To prevent opioid overdose deaths, naloxone distribution needs to be substantially expanded in nearly every US state, according to results from a modeling study published in The Lancet Public Health. The findings emphasized the inclusion of more community-based and pharmacy-initiated naloxone access points.

“We found that almost all US states have underdeveloped naloxone distribution efforts and that few are able to avert 80% of witnessed deaths due to opioid overdose with naloxone,” researchers reported. “Our models indicate that community-based and pharmacy-initiated naloxone distribution pathways have a larger public health effect in terms of deaths averted and potential for naloxone intervention than does an approach reliant only on prescriber-based naloxone access.”

The study estimated state-level naloxone needs in 2017 across 3 main naloxone access points (community-based programs, provider prescription, and pharmacy-initiated distribution) and by dominant opioid epidemic type (fentanyl, heroin, and prescription opioid).

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Community-based and pharmacy-initiated naloxone access points, researchers found, had a higher probability of naloxone use in the event of a witnessed overdose and higher numbers of deaths averted per 100,000 people compared with solely provider-prescribed naloxone access.

The study also found that naloxone need differed with epidemic type. Fentanyl epidemics had the highest probability of naloxone use during a witnessed overdose, while epidemics dominated by prescription opioids had the lowest probability of naloxone use.

To reach a target of naloxone use in 80% of witnessed overdoses, need varied by state: from no additional naloxone kits needed in Arizona to 1270 kits needed per 100,000 people per year in Illinois. Because fentanyl use has increased in Arizona since 2017, however, researchers believe the state may now need additional naloxone to align with the shift.

“Opioid epidemic type and how naloxone is accessed have large effects on the number of naloxone kits that need to be distributed, the probability of naloxone use, and the number of deaths due to overdose averted,” researchers wrote. “The extent of naloxone distribution, especially through community-based programs and pharmacy-initiated access points, warrants substantial expansion in nearly every US state.”

References

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

The Lancet Public Health: Substantial increase in life-saving opioid overdose intervention urgently needed in almost every US state. News release. The Lancet; February 10, 2022. Accessed February 18, 2022.