Wider Access To Naloxone: Harmful or Beneficial?

By Beth Leipholtz 03/15/18

In a new study, researchers examined the effects of increased naloxone access across the country.

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Pharmacist checking medicine on shelf at pharmacy

While wider access to the opioid overdose reversal drug naloxone is typically viewed as a positive step in the fight against the opioid epidemic, a new study says it could actually be increasing opioid abuse. 

The study, published on the research network SSRN, claims that although access to naloxone reduces the risk of fatalities at the hands of opioids, it makes more dangerous drug use and higher dosages more appealing. 

The National Institute on Drug Abuse (NIDA) defines naloxone as “an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids.”

Though originally used only by doctors and paramedics, some states now allow the purchase of the overdose reversal drug without a prescription. 

Jennifer Doleac, one of the study’s authors and an assistant professor of public policy and economics at the University of Virginia, argues that increasing access to naloxone is not a solution. 

"While naloxone can be a good harm-reduction strategy, it's clear that naloxone access alone is not a solution to the opioid epidemic," she told CNN. "As currently implemented, these policies may be making things worse."

In the study, Doleac and co-author Anita Mukherjee, who is an assistant professor at the Wisconsin School of Business at the University of Wisconsin-Madison, studied the effects of increased naloxone access across the country. Doleac and Mukherjee “estimated the effects of naloxone access laws across the 50 states and made comparisons across regions.”

Doleac explained to CNN that the economic term “moral hazard” employed in the study means that people will do more of something as it becomes less risky. 

"We were interested in to what extent making opioid abuse less risky leads to more opioid abuse," Doleac told CNN. "The main takeaway is that broadening access to naloxone leads to an increase in opioid abuse.”

Doleac and Mukherjee found that in states in the Midwest, naloxone access correlated to a 14% increase in opioid-related deaths, as well as an 84% increase in fentanyl-related deaths. Similar statistics were the case in the South as well. 

On the other hand, the West and Northeast did not follow that pattern. There, increased naloxone access saw decreased opioid deaths. 

According to Doleac, this could be related to treatment options. "In the best-case scenario, saving someone's life with naloxone gives them a chance to get treatment," she told CNN. "But that will only happen if there's treatment available."

The researchers also studied urban areas in the U.S. and noted in the study that after laws passed to increase access to naloxone, "arrests for possession and sales of opioids increased by 17% and 27%, respectively, opioid-related visits to the emergency room increased by 15%, and opioid-related theft increased by 30%.”

Doleac tells CNN that she believes strongly in the study’s findings, saying the "analysis has been put through the wringer over the past year."

Editor's Note, 4/11/2018: researcher Leo Beletsky presents a respectful and salient critique of this study in this Twitter thread: https://twitter.com/LeoBeletsky/status/973063917390958593.

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.

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