Impact of Naloxone Access Policies on Opioid Overdose Deaths

OBJECTIVES

Opioid overdoses, largely reversible with timely naloxone administration, have risen substantially since 1999. Several states have implemented policies that increase access to naloxone, such as third party prescribing, standing order prescriptions and prescriber immunity that removes liability when assisting with overdose treatment. We explore the relationship between these policies and trends in opioid overdose deaths.

METHODS

Dependent variable data, pharmaceutical opioid and heroin overdose deaths per state-year from 1999-2011, were obtained from the CDC WONDER database. Deaths were identified using International Classification of Disease version 10 codes for opioid poisoning of any intent: X40-44, X60-64, and Y10-14, with underlying substance codes T40.0-40.4 or T40.6. State naloxone access policies, including third party naloxone prescribing authorization, standing order prescriptions and prescriber immunity laws, were operationalized as independent variables at month-year of implementation.  A negative binomial, time series regression model with state and year fixed effects estimated the relationship between naloxone access policy implementation on opioid overdose deaths. State-level control variables included: population, operational prescription monitoring program, and unemployment.

RESULTS

During the study period, six states implemented at least one of the naloxone access policies examined. States with third party prescribing experienced a 44.36% decrease in opioid overdose per year after policy implementation (95% CI: 0.34-0.90), but doubled heroin overdoses (95% CI: 1.21-4.04).

CONCLUSIONS

This analysis provides foundational evidence for the potential slowing of pharmaceutical opioid overdose death trends due to greater naloxone access in states where third party prescribing was implemented. Research on optimal implementation of naloxone access laws is needed.