To examine the relative changes in opioid overdose mortality rates between states that have and have not adopted naloxone co-prescribing laws.
Methods
We performed a synthetic control analysis. National Vital Statistics data for the years 2012–2018 were analysed, and five states with naloxone co-prescribing laws were examined: Arizona, Florida, Rhode Island, Vermont, and Virginia. Opioid overdose-related deaths were identified through cause-of-death ICD-10 codes.
Results
Our pooled analysis for all opioid-related deaths showed no significant changes in opioid-related mortality rates in treated states, post naloxone co-prescribing law adoption (−0.05; 95% CI: −0.43, 0.33). Rates of other and unspecified narcotic-related mortality rates in Rhode Island were found to have decreased post-law adoption (−0.13; 95% CI: −0.25, −0.00).
Conclusions
These findings suggest that naloxone co-prescribing laws were not associated with changes to overall opioid overdose mortality rates, post-law adoption, during the study period. However, Rhode Island did see a decrease in other and unspecified narcotic-related mortality rates post-law adoption. This is perhaps due to the comprehensive nature of the state's law. As overall rates of naloxone co-prescribing remain low, interventions to enhance naloxone prescribing and distribution may be necessary for co-prescribing laws to impact opioid-related mortality rates.
AbadieAGardeazabalJ (2003) The economic costs of conflict: A case study of the basque country. American Economic Review93(1): 113–132.
3.
AbadieADiamondAHainmuellerJ (2010) Synthetic control methods for comparative case studies: estimating the effect of California’s tobacco control program. Journal of the American Statistical Association105(490): 493–505.
4.
AboukRPaculaRLPowellD (2019) Association between state laws facilitating pharmacy distribution of naloxone and risk of fatal overdose. JAMA Internal Medicine179(6): 805–811.
BarenieREGagneJJKesselheimAS, et al. (2020) Rates and costs of dispensing naloxone to patients at high risk for opioid overdose in the United States, 2014–2018. Drug Safety43(7): 669–675.
8.
BeharEBagnuloRCoffinPO (2018) Acceptability and feasibility of naloxone prescribing in primary care settings: a systematic review. Preventive Medicine114: 79–87.
9.
BouttellJCraigPLewseyJ, et al. (2018) Synthetic control methodology as a tool for evaluating population-level health interventions. Journal of Epidemiology & Community Health72(8): 673–678.
ChatterjeeALarochelleMRXuanZ, et al. (2019) Non-fatal opioid-related overdoses among adolescents in Massachusetts 2012-2014. Drug and Alcohol Dependence194: 28–31.
12.
CoffinPOSullivanSD (2013) Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Annals of Internal Medicine158(1): 1–9.
CrifasiCKMeyersJSVernickJS, et al. (2015) Effects of changes in permit-to-purchase handgun laws in connecticut and Missouri on suicide rates. Preventive Medicine79: 43–49.
DavisCSBurrisSBeletskyL, et al. (2016) Co-prescribing naloxone does not increase liability risk. Substance Abuse37(4): 498–500.
18.
DaytonLGicquelaisRETobinK, et al. (2019) More than just availability: who has access and who administers take-home naloxone in Baltimore, MD. PloS One14(11): e0224686.
19.
DengXZhengY(eds) (2020) Estimating the Effects of Taxes on E-cigarettes Sales and Price with a Generalized Synthetic Control Approach. In: Agricultural and Applied Economics Association (AAEA) Conferences 2020 Annual Meeting, Kansas City, Missouri, July 2020. DOI: 10.22004/ag.econ.304199.
20.
DowellDHaegerichTChouR (2016) CDC Guideline for prescribing opioids for chronic pain — United States, 2016. MMWR. Recommendations and Reports65(No. RR-1): 1–49.
21.
GreenTCDavisCXuanZ, et al. (2020) Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014–2018. American Journal of Public Health110(6): 881–887.
22.
GuyGPStrahanAEHaegerichT, et al. (2021) Concurrent naloxone dispensing among individuals with high-risk opioid prescriptions, USA, 2015-2019. Journal of General Internal Medicine36(10): 3254–3256.
