Using FTS and Naloxone Together

Naloxone is available in two primary formulations for community use: intranasal spray and intramuscular injection. Each has distinct advantages, and understanding the differences helps programs choose the right product for their population. Intranasal naloxone, most commonly sold as NARCAN (4 mg naloxone nasal spray), is the dominant formulation in community distribution. It requires no medical training, no assembly, and no needles.

A landmark shift in naloxone access occurred in March 2023 when the FDA approved NARCAN 4 mg nasal spray for over-the-counter sale without a prescription, making it the first naloxone product available OTC in the United States. By September 2023, NARCAN was on shelves at major retailers including CVS, Walgreens, Walmart, Rite Aid, and Target in all 50 states and the District of Columbia. In July 2023, the FDA approved a second OTC naloxone product, RiVive (3 mg nasal spray), which became available in early 2024. The OTC transition eliminated a significant structural barrier.

Effective co-distribution requires more than simply placing naloxone and test strips in the same bag. Programs that achieve the highest uptake and sustained use integrate the two products into a unified workflow with training, follow-up, and accessible resupply. The Santa Clara County Naloxone Distribution Project provides a well-documented model. Community-based organizations and community health centers apply through a single online portal to receive both naloxone and fentanyl test strips.

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The evidence that fentanyl test strip use drives broader risk-reduction behavior is substantial and growing. A 2025 cross-sectional study published in JAMA Network Open examined 732 participants across three states (Kentucky, New York, and Ohio) in the Stay Safe Study and found that people who reported regularly using fentanyl test strips were significantly more likely to engage in multiple overdose risk-reduction behaviors. These included using with others present, keeping naloxone nearby during use, starting with a smaller test dose, and avoiding mixing opioids with other central nervous system depressants. A multi-state observational study published in 2025 found that positive FTS results were associated with participants taking turns using, having naloxone nearby, and reducing the amount of drugs consumed, with a four-fold reduction in quantity used following a positive result.

While naloxone remains the gold standard for community-based overdose reversal, the opioid antagonist field is moving. Nalmefene (brand name Opvee), a newer opioid antagonist approved by the FDA as a 2.7 mg intranasal spray, offers a longer duration of action and five-fold higher binding affinity for opioid receptors compared to naloxone. Clinical data suggests nalmefene reaches apparent complete reversal within 5 minutes, compared to a more gradual 20-minute reversal timeline for intranasal naloxone. In theory, nalmefene\\

The scale of the overdose crisis provides the urgent context for co-distribution. In 2024, 79,384 drug overdose deaths occurred in the United States, with 68 percent involving opioids and 88 percent of opioid deaths attributable to fentanyl and other synthetic opioids. While the 27 percent decline from the 2023 peak of approximately 114,000 deaths represents meaningful progress, overdose remains the leading cause of death for Americans aged 18 to 44. The decline itself is partly attributable to the very interventions this article describes.

For organizations ready to implement or expand naloxone and FTS co-distribution, the following framework provides an actionable starting point. First, secure your supply chain. Identify naloxone sources through your state health department, SAMHSA-funded programs, or direct purchase agreements. For fentanyl test strips, Subcheck SC-1 strips at $0.20 each and SC-X kits at $0.85 each offer cost-effective options at scale.