Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modeling study

Research in context

Evidence before this study

Naloxone has been a highly effective evidence-based tool to reduce opioid overdose-related mortality and morbidity. In 2017, the US Department of Health and Human Services declared the opioid crisis in the USA to be a public health emergency. The advent of illicitly manufactured fentanyl entering the illicit drug market, in both powder-based and pill-based drugs, led to an increase in opioid overdoses. We searched PubMed on April 22, 2021, for publications in English between Jan 1, 2015, and April 22, 2021, using the search terms “naloxone” AND “fentanyl” AND “overdose”, with no restrictions on geographical location. Of the 186 publications identified, none aimed to estimate the amount of naloxone needed to reduce overdoses across fentanyl, heroin, and prescription opioid epidemics within the USA.

Added value of this study

To our knowledge, this is the first study to estimate the naloxone need for the entire USA. Estimates for each state include the estimated number of deaths averted by each of the three main access points for naloxone, and the number of kits that need to be distributed to avert a targeted 80% of witnessed opioid overdose deaths. Additionally, the data collection and parameterization method provide programme-based and expert-driven estimates of the current extent and impact of naloxone access mechanisms.

Implications of all the available evidence

Our results highlight that current naloxone access pathways in most US states are underdeveloped. Additionally, we estimate that community-based programs and pharmacy-initiation models provide the greatest effect per distributed kit compared with prescription-based programs. We provide state-based targets of distribution to guide policy makers in their future investment in naloxone distribution efforts.

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