New Report: Access to overdose reversing Naloxone increases riskier behavior

New research by Jennifer L. Dolec of the University of Virginia and Anita Mukherjee of the University of Wisconsin explores the moral hazard of the overdose reversing drug Naloxone.

According to the abstract, the United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: 

(1) saving the lives of active drug users, who survive to continue abusing opioids, and 

(2) reducing the risk of death per use, thereby making riskier opioid use more appealing. 

By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality.

These effects are driven by urban areas and vary by region. We find the most detrimental effects in the Midwest, including a 14% increase in opioid-related mortality in that region. We also find suggestive evidence that broadening Naloxone access increased the use of fentanyl, a particularly potent opioid. While Naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to Naloxone encourages riskier behaviors with respect to opioid abuse.

PA Governor Wolf: State Police to carry heroin antidote

Pennsylvania Gov. Tom Wolf wants to widen access to a prescription drug that can prevent fatalities from drug overdoses, reported The Associated Press.
In an op-ed piece published Monday by PennLive.com, Wolf said the Pennsylvania State Police will begin carrying nasal-spray kits of naloxone, also known by its brand name Narcan, in their patrol cars.
A spokesman says the policy will take effect in the coming weeks.
Wolf also says he's directed state Physician General Dr. Rachel Levin to write a "standing order" that serves as a prescription that allows every Pennsylvanian to obtain naloxone. The non-addictive drug can reverse the effect of heroin and other opioids such as oxycodone.
A new state law allows police to administer the antidote. It also allows doctors to prescribe it to friends and relatives of addicts.

The Cautionary Instruction: Arm police with drug to reverse overdoses

Matthew T. Mangino
The Pittsburgh Post-Gazette/Ipso Facto
February 7, 2014
As heroin overdoses have soared in Western Pennsylvania and across the country, more police departments are taking a hard look at equipping their police officers and other first responders with overdose reversing drug, Naloxone. Police are often the first to arrive at the scene, and experts say those early minutes can be the key to saving a life.
Since Quincy, MA police officers began carrying a nasal form of the drug, known by its trade name, Narcan, in October 2010, they have administered the drug 221 times and reversed 211 overdoses.
Narcan binds to the opioid receptors in the brain, displacing other drugs and reversing the effects. It works as an opioid antagonist, essentially reviving an unresponsive patient within seconds. Narcan can be administered by injection into a muscle or as a nasal spray and lasts 30 to 90 minutes.
Starting next week, Lorain County law enforcement officers will begin carrying Narcan “We are taking the initiative along with the risk, but it’s worth it because we are going to save lives,” said Lorain County Coroner Dr. Stephen Evans.
St. Louis County Police Chief Tim Fitch wants his department to be the Midwest’s first to carry the antidote, and he met recently with the National Council on Drug and Alcohol Abuse to lobby for support.
St. Louis County Police Association president Gabe Crocker called it an “aggressive approach” that officers would support. “I see this as no different than adding another tool to our first-aid kit to save a life,” he said.
Vermont state troopers are also training to use Narcan. "So the troopers across the state understand what Narcan is all about. The last thing I would want to happen is a trooper go into an apartment where an overdose is taking place, someone is trying to administer Narcan, and a trooper took action [to stop it]," Vermont State Police Col. Tom L’Esperance said.
The public safety department in Espanola Valley, New Mexico in early 2013 became the first police agency in the Southwest to equip its police and first responders with Narcan.
In Ocean County, NJ when overdose deaths doubled from 53 in 2012 to 112 in 2013, the criminal justice community looked at every option to address the problem including equipping officers with Narcan.
In Pittsburgh, every Sunday from noon to 3 p.m., a group of volunteers, including physicians, offer Narcan prescriptions for free at the Oakland Needle Exchange on Forbes Avenue, in the rear of the Allegheny County Health Department. They also teach users how to administer Narcan.
Now is the time to arm law enforcement officers with Narcan. Anything less in Western Pennsylvania would be an injustice and result in needless loss of life.

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Matthew T. Mangino is of counsel with Luxenberg, Garbett, Kelly & George, P.C. He is the former district attorney of Lawrence County and just completed a six year term on the Pennsylvania Board of Probation and Parole. His weekly column on crime and punishment is syndicated by GateHouse New Service. You can read his musings on the criminal justice system at www.mattmangino.com and follow Matt on Twitter @MatthewTMangino. His book The Executioner's Toll, 2010 is due out this summer.
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