In 2021, a record 100,000 people died from drug overdoses in the U.S. – the vast majority of them of opioids, and increasingly from the potent drug fentanyl. Access to the life-saving medication naloxone, which is used to reverse opioid overdoses, has expanded across communities as a key public health response to these trends. A new study in The Lancet Public Health journal answers a question that has long confounded the public health community: How much naloxone do states need to turn the tide on the ever-growing opioid overdose epidemic?
The research team, led by Professor Traci Green of Brandeis University’s Opioid Policy Research Collaborative and Michael Irvine of Simon Fraser University and the British Columbia Centre for Disease Control, developed a mathematical model and companion website that generates nuanced data on naloxone need in all 50 U.S. states.
“We have a massive overdose crisis,” says Green, “and naloxone is the only tried-and-true solution. So how much of it do we need? Without an answer to that question, we don’t know how much we should manufacture, how many organizations we need distributing this medication, or how much governments should budget for.”
Although naloxone is a prescription drug, many states have implemented legal mechanisms that allow harm reduction programs, pharmacies and community organizations to purchase and broadly distribute the lifesaving kits to people who use drugs and others who may witness and respond to an overdose. This patchwork delivery system means that there was no comprehensive data on naloxone distribution—so the study authors built one–collecting and compiling 2017 data from pharmacies and an array of community organizations in a partnered fashion.
“Our approach considered different modes of access for naloxone as well as different types of opioid epidemics,” says Irvine. “Naloxone distribution differs greatly by how it is distributed, which also impacts how likely it is to be used, and the epidemic type varies significantly by geography, which influences the level of need.”
For example, in 2017 the East Coast epidemic was dominated by fentanyl, which generates a higher need for naloxone than areas where the epidemic is characterized by heroin or prescription opioid use. The authors also found that more overdose deaths were averted when naloxone was distributed via community organizations and pharmacy-initiated programs, compared with prescriber-based access (for example, physicians prescribing naloxone alongside a pain medication or a medication to treat opioid use disorder).
To quantify the amount of naloxone still needed, the authors identified an end goal of naloxone being available in 80% of witnessed overdoses. “We found that very few states met this target, and some needed more than 1,000 additional kits per 100,000 people to achieve that goal,” says Irvine.
Their results also show wide variation between states. Says Green, “For example, in 2017 South Carolina had more prescription opioid overdoses, relied heavily upon prescribers and pharmacies for naloxone access, and lacked a community-based naloxone distribution program. It would need over 35,000 kits distributed per year in order to achieve the target benchmark of having naloxone available at 80% of witnessed overdoses.
“On the other hand, Illinois, a large state with high numbers of heroin and fentanyl overdoses, relied less upon prescribers and pharmacies to distribute naloxone and more upon one centralized, community-based program hub. Illinois would need 162,306 naloxone kits per year to meet the same goal.”
Coauthor Maya Doe-Simkins, codirector of Remedy Alliance, says, “After more than 25 years of naloxone distribution to people who use drugs, I am thrilled to have a benchmark to reference when I get the common question, ‘How much naloxone do we need to distribute?’ This study confirms my previous answer: We need to distribute more naloxone than we have been, and directly to people who use drugs via community-based harm reduction programs, including syringe services programs.”
These findings emphasize the need to significantly expand naloxone distribution in most states, ideally through community-based programs and more broadly through pharmacies, as well as the need for increased harm reduction measures that reduce the likelihood of unwitnessed overdoses. For additional state-level data from this study, visit naloxoneneededtosave.org.
Research reported in this press release was supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, under award number R01DAQ45745-01S1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.