Estimating Naloxone Need in the United States Across Fentanyl, Heroin, and Prescription Opioid Epidemics: A Modelling Study

39 Pages Posted: 18 Nov 2021

See all articles by Michael Irvine

Michael Irvine

BC Centre for Disease Control

Declan Oller

affiliation not provided to SSRN

Jesse Boggis

affiliation not provided to SSRN

Brian Bishop

affiliation not provided to SSRN

Daniel Coombs

affiliation not provided to SSRN

Eliza Wheeler

affiliation not provided to SSRN

Maya Doe-Simkins

affiliation not provided to SSRN

Alexander Walley

Boston University - School of Medicine

Brandon DL Marshall

Brown University - Department of Epidemiology

Jeffrey Bratberg

University of Rhode Island College of Pharmacy

Traci Green

Brandeis University - The Heller School for Social Policy and Management; COBRE on Opioids and Overdose, Rhode Island Hospital

Date Written: September 23, 2021

Abstract

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)

Note:
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

Suggested Citation

Irvine, Michael and Oller, Declan and Boggis, Jesse and Bishop, Brian and Coombs, Daniel and Wheeler, Eliza and Doe-Simkins, Maya and Walley, Alexander and Marshall, Brandon DL and Bratberg, Jeffrey and Green, Traci and Green, Traci, Estimating Naloxone Need in the United States Across Fentanyl, Heroin, and Prescription Opioid Epidemics: A Modelling Study (September 23, 2021). Available at SSRN: https://ssrn.com/abstract=3929585 or http://dx.doi.org/10.2139/ssrn.3929585

Michael Irvine

BC Centre for Disease Control

655 W 12th Avenue
Vancouver, V5Z 4R4
Canada

Declan Oller

affiliation not provided to SSRN

No Address Available

Jesse Boggis

affiliation not provided to SSRN

No Address Available

Brian Bishop

affiliation not provided to SSRN

Daniel Coombs

affiliation not provided to SSRN

No Address Available

Eliza Wheeler

affiliation not provided to SSRN

No Address Available

Maya Doe-Simkins

affiliation not provided to SSRN

No Address Available

Alexander Walley

Boston University - School of Medicine ( email )

771 Albany St
Boston, MA 02118
United States

Brandon DL Marshall

Brown University - Department of Epidemiology ( email )

United States

Jeffrey Bratberg

University of Rhode Island College of Pharmacy ( email )

Kingston, RI
United States
401-419-6303 (Phone)

Traci Green (Contact Author)

COBRE on Opioids and Overdose, Rhode Island Hospital ( email )

Providence, RI 02903
United States

Brandeis University - The Heller School for Social Policy and Management ( email )

P.O. Box 549110/MS 035
415 South Street
Waltham, MA 02454
United States

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