Over-the-counter should supplement not supplant current naloxone distribution systems.

Stakeholders recommended that decision makers ensure that OTC availability does not affect the funding and resources for free naloxone and active distribution of naloxone to at-risk populations, including emergency departments, harm reduction programs, and criminal justice systems. Caregivers, practitioners, and patients consistently expressed concerns that the availability of naloxone OTC may affect the allocation of public funds to support active methods of distribution.

States and localities currently operate highly effective overdose education and naloxone distribution programs (OENDPs). One study found that opioid overdose death rates were 27 to 46 percent lower in communities where OEND was implemented, which has been shown to increase the reversal of possibly fatal overdoses. Naloxone distribution programs were also found to be highly cost-effective, prevent overdose deaths, and improve quality-adjusted life years (QALY). One overdose death was expected to be avoided for every 227 naloxone kits distributed, or 6% of overdose fatalities.