,2 The United States Food and Drug Administration approved Narcan® nasal spray for over-the-counter availability in 2023. However, limited information exists on the uptake of OTC naloxone across the United States, especially in rural spaces across the Southern United States.

Methods: This study employed a cross-sectional survey study design of community pharmacists enrolled in the Rural Research Alliance of Community Pharmacies (RURAL-CP) practice-based research network (PBRN). Data were descriptively analyzed using IBM SPSS Statistics.

Objectives: This study aimed to describe the availability and cost of OTC naloxone at rural community pharmacies across the Southern US. Secondary outcomes included pharmacists' perceived barriers to OTC naloxone for both pharmacists and patients.

Results: There were N=47 responses to the survey, yielding a response rate of 34.8%. Of the responding community pharmacists, 40% indicated that their pharmacy carried OTC naloxone at the time of the survey (n=18/47, 38.3%). Among these pharmacies, the median cost of OTC naloxone was $50.00 (IQR $46.25-$64.25, range $43.00-$123.20).

Conclusions: Despite OTC Narcan® nasal spray being available in pharmacies as of September 2023, availability of this life-saving medication remains less than ideal in rural and Southern pharmacies. These findings emphasize the need for further educational and policy interventions to improve naloxone availability.