Estimating Naloxone Need in the United States Across Fentanyl, Heroin, and Prescription Opioid Epidemics: A Modelling Study
39 Pages Posted: 18 Nov 2021
Date Written: September 23, 2021
Background: The US overdose crisis is driven by fentanyl, heroin, and prescription opioids. One evidence-based policy response is broadened naloxone distribution, but how much naloxone a community would need to reduce fatal overdose is unclear. This study aimed to estimate US naloxone need in 2017 across three main naloxone access points (community-based programs, provider prescribed, pharmacy-initiated) and by dominant opioid epidemic type (fentanyl, heroin, prescription opioid).
Method: We developed, parameterized, and applied a mechanistic model of opioid overdose risk and used it to estimate the expected reduction in mortality following deployment of a given number of two-dose naloxone kits. A literature review and modified-Delphi panel informed parameter definitions. We refined an established model of the population at risk of overdose by incorporating changes in illicit drug supply toxicity and naloxone access point, then calibrated the model to 2017 using data from 12 states representative of each epidemic type. Counterfactual modeling projected the impact of increased naloxone distribution and estimated the number of witnessed opioid overdose deaths averted with naloxone by state and access point.
Findings: Need for naloxone differed by epidemic type, with fentanyl-dominated epidemics generating the highest naloxone use during witnessed overdose events (range 58%-76%) and prescription-dominated epidemics having the lowest (range 0%–20%). Community-based and pharmacy-initiated naloxone access points achieved greater deaths averted and naloxone use during witnessed overdose compared with prescriber-based access only. To achieve a targeted 80% naloxone use in witnessed overdoses, need varied from -361 to 1,270 additional kits per 100,000 population across states annually. Few states met this target.
Interpretation: State opioid epidemic type and how naloxone is accessed have large impacts on need for naloxone, probability of naloxone use, and overdose deaths averted. The extent of naloxone distribution, especially through community-based programs and pharmacy-initiation, warrants substantial expansion in most states.
Funding National Institute on Drug Abuse (Grant R01DAQ45745-01S1)
Funding Information: We acknowledge support from the National Institute on Drug Abuse (Grant R01DAQ45745-01S1).
Declaration of Interests: We declare no competing interests.
Keywords: naloxone, opioid, Bayesian inference, overdose, fentanyl
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