New Study: Major Shortage of Naloxone in Nearly Every U.S. State
Unless you live in Arizona, your state is not handing out enough of the life-saving drug.
How much naloxone does a state need to make a dent in the ever worsening overdose crisis? It’s a question that has confounded public health professionals on the front-lines. Naloxone, the opioid overdose antidote, can be expensive, and programs and pharmacies need to know how much of the drug to order, just as states need to know how much of the drug to budget for, just as manufacturers need to know how much of the drug to produce.
Making matters even more complicated, naloxone is accessed through a scattered, underfunded patchwork of distribution points across various states. So it’s difficult to know how much naloxone is being given out and which distribution point is the most effective means of getting naloxone in the hands of those who are most likely to witness an overdose (i.e. people who actually use drugs).
Now, a new first-of-its-kind study offers some answers. As promised in my first research round-up post, here is a link to the paper.
A complex modeling study published in The Lancet Public Health set benchmarks for how much naloxone states need so that it is available in 80 percent of witnessed overdoses. By setting the 80 percent threshold, the researchers can work from there to estimate how much more naloxone must be distributed per 100,000 people.
Based on the 80 percent benchmark, the study concluded that “almost all US states have underdeveloped naloxone distribution efforts and that few are able to avert 80% of witnessed deaths.” In other words, states are not giving out nearly enough of the drug, which means it’s not there when people truly need it. When naloxone is available, opioid overdoses are 100 percent preventable.
“We have a massive overdose crisis and naloxone is the only tried-and-true solution,” Traci Green, the study’s first author who leads Brandeis University’s Opioid Policy Research Collaborative, said.
Unless you live in Arizona, of all places, then your state is not distributing enough naloxone. Here is what research-scientist Dr. Nabarun Dasgupta had to say about the implications of this new study:
The research team behind the study also created a handy-dandy website so you can check out how much more naloxone your state needs: NaloxoneNeededToSave.org (ahem, show this to your state reps, mayors, etc. and hold them accountable!)
There are states that do make naloxone widely available, especially for those most likely to witness an overdose. Massachusetts, for instance, has well-established community-based naloxone distribution programs, but doesn’t hit the 80 percent benchmark. These programs in Mass. hand out naloxone to drug users, their families, local businesses, basically any potential bystander, and that’s a good thing. Since Massachusetts and other East Coast states are flooded with potent street fentanyl, they really need to flood the zone with naloxone. According to the study, Massachusetts would need to distribute an estimated 740 extra kits per 100,000 people to ensure that naloxone is present in 80 percent of witnessed overdose deaths.
Knowing such information can help activists and other groups push their states to make much bigger naloxone orders, or push manufacturers to produce more of the drug.
“I am thrilled to have a benchmark to reference when I get the common question, ‘How much naloxone do we need to distribute?’” Maya Doe-Simkins, a co-author on the study and co-director of Remedy Alliance, said. “This study confirms my previous answer: We need to distribute more naloxone than we have been, and directly to people who use drugs via community-based harm reduction programs, including syringe services programs.”
Every state has its own way of distributing naloxone, and the study found that some ways are better than others. The researchers found three different modes of distribution: 1) Community-based programs (a syringe programs and other harm reduction groups) 2) Provider prescription (a doctor might co-prescribe naloxone with an opioid prescription) or 3) Pharmacy-initiated distribution (a pharmacy decides to stock it and people can purchase it).
It turns out that community- and pharmacy-based are the best mode of distribution. According to the study:
Community-based and pharmacy-initiated naloxone access points had higher probability of naloxone use in witnessed overdose and higher numbers of deaths averted per 100,000 people in state-specific results with these two access points than with provider-prescribed access only.
This is an important finding for many reasons. What this means is that doctors prescribing naloxone is not really the best way to get it in the hands of those who need it most. And that makes sense for a lot of reasons. In America, many people who use drugs simply don’t have great relationships with mainstream health care providers. In fact, most Americans don’t regularly see a general practitioner or have a primary doctor at all. It’s great that some doctors want to prescribe naloxone and educate their patients about it, but it’s just not the most effective way to really make sure a community has enough naloxone to hit that 80 percent threshold.
Based on this finding, syringe programs and other harm reduction groups can argue that they should be prioritized as the main receivers of naloxone. Many harm reduction programs lament that cops get a ton of naloxone from the state that they don’t really need. Harm reduction workers have complained to me that the naloxone police departments do get tends to expire, or cops absurdly use it on themselves when they think they’ve been “exposed” to fentanyl (which isn’t a real thing).
The study found that naloxone was most often used to save a life when it came from community-based programs. It was through this route that the most overdose deaths were averted. Harm reduction and syringe programs do by far the most naloxone distribution, and tend to have the closest ties to the local drug user community. In contrast, provider- and pharmacy-based access points tend to require co-pays, as though you’re picking up any other prescription. Your local syringe program probably gives naloxone out for free.
These variations in distribution points appeared in the study’s findings. “For example, in 2017 South Carolina had more prescription opioid overdoses, relied heavily upon prescribers and pharmacies for naloxone access, and lacked a community-based naloxone distribution program,” says Green of Brandeis. “It would need over 35,000 kits distributed per year in order to achieve the target benchmark of having naloxone available at 80% of witnessed overdoses.”
Then there’s Illinois, home of the Chicago Recovery Alliance, which has historically been a major hub of naloxone distribution for not just the state, but the entire country. “Illinois, a large state with high numbers of heroin and fentanyl overdoses, relied less upon prescribers and pharmacies to distribute naloxone and more upon one centralized, community-based program hub,” Green continued. “Illinois would need 162,306 naloxone kits per year to meet the same goal.” Even in Illinois, where naloxone distribution to drug users first started, is still coming up short.
At the end of the day, this study emphasizes that states need to significantly scale-up naloxone distribution. The best way to do that is through community-based harm reduction programs, and in some states, pharmacies. Right now, far too many overdose deaths occur when no one is around, or when someone is there, they don’t have naloxone. Widely distributing this life-saving drug will reduce the likelihood that overdoses are fatal.
Thanks to this study, states now know exactly how much of the drug to distribute, and elected officials ought to be held accountable when they fall short.