The effect of untargeted naloxone distribution on opioid overdose outcomes.
harm reduction
naloxone
opioid overdose
public health
Journal
Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
06
06
2023
received:
06
12
2022
accepted:
23
08
2023
medline:
6
11
2023
pubmed:
6
9
2023
entrez:
6
9
2023
Statut:
ppublish
Résumé
Opioid overdose has claimed the lives of over 340,000 Americans in the last decade. Over that same period, policymakers have taken steps to increase the availability of naloxone-an opioid antagonist used to rescue overdose victims-to people in the community. Previous studies, most of which have examined the effects of state laws designed to facilitate access to naloxone, have reached mixed conclusions about the effects of naloxone access on fatal and non-fatal overdoses. This paper exploits a unique policy experiment provided by two naloxone giveaways intended to increase naloxone possession among the general public in Pennsylvania to estimate the causal impact of naloxone distribution on fatal overdoses and opioid-related emergency department (ED) visits. Using a difference-in-differences design, I find evidence that opioid overdose deaths fell immediately following the first giveaway but increased following the second giveaway and discuss these apparently contradictory findings in the context of the changing composition of the opioid supply. I also find some evidence of a decline in opioid overdose-related ED visits following the giveaways. This study is the first to examine the effects of untargeted naloxone distribution and has implications for other novel, naloxone distribution efforts currently underway.
Substances chimiques
Naloxone
36B82AMQ7N
Analgesics, Opioid
0
Narcotic Antagonists
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2801-2818Informations de copyright
© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.
Références
Abouk, R., Pacula, R. L., & Powell, D. (2019). Association between state laws facilitating pharmacy distribution of naloxone and risk of fatal overdose. JAMA Internal Medicine, 179(6), 805-811. https://doi.org/10.1001/jamainternmed.2019.0272
Ahmad, F. B., Cisewski, J., Rossen, L. M., & Sutton, P. (2022). Provisional drug overdose death counts. National Center for Health Statistics, Issue. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Angrist, J. D., & Pischke, J.-S. (2009). Mostly harmless econometrics: An empiricist's companion. Princeton University Press.
Atkins, D. N., Durrance, C. P., & Kim, Y. (2019). Good Samaritan harm reduction policy and drug overdose deaths. Health Services Research, 54(2), 407-416. https://doi.org/10.1111/1475-6773.13119
Bennett, A. S., Bell, A., Doe-Simkins, M., Elliott, L., Pouget, E., & Davis, C. (2018). From peers to lay bystanders: Findings from a decade of naloxone distribution in Pittsburgh, PA. Journal of Psychoactive Drugs, 50(3), 240-246. https://doi.org/10.1080/02791072.2018.1430409
Blanchard, J., Weiss, A. J., Barrett, M. L., McDermott, K. W., & Heslin, K. C. (2018). State variation in opioid treatment policies and opioid-related hospital readmissions. BMC Health Services Research, 18(1), 1-12. https://doi.org/10.1186/s12913-018-3703-8
Borusyak, K., Jaravel, X., & Spiess, J. (2021). Revisiting event study designs: Robust and efficient estimation. arXiv preprint arXiv:2108.12419.
