How Much Naloxone Does Each US State Need to Combat Opioid Epidemics?

Nearly all US states have underdeveloped distribution efforts for naloxone, and few states are able to avert 80% of witnessed opioid overdose deaths with the opioid receptor antagonist, according to study findings published in The Lancet Public Health.

For the study, researchers developed a model of US states with opioid overdose risk and calculated the potential decrease in opioid overdose mortality as a result of 2-dose naloxone kit distribution. Researchers chose representative states with available data on type of opioid epidemic and estimated naloxone needs for the corresponding states. The investigators also conducted a modified Delphi process with a panel of 10 nationally recognized experts in public health policy, naloxone, harm reduction, law enforcement, and illicit drug markets, who helped identify 3 opioid epidemic types (fentanyl, heroin, and prescription opioids) in addition to 2 mixed types (fentanyl plus prescription opioids and fentanyl plus heroin).  Researchers sourced data from state health departments, national surveys, and online search engines from January 1, 2017 to December 31, 2017. The primary endpoint was the decrease in opioid-related overdose mortality.

Study results showed that, in 2017, US states’ need for naloxone varied by type of opioid epidemic. The likelihood of receiving treatment with naloxone during witnessed opioid overdoses and amount of deaths averted also differed by epidemic type. States with fentanyl epidemics had the highest probability of individuals receiving treatment with naloxone during witnessed overdose events (range 58%-76% in 3 modelled states). Conversely, states with prescription opioid epidemics had the lowest probability (range 0%-20%).

Compared with provider-prescribed access to naloxone, pharmacy-initiated and community-based access to naloxone resulted in a higher likelihood of individuals receiving treatment with naloxone during a witnessed overdose event. The 2 access points also had a greater number of averted opioid overdose mortality per 100,000 people. Almost all of the 12 representative states did not meet the target intervention goal of averting 80% of opioid overdose deaths by providing naloxone kits.

Researchers emphasized the need for interventions to increase the probability of witnessing opioid overdoses and be able to provide naloxone to affected individuals. Supervised consumption sites, services like Never Use Alone, or harm reduction practices were noted to help increase the chance of witnessing an active overdose and being able to intervene with naloxone.

Study limitations included an assumed saturation in naloxone distribution and having used data on opioid overdose rates from 2017, which have since increased over time.

“Our analysis indicated varying effectiveness of naloxone by distribution pathway; however, when total distribution of naloxone is low, distribution through any mechanism can have a large effect on the probability of naloxone use during a witnessed overdose,” the study authors noted. “Our model further indicated that when naloxone distribution is high, it is more effective to increase community-based and pharmacy-initiated distribution approaches than provider-initiated distribution approaches.”

Reference

Irvine MA, Oller D, Boggis J, et al. Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study. Lancet Public Health. Published online February 10, 2022. doi:10.1016/S2468-2667(21)00304-2