Increase in naloxone accessibility needed in almost every US state to combat opioid overdoses, study says

The distribution and accessibility of naloxone, a drug used to counteract the effects of an opioid overdose, needs to be increased and expanded in almost every US state in order to more effectively combat opioid overdoses and prevent more overdose deaths, according to a new study.

The study, published in The Lancet Public Health journal and funded by the US National Institute on Drug Abuse — part of the US National Institutes of Health — is the first to analyze and draw estimates of naloxone needs for each US state. According to researchers, most states suffered from significant disparities in their accessibility and distribution of naloxone. It’s been reported that 1.2 million Americans are expected to die of opioid overdoses between 2020 and 2029.

“As the COVID-19 pandemic continues to collide with the opioid crisis and we see more fentanyl in the illicit drug supply, we must ensure we have life-saving interventions, such as naloxone, in the hands of people who are most likely to be there when an overdose happens,” senior author of the study, Traci Green of Brandeis University, said in a press release. “People who use drugs and people living in the community must be considered first responders and need easy access to naloxone so they can act quickly to save a life.”

The study examined data obtained from state health departments, nationwide surveys, and addiction sources from 12 “modeled states” from 2017, while including differences in drug toxicity and “naloxone access points.” Access points are places where people can access naloxone in the area, including through community programs, prescriptions, or pharmacies.

The 12 states included in the study were representative of differing epidemic types, which tend to vary by region: the eastern United States largely concentrates on the fentanyl epidemic; the Midwest is a combination of prescription opioids, fentanyl, and heroin; the western US primarily struggles with opioids, though the southwest and Pacific Northwest are a mix of prescription opioid and heroin epidemics; and Alaska and Hawaii were evaluated for prescription opioid epidemics.

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Researchers found that to avoid 80 percent of opioid overdose deaths (in which another person is a witness) some states need to fund an additional 1,270 naloxone kits per 100,000 people each year.

Naloxone needs vary by state and region, depending upon the types of epidemics being faced. For example, regions heavily struggling with fentanyl use and overdoses, such as the eastern US are in the most desperate need of additional naloxone intervention due to the drug’s high toxicity and lethality. Fentanyl is 80 to 100 times stronger than morphine and the primary driver of drug overdose deaths in the United States, according to the US Drug Enforcement Administration.

“Our study provided estimates for naloxone needs by state, but a consistent national framework for reporting opioid overdoses and tracking community-based and pharmacy-initiated naloxone distribution is also urgently needed to inform policies and allocate resources that will finally turn the tide on this unprecedented epidemic,” Green said.

However, some states are already working to make naloxone more easily accessible.

In NovNew York became the first US city to green light supervised consumption sites for illegal drug use, in another effort to combat the opioid epidemic and increase in overdoses.

OnMondaythe Justice Department said it was “evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety.”

Additionally, New York is in the process of installing 10 PHVMs throughout the citywhich will dispense sterile syringes, naloxone, and additional health supplies.

In response, Phyllis Losikoff, addiction medicine and medical director of research and development at CleanSlate — a national medical group that provides treatment for individuals suffering from opioid and alcohol use disorders — supported the installation and distribution of such supplies, but also highlighted the need to address the fundamental roots of addiction with better accessibility to health care and mental health care.

“There is no question that the availability of clean syringes and naloxone vending machines are key to saving lives and that harm reduction is an important tool in this fight. However, we remain concerned that state and large municipal governments have historically funded these types of innovations despite not being long-term solutions,” Losikoff said in a statement to Changing America, adding, “We cannot accept a status quo where thousands of Americans do not have access to proper treatment of their opioid addiction.”

This sentiment for the complexity and need for additional action to address drug addiction and, specifically, the opioid crisis was echoed by Green in her study.

Green said, “The deep underlying social determinants of health that can perpetuate drug addiction and overdoses, such as poverty, excessive incarceration, and structural racism must be addressed to break the deadly cycle of addiction.”

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