Public perceptions and willingness-to-pay regarding over-the-counter (OTC) naloxone: A national cross-sectional survey informed by the Theory of Planned Behavior.

Background: Little is known regarding the U.S. general public's beliefs and willingness to purchase over-the-counter (OTC) naloxone. Therefore, the purpose of this study was to better understand the U.S. public's knowledge, perceptions, and willingness-to-pay regarding OTC naloxone nasal spray, and differences across sociodemographic characteristics. Methods: Adults residing in the US were recruited to participate in an online, anonymous cross-sectional survey using Amazon's Mechanical Turk (MTurk) in September 2023. The survey instrument was developed by the investigators, guided by the Theory of Planned Behavior (TPB). Outcomes included: 1) awareness and knowledge; 2) willingness-to-pay (WTP); 3) community pharmacy preferences; 4) perceived access in community pharmacies; 5) perceived acquisition barriers; 6) utilization comfort; and 7) TPB constructs including general attitudes, subjective norms, perceived behavioral control, and purchase intention. Data was analyzed using descriptive statistics, and Mann-Whitney Results: Among 299 respondents, awareness was low (31.8%), with mean(SD) WTP of $27.06(25.44). There was higher perceived pharmacy access, comfort, general attitudes, and purchase intentions among those reporting a history of chronic pain. Likewise, those with exposure to SUD reported more positive attitudes and higher purchase intentions. Females perceived more barriers to OTC naloxone access versus males, and WTP was lower among those reporting annual household income <$50,000. Conclusion: Overall, WTP for OTC naloxone was lower than average retail prices. Perceptions, intentions, and WTP differed across sociodemographics. Future studies may further investigate these disparities.