Callaway, B., & Sant’Anna, P. H. (2021). Difference-in-differences with multiple time periods. Journal of Econometrics, 225(2), 200-230. https://doi.org/10.1016/j.jeconom.2020.12.001
Cataife, G., Dong, J., & Davis, C. S. (2020). Regional and temporal effects of naloxone access laws on opioid overdose mortality. Substance Abuse, 42(3), 1-10. https://doi.org/10.1080/08897077.2019.1709605
Collins, A. B., Ndoye, C. D., Arene-Morley, D., & Marshall, B. D. (2020). Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19. International Journal of Drug Policy, 83, 102872. https://doi.org/10.1016/j.drugpo.2020.102872
De Chaisemartin, C., & d'Haultfoeuille, X. (2020). Two-way fixed effects estimators with heterogeneous treatment effects. The American Economic Review, 110(9), 2964-2996. https://doi.org/10.1257/aer.20181169
Doleac, J. L., & Mukherjee, A. (2022). The effects of naloxone access laws on opioid abuse, mortality, and crime. The Journal of Law and Economics, 65(2), 211-238. https://doi.org/10.1086/719588
Erfanian, E., Grossman, D., & Collins, A. R. (2019). The impact of naloxone access laws on opioid overdose deaths in the US. The Review of Regional Studies, 49(1), 45-72. https://doi.org/10.52324/001c.7932
Feldman, N. (2022). Philly unveils first-of-its-kind Narcan vending machine at West Philly Free Library. https://whyy.org/articles/philly-unveils-first-of-its-kind-narcan-vending-machine-at-west-philly-free-library/
Friedman, J., Montero, F., Bourgois, P., Wahbi, R., Dye, D., Goodman-Meza, D., & Shover, C. (2022). Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug and Alcohol Dependence, 233, 109380. https://doi.org/10.1016/j.drugalcdep.2022.109380
Goodman-Bacon, A. (2021). Difference-in-differences with variation in treatment timing. Journal of Econometrics, 225(2), 254-277. https://doi.org/10.1016/j.jeconom.2021.03.014
Governor's Press Office. (2018). Gov. Wolf receives naloxone kit for stop overdoses in PA: Get Help Now week. https://www.governor.pa.gov/newsroom/gov-wolf-receives-naloxone-kit-part-stop-overdoses-pa-get-help-now-week/
Graves, R. L., Andreyeva, E., Perrone, J., Shofer, F., Merchant, R. M., & Meisel, Z. F. (2019). Naloxone availability and pharmacy staff knowledge of standing order for naloxone in Pennsylvania pharmacies. Journal of Addiction Medicine, 13(4), 272-278. https://doi.org/10.1097/adm.0000000000000492
Greene, J. (2018). Naloxone “moral hazard” debate pits economists against physicians. Annals of Emergency Medicine, 72(2), A13-A16. https://doi.org/10.1016/j.annemergmed.2018.05.020
Guy, G. P., Jr., Haegerich, T. M., Evans, M. E., Losby, J. L., Young, R., & Jones, C. M. (2019). Vital signs: Pharmacy-based naloxone dispensing-United States, 2012-2018. Morbidity and Mortality Weekly Report, 68(31), 679-686. https://doi.org/10.15585/mmwr.mm6831e1
Hausman, C., & Rapson, D. S. (2018). Regression discontinuity in time: Considerations for empirical applications. Annual Review of Resource Economics, 10(1), 533-552. https://doi.org/10.1146/annurev-resource-121517-033306
Heavey, S. C., Chang, Y.-P., Vest, B. M., Collins, R. L., Wieczorek, W., & Homish, G. G. (2018). ‘I have it just in case’-Naloxone access and changes in opioid use behaviours. International Journal of Drug Policy, 51, 27-35. https://doi.org/10.1016/j.drugpo.2017.09.015
Hedegaard, H., Miniño, A., Spencer, M. R., & Warner, M. (2021). Drug overdose deaths in the United States, 1999-2020. NCHS data brief, Issue. https://www.cdc.gov/nchs/products/databriefs/db428.htm
Hill, L. G., Zagorski, C. M., & Loera, L. J. (2022). Increasingly powerful opioid antagonists are not necessary. International Journal of Drug Policy, 99, 103457. https://doi.org/10.1016/j.drugpo.2021.103457
Johnson, J., Pizzicato, L., Johnson, C., & Viner, K. (2021). Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010-2019. Injury Prevention, 27(4), 395-398. https://doi.org/10.1136/injuryprev-2020-043968
Kariisa, M., Patel, P., Smith, H., & Bitting, J. (2021). Notes from the field: Xylazine detection and involvement in drug overdose deaths-United States, 2019. Morbidity and Mortality Weekly Report, 70(37), 1300-1302. https://doi.org/10.15585/mmwr.mm7037a4
