Drug overdoses now kill more Americans than car crashes, guns, and even HIV/AIDS at its peak in the 1990s — a startling result of the country’s opioid painkiller and heroin epidemic.
The good news is new research shows there are some ways to combat the epidemic. Specifically, a study published this month by the National Bureau of Economic Research (NBER) found that improving access to the opioid overdose antidote naloxone is linked to a 9 to 11 percent reduction in opioid-related deaths. (This would amount to around 3,500 averted deaths nationwide each year.)
Naloxone, short for naloxone hydrochloride, temporarily reverses the effects of opioids like heroin, OxyContin, and Percocet. So it reverses all the positive effects, including the painkilling benefits, but also the negative effects, such as a deadly overdose.
It lasts 30 minutes to an hour, which is usually enough to stave off a potentially fatal overdose and, if necessary, get someone to lifesaving care. If the effect doesn’t last long enough, naloxone can be reapplied, which is done through an injection or nasal spray.
Over the past few years, state and local lawmakers have taken steps to increase access to naloxone, which typically requires a prescription from a doctor. Depending on the state and city, this has allowed not only first responders such as police and firefighters to carry the drug, but also family members, friends, roommates, and even drug users. In total, 45 states and Washington, DC, have passed laws easing access to naloxone since 2001, but just how much access is eased greatly varies from state to state.
The NBER study looks at whether easing access to naloxone actually saves lives, finding that it really does. And that suggests that improving access to naloxone could be part of a broader policy plan that tackles the worst drug overdose epidemic in US history.
What the NBER study on naloxone access laws found
The study found that laws that increase access to naloxone were generally linked to a 9 to 11 percent reduction in opioid-related deaths. Digging deeper, the study found that laws that specifically remove criminal liability for possessing naloxone were associated with a 13 percent drop in opioid-related deaths. (Naloxone isn’t addictive and can’t be abused, but having it without a prescription can be illegal.) And it found that naloxone access laws are particularly effective when dealing with painkiller overdoses, but not statistically significant with heroin.
The study looked at the period between 1999 and 2014, using data from the National Vital Statistics System. Due to the limited time period, it’s missing effects from some states that have passed naloxone access laws since 2014.
The study also only found a correlation, not causation. There may have been other causal factors that drove the drop in opioid-related deaths. For example, states that passed a naloxone access law early on may have been more aware of the opioid crisis, and this awareness could have also contributed to the drop in opioid-related deaths.
The study also looked at the effect of Good Samaritan laws that make it so anyone “who, in good faith, seeks medical assistance for someone experiencing a drug-related overdose shall not be charged or prosecuted for possession of a controlled substance.” The typical hypothetical scenario this is meant to address is when, for example, two people are using heroin and one of them overdoses. A Good Samaritan law lets the non-overdosing heroin user call 911 to save his friend without having to fear that the police will show up and arrest him for possessing illegal drugs.
But the study found no statistically significant effect on overdose deaths from Good Samaritan laws, so it’s unclear if they have any actual impact.
Finally, researchers looked at the most common argument against naloxone access legislation and Good Samaritan laws: that they supposedly increase drug use. The typical argument is that if you remove some of the risk to opioid and heroin use by letting people easily access an overdose antidote or avoid criminal penalties, then people will be less deterred from using dangerous drugs.
The study, however, found no evidence for the concern: There was no statistically significant change in recreational painkiller use linked to either type of law.
Taken together, the findings suggest that at least naloxone access laws can play a big role in reducing opioid overdose deaths without leading to more drug use. These laws won’t be able to end the crisis on their own, but they can be part of a broader plan — particularly one that boosts access to treatment for addiction. And as the death toll of the opioid epidemic rises, these kinds of approaches are becoming more and more necessary.
The opioid epidemic, explained
In 2015, more Americans died of drug overdoses than any other year on record — more than 52,000 deaths in just one year. That's higher than the more than 36,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic's peak in 1995.
This latest drug epidemic, however, is not solely about illegal drugs. It began, in fact, with a legal drug.
Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There's a good reason for that: About one in three Americans suffer from chronic pain, according to a 2011 report from the Institute of Medicine.
Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is fairly weak, despite their effectiveness for acute, short-term pain. Painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.
So opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, they totaled more than 33,000 — close to two-thirds of all drug overdose deaths.
Seeing the rise in opioid abuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.
Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren’t conducting even such basic checks are now being told to give more thought to their prescriptions.
Yet many people who lost access to painkillers were still addicted. So some who could no longer access prescribed painkillers — or perhaps could no longer afford them — turned to cheaper, more potent opioids: heroin and fentanyl, a synthetic opioid that's often manufactured illegally for nonmedical uses.
Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
So other types of deadly opioid overdoses, excluding painkillers, also rose.
That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of potential addicts.
But the likely solution is to get opioid users into treatment. According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn't get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care.
Some states, like Louisiana and Indiana, have taken a "tough on crime" approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current opioid crisis.
That’s why many states have turned to alternative policies such as easing access to naloxone. The good news for these states is that, based on the latest research, this kind of public health–minded approach is actually working.