The state of naloxone: Access amid a public health crisis

Abstract

Over the past decade, opioid use has been at the forefront of a public health crisis throughout the United States (US). The US Centers for Disease Control and Prevention (CDC) reported opioid overdose deaths increased from 4030 to 16,917 between 1999 and 2011. 1 This increase was accompanied by a corresponding uptick in opioid prescribing. In fact, increases in opioid-prescribing paralleled increases in morbidity, mortality, opioid-related overdose death rates, and substance-use-disorder-treatment admissions from 2006 to 2012. 2 In response to the tremendous negative societal, personal, and economic impacts that this growing public health crisis (also called the "opioid crisis" or "opioid epidemic") caused, several governmental agencies began to respond. In 2016, the CDC developed and published a controversial set of guidelines on the prescribing of opioids for chronic pain, which, in part, included limits of morphineequivalent daily doses (MEDD) to ⩽90 mg/day for anyone on long-term opioids. 3 Such a cap could be more harmful than good given the widespread lack of understanding for the variation in potency, receptor-binding, affinity, physical tolerance, and pharmacokinetic properties among different opioids. Furthermore, there are inconsistencies among MEDD calculators which limit reliable conversion from one opioid to another. 4 In addition to concerns related to MEDD, the conclusions drawn in the CDC guidelines are largely based on poor quality evidence and, it is noted that no pharmacists were included in the author panel. 5,6 Perhaps, most concerning is the fact that these misguided