23.
HedegaardHBastianBTrinidadJ, et al. (2019) Regional differences in the drugs most frequently involved in drug overdose deaths: United States, 2017. National Vital Statistics Reports68(12): 1–15. Available at:https://stacks.cdc.gov/view/cdc/82186(accessed 29 August 2020).
24.
IrvineMAOllerDBoggisJ, et al. (2022) Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: A modelling study. The Lancet Public Health7(3): e210–e218.
25.
KhatiwodaPProeschold-BellRJMeadeCS, et al. (2018) Facilitators and barriers to naloxone kit use among opioid-dependent patients enrolled in medication assisted therapy clinics in north Carolina. North Carolina Medical Journal79(3): 149–155.
26.
LeeBZhaoWYangK-C, et al. (2021) Systematic evaluation of state policy interventions targeting the US opioid epidemic, 2007-2018. JAMA Network Open4(2): e2036687.
MaderSRüttenauerT (2021) The effects of non-pharmaceutical interventions on COVID-19-related mortality: A generalized synthetic control approach across 169 countries. v2ef8, SocArXiv, 13 June. Center for Open Science. Available at: https://econpapers.repec.org/paper/osfsocarx/v2ef8.htm (accessed 22 August 2021).
NolanSBuxtonJDobrerS, et al. (2017) Awareness, possession, and use of take-home naloxone among illicit drug users, Vancouver, British Columbia, 2014–2015. Public Health Reports (Washington, D.C.: 1974)132(5): 563–569.
31.
O’DonnellJKGladdenRMSethP (2017) Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region - United States, 2006–2015. MMWR. Morbidity and Mortality Weekly Report66(34): 897–903.
PowellDPaculaRLJacobsonM (2015) Do medical Marijuana laws reduce addictions and deaths related to pain killers? Working Paper Series 21345, Working Paper, July. National Bureau of Economic Research. DOI: 10.3386/w21345.
35.
Prescribing for subacute and chronic pain (2018) 4731-11–14. Available at: http://codes.ohio.gov/oac/4731-11 (accessed 9 March 2020).
SchollLSethPKariisaM, et al. (2018) Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR. Morbidity and Mortality Weekly Report67(5152): 1419–1427.
39.
SchulerMSGriffinBACerdáM, et al. (2020) Methodological challenges and proposed solutions for evaluating opioid policy effectiveness. Health Services and Outcomes Research Methodology. DOI: 10.1007/s10742-020-00228-2.
40.
SlavovaSO’BrienDBCreppageK, et al. (2015) Drug overdose deaths: let’s get specific. Public Health Reports130(4): 339–342.
41.
SmartRPardoBDavisCS (2020) Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. Addiction. DOI: 10.1111/add.15163.
42.
SohnMTalbertJCHuangZ, et al. (2019) Association of naloxone coprescription laws with naloxone prescription dispensing in the United States. JAMA Network Open2(6): e196215–e196215.
SteinBDSmartRJonesCM, et al. (2021) Individual and community factors associated with naloxone co-prescribing among long-term opioid patients: A retrospective analysis. Journal of General Internal Medicine36(10): 2952–2957.
45.
SteinBDJonesCMSmartR, et al. (2021) Patient, prescriber, and community factors associated with filled naloxone prescriptions among patients receiving buprenorphine 2017-18. Drug and Alcohol Dependence221: 108569.
46.
The United States Census Bureau (n.d.) Data. Available at: https://www.census.gov/data (accessed 22 August 2021).
47.
VestalC (2019) New naloxone laws seek to prevent opioid overdoses. Available at: https://pew.org/2J65s2I (accessed 26 January 2020).
WarnerMPaulozziLJNolteKB, et al. (2013) State variation in certifying manner of death and drugs involved in drug intoxication deaths. Academic Forensic Pathology3(2): 231–237.
WigleySDielemanJLTemplinT, et al. (2020) Autocratisation and universal health coverage: Synthetic control study. BMJ371: m4040.
52.
XuY (2017) Generalized synthetic control method: causal inference with interactive fixed effects models. Political Analysis25(1): 57–76.
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