The opioid epidemic of the United States is an ongoing public health crisis spanning the past two decades, characterized by addiction and overdose events claiming the lives of over 500,00 people. While the epidemic began with malfeasant prescribing of prescription opioid pills, it is now also characterized by heroin and fentanyl use, with injectable formulations posing the most health risks. In attempts to combat the epidemic, authorities have targeted unscrupulous prescribing, false drug information claims, and illicit distribution activity. As it pertains to treating users, naloxone is a cornerstone in overdose treatment, and access to the medication has been greatly expanded across the country over the past 8 years. By reversing the activity of opioid-based agents, naloxone can reduce mortality associated with respiratory depression and severe sedation caused by opioids. Some have speculated that increased naloxone access may allow for opioid users to adopt decreased perceptions of harm due to the presence of a readily available antidote. This paper investigates the relationship between naloxone access and perceived risks of heroin use.
The study extracted data from the annual National Survey on Drug Use and Health (NSDUH) and incorporated 884,800 responses recorded between 2004 and 2016. The following variables within the NSDUH were used in the study: demographics, substance use, perceived risk of heroin initiation, perceived risk of regular heroin use, naloxone access laws in a respondent’s residential vicinity, prescription drug monitoring programs in a respondent’s state, and medical cannabis access. The data was analyzed primarily using logistic regression modelling and Bayes factors.
Results of the analysis found no association between expanded naloxone access-related laws and decreased perceptions of heroin use risk. This conclusion also held true across at-risk populations, active opioid users, all included genders, and all included races/ethnicities.
Takeaway: there is no evidence to-date which suggests that heroin use risk perceptions will decrease as naloxone access is expanded. This speculative viewpoint is myopic in scope, often politically motivated, and fails to account for the other numerous harms heroin use may incur in addition to overdose events (e.g., Hepatitis B and HIV exposure, bloodborne bacterial infections, permanent tissue damage, social harms, etc.).