The Impact of Naloxone Access Laws on Opioid Overdose Deaths in the U.S.

Abstract

Opioid overdoses are the leading cause of unintentional death in the U.S. This research investigates the effects of state-level Naloxone access laws on opioid overdose death rates. Spatial difference-indifferences models reveal that no matter how the access law is measured (either as a binary variable, number of days after the law, or differentiated between access law provisions), the only consistent result is positive indirect effects on overdose death rates. These results indicate that Naloxone access provisions have regional impacts via spillover effects in neighboring states. Looking across multiple provisions, our findings show that, except for third party authorization, there are significant positive effects on overdose death rates. When access laws are evaluated in isolation of any other state level policy response to opioids, increasing access to Naloxone does not reduce overdose death rates, but leads to an overall increase. Thus, the moral hazard problem stemming from this public health policy may be an accurate assessment of the outcome.

Retracted: Longitudinal Study on Deterrent Effect of Drug-Induced Homicide Law on Opioid-Related Mortality Across 92 Counties and the District of Columbia in the U.S.

“…In recent years, drug misuse and overdose have been a growing public health concern and a substantial burden on the national economy in the United States (McClellan et al, 2018). Fatal drug addiction has increased by nearly six-fold over the last few decades and is now a leading cause of deaths in the U.S. (Davis, Johnston, & Pierce, 2015;Erfanian, Collins, & Grossman, A few other policies are demand-interruption oriented and designed to change patient behaviors with opioid abuse and dependency. Medical marijuana legalization has been a nation-wide response to the opioid crisis in an effort to provide individuals with access to marijuana for medical purposes through certified dispensaries (Powell, Pacula, & Jacobson, 2018).…”

Explaining Spatial Disparities in Fatal Drug Overdoses, 1970-2016

“…Relatedly, it is important to examine the efficacy of specific policies designed to reduce overdoses. For example, Erfanian et al (2019) show that how access is provided to Naloxone and the attendant conditions for immunity matter in important ways, both positive and negative, as do spillover effects across state boundaries. A more recent study by Wettstein (2019), using a quasi-experimental setting, also suggests that the expansion of insurance among young adults under the affordable care act has contributed to a significant decline in opioid mortality among this age population (Wettstein (2019)).…”

The National Drug Crisis - What Have We Learned from the Regional Science Disciplines?

“…Because the drug crisis seems tailor-made for regional/spatial analysis, Cushing (2017) lamented the apparent lack of participation of the regional science community in drug-crisis-related research and policy analysis. At the time the address was written, conference papers by O'Connor (2016) and Erfanian et al (2019) were the only evidence of regional science involvement. The next section documents research on the U.S. drug crisis from the regional science community in recent years.…”

“…An important question related to Naloxone is whether, ultimately, it decreases drug overdose mortality (by directly preventing deaths) or increases mortality through moral hazard -encourages riskier behavior. Erfanian et al (2019) address this question using a state-level spatial difference-in-difference model. The spatial analysis allowed the authors to consider not only the direct impact on the state that enacted a particular law, but also the indirect effect on overdose mortality in neighboring states.…”

“…Shakya (2020a) (discussed above), using a straightforward methodology, shed some light on the importance of spatial analysis that accounts for correlations and clustering over space -mandatory-access PDMPs had a diminished effect if neighboring locations were not also constrained by a mandatory-access PDMP. Erfanian et al (2019) took spatial analysis to a much higher level, employing a spatial difference-in-difference model to account for spatial correlation and provide estimated direct and indirect effects for each explanatory variable. McLuckie et al (2019) and Kolak et al (2020) illustrate the vast potential for advanced spatial methods to greatly increase knowledge regarding important issues and to help design more nuanced policy responses.…”