Kinnard, E. N., Bluthenthal, R. N., Kral, A. H., Wenger, L. D., & Lambdin, B. H. (2021). The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA. Drug and Alcohol Dependence, 225, 108759. https://doi.org/10.1016/j.drugalcdep.2021.108759
Koester, S., Mueller, S. R., Raville, L., Langegger, S., & Binswanger, I. A. (2017). Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose? International Journal of Drug Policy, 48, 115-124. https://doi.org/10.1016/j.drugpo.2017.06.008
Krieter, P., Gyaw, S., Crystal, R., & Skolnick, P. (2019). Fighting fire with fire: Development of intranasal nalmefene to treat synthetic opioid overdose. Journal of Pharmacology and Experimental Therapeutics, 371(2), 409-415. https://doi.org/10.1124/jpet.118.256115
Lambdin, B. H., Davis, C. S., Wheeler, E., Tueller, S., & Kral, A. H. (2018). Naloxone laws facilitate the establishment of overdose education and naloxone distribution programs in the United States. Drug and Alcohol Dependence, 188, 370-376. https://doi.org/10.1016/j.drugalcdep.2018.04.004
Lindo, J. M., Myers, C. K., Schlosser, A., & Cunningham, S. (2020). How far is too far? New evidence on abortion clinic closures, access, and abortions. Journal of Human Resources, 55(4), 1137-1160. https://doi.org/10.3368/jhr.55.4.1217-9254r3
McClellan, C., Lambdin, B. H., Ali, M. M., Mutter, R., Davis, C. S., Wheeler, E., Pemberton, M., & Kral, A. H. (2018). Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors, 86, 90-95. https://doi.org/10.1016/j.addbeh.2018.03.014
McDonald, R., Campbell, N. D., & Strang, J. (2017). Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids-Conception and maturation. Drug and Alcohol Dependence, 178, 176-187. https://doi.org/10.1016/j.drugalcdep.2017.05.001
Nadelmann, E., & LaSalle, L. (2017). Two steps forward, one step back: Current harm reduction policy and politics in the United States. Harm Reduction Journal, 14(1), 1-7. https://doi.org/10.1186/s12954-017-0157-y
National Harm Reduction Coalition. (n.d.). National community-based naloxone finder. Retrieved September 20, 2022 from https://harmreduction.org/resource-center/harm-reduction-near-you/
Office of Drug Surveillance and Misuse Prevention. (2022). Interactive data report: Overdose DataTechnical notes. https://www.health.pa.gov/topics/Documents/Opioids/OverdoseDataTechnicalNotes.pdf
OpenData PA. (2022). Opioid data dashboard. https://data.pa.gov/stories/s/Pennsylvania-Opioids/9q45-nckt/
Peet, E. D., Powell, D., & Pacula, R. L. (2022). Trends in out-of-pocket costs for naloxone by drug brand and payer in the US, 2010-2018. JAMA Health Forum, 3(8), e222663. https://doi.org/10.1001/jamahealthforum.2022.2663
Pennsylvania Pressroom. (2018a). More than 6000 kits of naloxone distributed as part of stop overdoses in Pa: Get Help Now week. https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=554
Pennsylvania Pressroom. (2018b). Wolf administration to distribute free naloxone on December 13 at locations across Pennsylvania as part of stop overdoses in Pa.: Get Help Now week. https://www.media.pa.gov/pages/Health-details.aspx?newsid=547
Pennsylvania Pressroom. (2019a). Wolf administration distributes 6,800 kits of free naloxone. https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=668
Pennsylvania Pressroom. (2019b). Opioid command center highlights progress made in battling the opioid overdose epidemic, provides update on current crisis. https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=632
Pennsylvania Pressroom. (2019c). Wolf administration to distribute free naloxone on September 18 and 25 at locations across Pennsylvania as part of stop overdoses in Pa.: Get Help Now week. https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=648
Pruyn, S., Frey, J., Baker, B., Brodeur, M., Graichen, C., Long, H., Zheng, H., & Dailey, M. W. (2019). Quality assessment of expired naloxone products from first-responders’ supplies. Prehospital Emergency Care, 23(5), 647-653. https://doi.org/10.1080/10903127.2018.1563257
Rambachan, A., & Roth, J. (2022). A more credible approach to parallel trends. Review of Economic Studies, rdad018.
