Narcan in Every Medicine Cabinet: Will Increasing Naloxone Access Save Lives?

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Narcan in Every Medicine Cabinet: Will Increasing Naloxone Access Save Lives?

By Travis Lupick 04/12/18

A recent large scale study examined the effectiveness of two harm reduction measures: access to naloxone, and Good Samaritan laws.

Image: 
A case with "Naloxone" label, vial, and syringe.
The Surgeon General wants more of us to have the overdose reversal drug on hand.

The office of United States Surgeon General has issued its first public-health advisory in more than a decade, and it’s aimed at the country’s overdose epidemic.

“I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of the overdose-reversing drug naloxone,” it begins. “Knowing how to use naloxone and keeping it within reach can save a life.”

The advisory published on April 5 is perhaps the most significant endorsement of a harm reduction initiative to ever come from the federal government.

In it, Adams emphasizes that the so-called overdose antidote is not only appropriate for long-time, injection-drug users, but should be held by "patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose."

Broadening the recommendation to include these other groups means that naloxone could be much more ubiquitous, taking its place next to aspirin in American medicine cabinets. But by making naloxone more widely available, are we enabling or even encouraging dangerous drug use as some people suggest?

Naloxone (brand name Narcan) is a medication that reverses the effects of opioids like heroin and fentanyl. If you make it easier for people to obtain the overdose antidote, opponents believe, you are implicitly giving permission for them to use opioids in excess (or, to overdose).

A group of researchers recently investigated this sort of question.

They examined two variables: access to naloxone, and Good Samaritan laws, which can generally be described as shielding someone from arrest and prosecution for drug crimes if they’ve called 911 to report an overdose.

The researchers’ sample was large. Essentially, they looked at the entire United States, examining where naloxone was made available and/or where Good Samaritan laws were passed and then comparing overdose mortality as well as drug use in those areas to jurisdictions that had not implemented such measures.

Have these harm reduction initiatives lowered numbers of drug overdose deaths? And, if they have, was there an unintended consequence of more people using illegal drugs?

A paper published in the academic journal Addictive Behaviors last month presents the answers.

“Naloxone access and Good Samaritan laws are associated with 14% and 15% reductions, respectively, in opioid overdose deaths,” it reads. “Among African-Americans, naloxone and Good Samaritan laws reduce opioid overdose deaths by 23% and 26% respectively.

“Neither of these harm reduction measures result in increases in non-medical opioid use,” the paper continues.

“These measures should be considered an important component of the strategy used to address the opioid overdose epidemic.”

In a telephone interview, the paper’s lead author, Chandler McClellan, said his team’s results are good news for jurisdictions struggling with the overdose epidemic, which killed an estimated 64,000 people in America in 2016.

“Our initial results show that harm reduction strategies like these don’t lead to moral hazard,” the health economist with the Substance Abuse and Mental Health Services Administration (SAMHSA) told The Fix.

“It’s like with needle exchange during the AIDS epidemic,” McClellan continued. “A number of studies were done to show that harm reduction strategies in those settings didn’t actually increase risky behaviors and the risky use.

“I think those sorts of studies combined with this sort of study shows that harm reduction strategies can be very effective without necessarily causing the sort of moral hazard that most people worry about.”

The research team consisted of eight academics, including high-profile names in harm reduction circles such as Alex Kral, principal scientist of RTI International’s behavioral health and criminal justice division, and Barrot Lambdin, an assistant adjunct professor with the University of California, San Francisco’s epidemiology department.

The group analyzed data from the U.S. Center for Disease Control and Prevention’s National Vital Statistics System and from the U.S. National Survey on Drug Use and Health covering a 12-year period from 2002 to 2014.

“By the end of 2014, a total of 28 (55%) states had passed a naloxone access law,” the paper reads. “A total of 21 (42%) states had passed overdose Good Samaritan laws, of which 8 (16%) had provisions that protected people who report an overdose from arrest for possession of controlled substances, and 7 (14%) had provisions protecting people from probation and/or parole violations.”

The paper notes that these years coincided with an unprecedented rise in drug overdose deaths.

“For the United States population, opioid-overdose mortality increased from 2.71 per 100,000 people in 2000 to 8.43 per 100,000 people in 2014,” it reads.

Without the harm reduction initiatives examined, it suggests that the death toll would have been higher.

“After states enacted a naloxone access law, they had a 14% lower incidence of opioid-overdose deaths, as compared to when states did not have a naloxone law,” it reads. “Similarly, after states enacted an overdose Good Samaritan law, they had a 15% lower incidence of opioid-overdose deaths, as compared to when states did not have an overdose Good Samaritan law.”

Meanwhile, “There were no statistically significant increases in the prevalence of nonmedical opioid use after the enactment of naloxone access laws or Good Samaritan laws.”

McClellan said he hopes the paper spurs discussions about harm reduction in jurisdictions that have yet to make naloxone widely available.

“The easier we can make it to access the help that people need, the better outcomes that we’re going to get,” he said.

 

Travis Lupick is a journalist based in Vancouver. His first book, Fighting for Space: How a Group of Drug Users Transformed One City's Struggle with Addiction, will be published in June 2018. You can follow him on TwitterFacebook, and Instagram.

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