Naloxone Sales Likely to Increase after Switch to Over-the-Counter Status

by Sarah Gutkind, MSPH

February 21, 2019

Naloxone is an opioid antagonist rescue medication that reverses the effects of an opioid overdose, and thus a critical tool to prevent fatal opioid overdoses. CHERISH Investigators Drs. Sean Murphy, Jake Morgan, and Bruce Schackman, and CHERISH staff member Philip Jeng, MS predicted pharmacy sales following conversion of naloxone to over-the-counter (OTC) in a new study published in Health Services Research.

The Center for Disease Control and Prevention reported 47,600 opioid-related overdose deaths in 2017. In an effort to increase access to life saving naloxone many states and jurisdictions have passed naloxone standing order laws that allow pharmacists to dispense naloxone without a prescription. Increased availability of naloxone has been bolstered by public figures such as the US Surgeon General. To further increase access to naloxone, the Food and Drug Administration announced unprecedented new efforts to support development of OTC naloxone products. According to Dr. Murphy “although we would expect a conversion of naloxone to over-the-counter to reduce access barriers and increase demand, the conversion could also result in an increase in out-of-pocket price for consumers, which would moderate the demand-side effects.”

Using a nationwide longitudinal prescription claims database the CHERISH investigators estimated the demand and supply functions for naloxone purchased at US retail pharmacies, which allowed them to estimate the own-price elasticity of naloxone demand in these settings, and ultimately predict retail pharmacy sales following conversion of naloxone to OTC. Using a generalized structural equation model, the investigators found that for every 1% increase in the out-of-pocket price paid for naloxone, there would be a 0.27% decrease in pharmacy sales. Applying this estimated own-price elasticity of demand for naloxone to estimates from the literature of changes in demand and price following conversions of other medications to OTC, the authors predict an increase in naloxone sales of 15%- 179% following its conversion to OTC. Dr. Murphy states “one hopes that the increase in naloxone sold at retail pharmacies would decrease the number of fatal opioid overdoses; however, this will depend on whether the changes in the marketplace result in an increase in the amount of naloxone among persons most likely to encounter an opioid overdose.”