Naloxone is a lifesaving medicine that can reverse fatal opioid overdoses. All 50 states in the US have enacted laws to increase access to naloxone, but the specific guidelines vary by state. Opioid overdose remains a critical public health issue that claims more lives each year than any other type of drug overdose, and naloxone access is essential in order to help safeguard lives. [1]
- All 50 states allow over-the-counter access to naloxone, following action taken by the FDA in 2023 to reclassify this medication as an approved over-the-counter medication, though availability can vary.
- Some states allow individuals to access naloxone for free at community outreach locations, while others restrict access to public health and first responder professionals.
- Most states allow third-party prescriptions for people to access naloxone, and all states have Good Samaritan laws in place to protect citizens from liability in case there is a need to administer the medication to another citizen experiencing a suspected life-threatening opioid overdose.
Why naloxone access is a public health concern
Naloxone is a life-saving emergency medicine that can reverse fatal symptoms of an opioid overdose. Every year, more people die from overdoses on opioids than from any other type of drug or medication, making this a significant public health concern across the United States. When administered soon after ingestion, naloxone can reverse the effects of the opioids, including stopped breathing, and can save the person’s life. [1]
Recognizing the high risk for overdose with opioid drugs, some states have enacted co-prescribing legislation. This legislation ensures that people prescribed opioid medications will also be prescribed naloxone in case of accidental overdose. [2][3]
In response to the opioid epidemic, health regulators and legislators have worked to increase access to naloxone beyond just medical professionals and first responders. For example, more states are providing access to citizens and laypeople through third-party prescribing laws, by making this medication available at low or no cost in community centers, and through over-the-counter purchase. [1]
Naloxone access laws: National overview
Naloxone access has increased significantly in recent years. In 2023, the FDA approved naloxone for over-the-counter sale, making it available to individuals who do not have a prescription. This change in classification paved the way for significant increases in access across all 50 states. [1]
The way naloxone is made available and distributed varies by state. In some states, naloxone is primarily available at pharmacies, and in others, it is distributed more freely in certain locations within the community, including in schools, fire departments, and health departments. [1][3]
State-by-state naloxone guide
All 50 states allow citizens to access naloxone, which is largely related to the FDA reclassifying it as an over-the-counter medication, making it legal to access without a prescription. The specific places and methods citizens can access naloxone differ slightly from state to state. Here are some of the methods of administration that will be reviewed in the table below: [1][2][3]
- Standing order laws: Standing order laws describe the ability of a pharmacist to legally dispense naloxone to individuals who do not have a prescription.
- Good Samaritan laws: Laws protecting citizens from civil or legal penalties when providing life-saving interventions, including the administration of naloxone to someone showing signs of overdose.
- Third-party prescribing laws: Laws allowing prescribers to issue prescriptions to family, friends, or bystanders to administer to someone else in the event of an overdose.
- Syringe Service Programs (SSP’s): Programs that distribute naloxone for free to the community at designated locations within the community.
States are periodically updating their laws related to naloxone availability, and the FDA’s approval for OTC sales has made some of these classifications obsolete, so check frequently to stay informed about the laws related to your state or jurisdiction. [2][3]
| State | Standing order laws | Good Samaritan laws | Third-party prescribing laws | Syringe Service Program laws |
|---|---|---|---|---|
| Alabama | ✓ | ✓ | ✓ | |
| Alaska | ✓ | ✓ | ✓ | |
| Arizona | ✓ | ✓ | ✓ | ✓ |
| Arkansas | ✓ | ✓ | ||
| California | ✓ | ✓ | ✓ | ✓ |
| Colorado | ✓ | ✓ | ✓ | ✓ |
| Connecticut | ✓ | ✓ | ||
| Delaware | ✓ | ✓ | ||
| Washington DC | ✓ | ✓ | ✓ | |
| Florida | ✓ | ✓ | ✓ | |
| Georgia | ✓ | ✓ | ✓ | |
| Hawaii | ✓ | ✓ | ||
| Idaho | ✓ | ✓ | ||
| Illinois | ✓ | ✓ | ✓ | ✓ |
| Indiana | ✓ | ✓ | ✓ | |
| Iowa | ✓ | ✓ | ✓ | |
| Kansas | ✓ | ✓ | ✓ | |
| Kentucky | ✓ | ✓ | ✓ | |
| Louisiana | ✓ | ✓ | ✓ | |
| Maine | ✓ | ✓ | ✓ | |
| Maryland | ✓ | ✓ | ✓ | |
| Massachusetts | ✓ | ✓ | ✓ | |
| Michigan | ✓ | ✓ | ✓ | |
| Minnesota | ✓ | ✓ | ||
| Mississippi | ✓ | ✓ | ✓ | |
| Missouri | ✓ | ✓ | ✓ | |
| Montana | ✓ | ✓ | ✓ | |
| Nebraska | ✓ | ✓ | ||
| Nevada | ✓ | ✓ | ||
| New Hampshire | ✓ | ✓ | ✓ | |
| New Jersey | ✓ | ✓ | ✓ | |
| New Mexico | ✓ | ✓ | ✓ | |
| New York | ✓ | ✓ | ✓ | ✓ |
| North Carolina | ✓ | ✓ | ✓ | ✓ |
| North Dakota | ✓ | ✓ | ||
| Ohio | ✓ | ✓ | ✓ | ✓ |
| Oklahoma | ✓ | ✓ | ✓ | ✓ |
| Oregon | ✓ | ✓ | ✓ | ✓ |
| Pennsylvania | ✓ | ✓ | ✓ | |
| Rhode Island | ✓ | ✓ | ||
| South Carolina | ✓ | ✓ | ✓ | |
| South Dakota | ✓ | ✓ | ✓ | |
| Tennessee | ✓ | ✓ | ✓ | |
| Texas | ✓ | ✓ | ✓ | |
| Utah | ✓ | ✓ | ✓ | ✓ |
| Vermont | ✓ | ✓ | ✓ | |
| Virginia | ✓ | ✓ | ✓ | ✓ |
| Washington | ✓ | ✓ | ✓ | |
| West Virginia | ✓ | ✓ | ✓ | ✓ |
| Wisconsin | ✓ | ✓ | ✓ | |
| Wyoming | ✓ | ✓ | ✓ |
How and where to get Narcan
In all 50 states in the US, citizens have legal access to naloxone, although there may be availability issues as well as costs associated with obtaining it. In some states, there are organizations and community programs that provide naloxone to the public at no cost, although the supply may be limited. [1] Some individual health insurance plans will also cover part or all of the costs associated with naloxone, but prices may vary by plan. [3]
Where to purchase naloxone if a free option isn't available
Naloxone was approved by the FDA as an over-the-counter medication in 2023, allowing states to provide this medication to people without a valid, personalized prescription. In most states, naloxone can be obtained by talking to a prescribing doctor or going to a local pharmacy. Whether or not there will be a cost associated with it will depend on the specific legislation in the place where you live, as well as the details of any insurance policy you are using to obtain this medication, or if it is being purchased over-the-counter. [1][2][3]
