OTC naloxone still unavailable same day at nearly 4 in 10 US pharmacies

Clinical takeaway: When recommending OTC naloxone, remind patients that same-day availability is not guaranteed. Encourage high-risk patients and their families to obtain naloxone before it is urgently needed and be prepared to direct them to alternative pharmacies or community resources if it is unavailable.

Making naloxone available over the counter was intended to improve rapid access to this lifesaving medication. However, a new national study suggests that many patients may still encounter barriers when they try to purchase it.

Researchers used a secret shopper design to contact 1,108 retail pharmacies across the US between January and April 2024. Overall, 61.4% of pharmacies reported that naloxone was available the same day without a prescription, leaving nearly 40% unable to provide immediate access. Among pharmacies with same-day availability, the average out-of-pocket price was $52.07.

Even when naloxone was available, it was usually kept behind the pharmacy counter rather than on open shelves (58.1% vs 31.7%), meaning patients often still had to request it from pharmacy staff. Nearly one in five pharmacies with naloxone in stock also incorrectly indicated that a prescription was required for same-day purchase.

Availability varied substantially by pharmacy type. Independent pharmacies had markedly lower odds of offering same-day naloxone than corporate chain pharmacies, with similar disparities seen among food or mass-merchandise pharmacies and medical-affiliated pharmacies. Pharmacies located in communities with a higher proportion of White residents were also more likely to have naloxone available, suggesting persistent inequities in access.

For prescribers, the findings underscore that recommending naloxone alone may not ensure patients can obtain it promptly. Verifying local availability, encouraging patients at risk of opioid overdose to purchase naloxone before an emergency arises, and being familiar with alternative community sources may help reduce delays in access.

"Although enactment of the OTC policy was necessary, its intended benefits were not realized equally in practice," the study authors concluded.

Source: Eldridge LA, et al. (2026 Jul 17) JAMA Netw Open. Availability of naloxone in retail pharmacies following introduction of over-the-counter status