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Greater naloxone availability, especially for fentanyl, could lower overdose deaths

A large expansion in the availability of naloxone kits could substantially reduce opioid overdose deaths, especially from fentanyl, according to a new study.

The study modeled the risk of fatal overdose in 12 states, incorporating overdose data, prevalent opioid epidemic type (prescription versus heroin versus fentanyl, or a combination) and naloxone access points (community-based programs, provider prescription, or pharmacy-initiated distribution), and asked how many naloxone kits would be needed to be available for at least 80% of witnessed opioid overdoses.

The model indicated that the number of overdose deaths averted per 100,000 population was highest in fentanyl-dominated epidemic areas, as was responsiveness to increasing the supply of naloxone kits. Areas dominated by prescription opioids had lower probability of naloxone use in a witnessed overdose, and had the least reduction in overdose deaths with an increase in naloxone kits.

“Our models indicate that community­based and pharmacy­initiated 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 prescriber­based naloxone access,” the authors concluded. “Our study adds to the increasing evidence that expanding naloxone access, in combination with other prevention and harm reduction initiatives, can have a substantial impact on the overdose epidemic…To achieve a target of naloxone use in 80% of witnessed overdoses, need varied from no additional kits (estimated as sufficient) to 1,270 kits needed per 100,000 population across the 12 modelled states annually. In 2017 [the year from which data was drawn], only Arizona had sufficient kits to meet this target.”

Irvine MA, Oller D, Boggs J, et al. Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study. Lancet Public Health. 2022 Feb 10:S2468-2667(21)00304-2.