Community-Originated Research to Identify Access Gaps in Over-the-Counter Naloxone Availability in Connecticut Pharmacies

TL;DR

This study examines how accessible naloxone is in Connecticut pharmacies, finding that while it's available, it's often hard to find, expensive, and poorly advertised.

Contribution

The study provides new insights into naloxone accessibility gaps in pharmacies post-over-the-counter approval, using community-based data collection.

Findings

Most pharmacies keep naloxone behind the counter, limiting easy access.

Independent pharmacies had higher naloxone prices compared to others.

Few pharmacies displayed naloxone availability signage, and all were in English.

Abstract

Naloxone, a life-saving medication that reverses opioid overdoses, was available in the United States only by prescription until March 2023, when the federal government approved nasal-spray formulations for over the counter sales to expand access. We assessed the availability of naloxone in a sample of pharmacies across the state of Connecticut.

Between September 15 and November 24, 2024, trained community-based volunteers surveyed a convenience sample of pharmacies throughout the state, focusing on naloxone signage, availability, cost, and in-store location. Pharmacies were categorized into three groups: chain pharmacies, pharmacies within grocery stores, and independent pharmacies. Summary statistics for the full sample and the three subgroups were tabulated, and differences between groups were analyzed using Fisher’s exact tests.

A total of 162 pharmacies across all Connecticut counties were evaluated. While naloxone was available in most pharmacies, it was predominantly kept behind the pharmacy counter (n = 111, 73.5%) or the general checkout counter (n = 46, 30.5%). Fewer than 20% of pharmacies (n = 29) had naloxone easily accessible on an aisle shelf. Pricing was often high (≥ $60), particularly in independent pharmacies (n = 7, 22.6%; p < 0.001). Additionally, fewer than 20% of pharmacies (n = 31) displayed signage related to naloxone availability, and all signage was exclusively in English.

Despite widespread availability, naloxone access was restricted by its in-store location, high cost, and inadequate signage. This highlights a notable discrepancy between naloxone availability and accessibility, suggesting a lag in the effective implementation of policy in intended settings.

The online version contains supplementary material available at 10.1186/s12954-025-01268-y.

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