Naloxone Access Laws Significantly Prevented Opioid Deaths, Report Finds

A popular strategy to help stem the tide of opioid-related deaths has been the implementation of laws that expand access to naloxone, a drug that halts and reverses overdoses. A recent paper has found that these laws did in fact save lives, as their adoption was associated with a 9% to 11% reduction in deaths caused by opioids. Good Samaritan laws encouraging bystanders to call for help during an overdose were also associated with fewer opioid-related deaths, though these decreases were not statistically significant.

Generally, naloxone access programs have been supported by medical professionals and bipartisan lawmakers, leading to their implementation in 45 states and the District of Columbia. Increasingly, state health officials have issued standing orders that allow pharmacists to dispense naloxone to a layperson without needing a prescription. Within the past 3 months, both Utah and Louisiana issued such standing orders to boost naloxone access, drawing praise from groups like the American Medical Association.

Another legislative strategy to prevent deaths has been the adoption of Good Samaritan laws, which ensure that bystanders cannot be charged for drug possession when they call emergency services to help someone experiencing an overdose. These laws are currently in place in 34 states and the District of Columbia.

However, not everyone is on board with these ideas. Critics of naloxone access laws fear that they could encourage substance abuse by reducing the perceived likelihood of harm. Maine Governor Paul LePage faced heavy criticism last year when he vetoed a standing order law, saying that “naloxone does not truly save lives; it merely extends them until the next overdose.” His veto was later overturned.

Faced with these conflicting viewpoints, a group of researchers set out to determine the effect of these laws on the rate of overdoses. Their paper, “With a Little Help from My Friends: The Effects of Naloxone Access and Good Samaritan Laws on Opioid-Related Deaths,” was published by the National Bureau of Economic Research.

They found that the adoption of a naloxone access law was associated with a decrease in opioid-related deaths of nearly 11%. After 2 years from the law’s adoption, this effect grew to an average 21% reduction in such deaths. Even after controlling for the presence of a prescription drug monitoring program in that state, the adoption of a naloxone access law was associated with a 9% decrease in opioid deaths. An effect of similar magnitude was found for Good Samaritan laws, though it did not reach statistical significance.

Interestingly, the researchers found that both types of laws had a stronger effect on reducing deaths that involved an opioid other than heroin, although prior research has indicated that naloxone is more commonly used for heroin overdoses. They also found that the adoption of a Good Samaritan law was associated with a 16% decrease in deaths that involved both alcohol and opioids.

The analysis did not find any evidence to support the claim that these laws present a moral hazard by encouraging opioid use. There were no significant changes in recreational prescription painkiller use associated with the adoption of either law. Instead, the researchers wrote, any danger of inciting opioid abuse “is clearly outweighed by their intended use as an antidote to opioid overdoses in emergency situations.”

Taking these findings into account, the authors advocated for expanded and strengthened laws to ensure access to naloxone and immunity for bystanders. They did raise concerns about the rising costs of naloxone, which could present a barrier to those seeking the life-saving drug.

“If these trends continue,” they wrote, “it is not clear whether [naloxone access laws] will continue to be as effective at reducing opioid-related deaths as they have been in the past.”