Regional variation in states’ naloxone accessibility laws in association with opioid overdose death rates-Observational study (STROBE compliant)

Abstract

Though overall death from opioid overdose are increasing in the United States, the death rate in some states and population groups is stabilizing or even decreasing. Several states have enacted a Naloxone Accessibility Laws to increase naloxone availability as an opioid antidote. The extent to which these laws permit layperson distribution and possession varies. The aim of this study is to investigate differences in provisions of Naloxone Accessibility Laws by states mainly in the Northeast and West regions, and the impact of naloxone availability on the rates of drug overdose deaths. This cross-sectional study was based on the National Vital Statistics System multiple cause-of-death mortality files. The average changes in drug overdose death rates between 2013 and 2017 in relevant states of the Northeast and West regions were compared according to availability of naloxone to laypersons. Seven states in the Northeast region and 10 states in the Western region allowed layperson distribution of naloxone. Layperson possession of naloxone was allowed in 3 states each in the Northeast and the Western regions. The average drug overdose death rates increased in many states in the both regions regardless of legalization of layperson naloxone distribution. The average death rates of 3 states that legalized layperson possession in the West region decreased (-0.33 per 100,000 person); however, in states in the West region that did not allow layperson possession and states in the Northeast region regardless of layperson possession increased between 2013 and 2017. The provision to legalize layperson possession of naloxone was associated with decreased average opioid overdose death rates in 3 states of the West region.

Assessment of Same-Day Naloxone Availability in New Mexico Pharmacies

“…Increased access to naloxone at the state and community level is associated with reduced risk for death from overdose, and, consequently, widespread availability is recommended. [14][15][16][17] Statewide real-time pharmacy availability of naloxone-as patients would experience availability-has not been previously reported. These findings suggest unpredictable same-day availability that may affect experience and care outcomes.…”

Gaps in Naloxone Ownership among People who Inject Drugs during the Fentanyl Wave of the Opioid Overdose Epidemic in New York City, 2018

“…7 Despite advancements in easing legal restrictions on naloxone distribution to expand mechanisms for people to access this medication, studies have demonstrated mixed effectiveness of NALs in reducing opioid overdose deaths. [7][8][9] A recent systematic review found no associations between state-level NALs and opioid overdose deaths in more recent years (2015-2016) compared to earlier analyses where significant protective effects were found. 7 These results suggest that policy change alone may not be enough to achieve widespread naloxone possession among people likely to witness or experience an opioid overdose.…”

“…Because naloxone is a prescription medication and not available over-the-counter (OTC), the implementation of community naloxone distribution programs has relied on state-level naloxone access laws (NALs), which vary by state 7 . Despite advancements in easing legal restrictions on naloxone distribution to expand mechanisms for people to access this medication, studies have demonstrated mixed effectiveness of NALs in reducing opioid overdose deaths 7 – 9 . A recent systematic review found no associations between state-level NALs and opioid overdose deaths in more recent years (2015–2016) compared to earlier analyses where significant protective effects were found 7 .…”

A Study on the Efficacy of a Naloxone Training Program

“…Underutilization of naloxone may be in part due to stigma over its possession, lack of availability, as well as variability among state laws regarding layperson distribution [11][12][13]. In states in which naloxone availability is mandated at pharmacies, it has been found that locations in neighborhoods with lower socioeconomic status reported either lower quantity or no stock at all, potentially contributing to a lack of access in these environments [12].…”