Rees, D. I., Sabia, J. J., Argys, L. M., Dave, D., & Latshaw, J. (2019). With a little help from my friends: The effects of Good Samaritan and naloxone access laws on opioid-related deaths. The Journal of Law and Economics, 62(1), 1-27. https://doi.org/10.1086/700703. http://search.ebscohost.com/login.aspx?direct=true&db=ecn&AN=1785033&site=ehost-live&authtype=ip,shib&user=s1523151
Sant’Anna, P. H., & Zhao, J. (2020). Doubly robust difference-in-differences estimators. Journal of Econometrics, 219(1), 101-122. https://doi.org/10.1016/j.jeconom.2020.06.003
Seal, K. H., Downing, M., Kral, A. H., Singleton-Banks, S., Hammond, J.-P., Lorvick, J., & Edlin, B. R. (2003). Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: A survey of street-recruited injectors in the San Francisco Bay area. Journal of Urban Health, 80(2), 291-301. https://doi.org/10.1093/jurban/jtg032
Smart, R., Pardo, B., & Davis, C. S. (2021). Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction, 116(1), 6-17. https://doi.org/10.1111/add.15163
Substance Abuse and Mental Health Services Administration. (n.d.). National Survey of Substance Abuse Treatment Services (N-SSATS). https://www.samhsa.gov/data/data-we-collect/n-ssats-national-survey-substance-abuse-treatment-services
Sun, L., & Abraham, S. (2021). Estimating dynamic treatment effects in event studies with heterogeneous treatment effects. Journal of Econometrics, 225(2), 175-199. https://doi.org/10.1016/j.jeconom.2020.09.006
Tse, W. C., Djordjevic, F., Borja, V., Picco, L., Lam, T., Olsen, A., Larney, S., Dietze, P., & Nielsen, S. (2022). Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply. International Journal of Drug Policy, 100, 103513. https://doi.org/10.1016/j.drugpo.2021.103513
United States Census Bureau. (2022a). Glossary. https://www.census.gov/programs-surveys/geography/about/glossary.html
United States Census Bureau. (2022b). American Community Survey data. census.gov/programs-surveys/acs/data.html
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ, 346(jan30 5), f174. https://doi.org/10.1136/bmj.f174
Wenger, L. D., Doe-Simkins, M., Wheeler, E., Ongais, L., Morris, T., Bluthenthal, R. N., Kral, A. H., & Lambdin, B. H. (2022). Best practices for community-based overdose education and naloxone distribution programs: Results from using the Delphi approach. Harm Reduction Journal, 19(1), 1-9. https://doi.org/10.1186/s12954-022-00639-z
Wenner, D. (2018). Free naloxone: Pa. plans nation’s biggest giveaway of overdose reversal drug. PennLive Patriot-News. https://www.pennlive.com/news/2018/12/free-naloxone-pa-plans-nations-biggest-giveaway-of-overdose-reversal-drug.html
White, J. M., & Irvine, R. J. (1999). Mechanisms of fatal opioid overdose. Addiction, 94(7), 961-972. https://doi.org/10.1046/j.1360-0443.1999.9479612.x
Xu, J., & Mukherjee, S. (2021). State laws that authorize pharmacists to prescribe naloxone are associated with increased naloxone dispensing in retail pharmacies. Drug and Alcohol Dependence, 227, 109012. https://doi.org/10.1016/j.drugalcdep.2021.109012
Yang, C., Favaro, J., & Meacham, M. C. (2021). NEXT harm reduction: An online, mail-based naloxone distribution and harm-reduction program. American Journal of Public Health, 111(4), 667-671. https://doi.org/10.2105/ajph.2020.306124
Yi, G., Dayton, L., Uzzi, M., Browne, K., Konstantopoulos, A., & Latkin, C. (2022). Spatial and neighborhood-level correlates of lay naloxone reversal events and service availability. International Journal of Drug Policy, 106, 103739. https://doi.org/10.1016/j.drugpo.2022.103739