Experts are puzzling over which interventions are saving lives. The evolving illicit supply itself may hold important clues.After years of relentless rises in overdose deaths, the United States has seen a remarkable reversal. For seven straight months, according to federal data, drug fatalities have been declining.Expanded treatment, prevention and education efforts are playing a role, but drug policy experts believe there is another, surprising reason: changes in the drug supply itself, which are, in turn, influencing how people are using drugs.The fentanyl on the street is starting to become weaker. Anne Milgram, who heads the Drug Enforcement Administration, announced last week that for the first time since 2021, the agency was seeing a decline in fentanyl potency, a development she attributed to the government’s crackdown on Mexican cartels and international supply chains. Last year, seven out of 10 counterfeit pills tested in D.E.A. labs contained a life-threatening amount of fentanyl, she said, but that number has dropped to five out of 10.Addiction experts say that other interventions contributed to the declining fatalities, including wider distribution of overdose reversal medications like Narcan; an uptick in some states in prescriptions for medication that suppresses opioid cravings; and campaigns warning the public about fentanyl-tainted counterfeit pills.Harm reduction programs that offer sterile syringe exchanges and fentanyl test strips are also saving lives, experts note. Many treatment and support services that were shuttered during the coronavirus pandemic have become more accessible.“They are all part of a health response to substance use that is bending the curve,” said Dr. Brian Hurley, the president of the American Society of Addiction Medicine.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The overdose-reversal drug should be more widely available, health experts have said. It arrives in many stores next week, no prescription necessary.Narcan, the first opioid overdose reversal medication approved for over-the-counter purchase, is being shipped to drugstore and grocery chains nationwide, its manufacturer said Wednesday. Big-box outlets like Walgreens, CVS, Walmart and Rite Aid said they expected Narcan to be available online and on many store shelves early next week.Public health experts have long called for greater accessibility to the drug, which they describe as a critical weapon against rising overdose rates. There were more than 100,000 opioid overdose fatalities in each of the last two years in the United States.Narcan is already a staple for emergency personnel and street outreach teams. Now scientists and health officials are hoping Narcan will eventually become commonplace in public libraries, subways, dorms, corner delis and street vending machines.They also predict it may become a fixture in medicine cabinets, as more people realize that illicit party drugs like cocaine and counterfeit Xanax pills may be tainted with deadly fentanyl, an opioid.Here’s what you need to know about buying this lifesaving medication.How Narcan WorksNarcan is a nasal-spray version of the drug naloxone, which blocks an opioid’s effects on the brain, rescuing a person overcome by drugs like fentanyl, heroin or oxycodone.An individual may be overdosing if his or her breathing is slowed or stopped, and the pupils of the eyes narrow to a pinpoint. Naloxone is generally considered so safe that experts say that, when confronted with a possible overdose, it is better to risk using it than to hesitate.Each carton contains two palm-size plunger devices, each filled with four milligrams of naloxone. The rescuer inserts the spray tip into the patient’s nostril and depresses the plunger.Usually one dose is sufficient to reverse an overdose within two to three minutes. But addiction specialists have reported that in areas where the fentanyl supply is quite potent, a second dose may be needed.How To Use Narcan to Save a LifeNarcan and other naloxone nasal sprays swiftly reverse an opioid overdose and are easy to use.How Much Will It Cost?The cost is likely to dictate the extent of Narcan’s uptake. The manufacturer, Emergent BioSolutions, suggests $44.99 as the price of the two-dose box.“People with some money and motivation will seek this product out, which is fantastic,” said Brendan Solaner, an addiction policy expert at Johns Hopkins Bloomberg School of Public Health. “That may include concerned family members.”But those who will need Narcan the most may not be able to afford it, he added, saying that “this includes people who are unhoused or financially insecure and are at greatest risk of overdose.”When Narcan was available only by prescription, public and private insurance readily covered it. But those plans typically restrict coverage of over-the-counter drugs.Some state Medicaid programs have already announced that they will cover Narcan when it becomes available over the counter. Those states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.Emergent said that prices would be lower for bulk sales to public interest groups and state health departments, which will in turn distribute Narcan to local outreach organizations and clinics.How Will I Find Narcan in Stores?Retailers often put pricier products or those that are likely to be stolen behind a counter or in a locked case. But behavioral health experts say that customers may be reluctant to ask store workers for Narcan, fearing raised eyebrows and dismissive comments — marks of the pervasive stigma surrounding drug use and addiction.Through a spokeswoman, Rite Aid said Narcan would be available at its pharmacy counter and in pain care aisles. Many stores, including CVS, will also have it by the front register. Rite Aid, Walgreens, Walmart and CVS also said that Narcan could be purchased next week through their online sites, offering greater privacy.“Stigma will always be there, but I think there’s been a sea change in how the public perceives naloxone over the last decade, and many more people are willing to carry it,” Dr. Solaner said.What’s Next?Although Narcan is the first overdose reversal medicine to be sold over the counter, the field is likely to be crowded soon with less expensive competitors.A generic naloxone spray by Teva Pharmaceuticals is still available by prescription, which means that public and private insurance policies typically cover it. Pharmacists in most states rely on a “standing order” for the spray, which means they don’t need a physician’s prescription to dispense it. For a person with Medicaid or commercial insurance, generic naloxone could well be less than $10.CVS is encouraging customers to ask for Narcan at the pharmacy counter “so our pharmacy teams can check a patient’s insurance plan for potential savings on prescription naloxone products,” a spokesman said.Earlier this summer, the Food and Drug Administration gave over-the-counter approval to RiVive, a naloxone spray expected in early 2024. RiVive, manufactured by Harm Reduction Therapeutics, is intended as a low-cost product largely for outreach groups.Other forms of naloxone, including some with higher concentrations and some that are loaded in syringes, are already available by prescription.