Naloxone is a life-saving medication which helps reverse the effects of an opioid overdose. Improving naloxone access is a central pillar of the federal response to the worsening opioid crisis in the United States. Existing studies have evaluated the effects of state naloxone access laws, including those that permit naloxone to be dispensed by pharmacies directly to consumers. However, this literature has ignored the role of pharmaceutical innovations like Narcan. Narcan, introduced to the marketplace in February 2016, is a naloxone nasal spray that permits laypersons to successfully administer the drug without training. We first test the hypothesis that naloxone access laws alone increased the distribution of naloxone prior to Narcan, followed by testing the hypothesis that the introduction of Narcan further expanded naloxone’s distribution and its life-saving impacts. We analyze cross-state variation in the adoption of naloxone access laws and their timing relative to Narcan’s introduction. We find that states with naloxone access laws permitting pharmacists to dispense to consumers experienced substantially greater naloxone dispensing after Narcan’s introduction, effects that far outpaced the independent effects of the laws themselves. We also find that while these naloxone access laws did not reduce non-synthetic opioid-related mortality rates on their own, once Narcan was introduced, these mortality rates significantly declined. These findings indicate the important interaction of innovation and policy.
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- Acknowledgements & Disclosure
- We would like to thank Rosanna Smart, Bradley Stein, and Corey Davis for useful insights about the policy data. We received especially helpful feedback from seminar and conference participants at the American Economic Association Annual Meeting (2023), Southeastern Health Economics Study Group Conference (2023), and the NYU Center for Opioid Policy & Epidemiology (2023). Any opinions and conclusions expressed herein are those of the authors and do not necessarily represent the views of any affiliate. All results have been reviewed to ensure that no confidential information is disclosed. Financial support for this research from the CDC (R01CE02999) and NIDA (2P50DA046351) is gratefully acknowledged. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
- DOI
- https://doi.org/10.3386/w33105
- Pages
- 58
- Published in
- United States of America
Table of Contents
- NBER WORKING PAPER SERIES 1
- USING POLICY AND INNOVATION TO IMPROVE LIFE-SAVING ACCESS TO NALOXONE 1
- Evan D. Peet David Powell Rosalie Liccardo Pacula 1
- Working Paper 33105 httpwww.nber.orgpapersw33105 1
- NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge MA 02138 November 2024 1
- Using Policy and Innovation to Improve Life-Saving Access to Naloxone Evan D. Peet David Powell and Rosalie Liccardo Pacula NBER Working Paper No. 33105 November 2024 JEL No. I1 I12 I18 2
- Evan D. Peet RAND Corporation 4570 Fifth Avenue Ste 600 Pittsburgh PA 15213 epeetrand.org 2
- David Powell RAND Corporation 1776 Main Street P.O. Box 2138 Santa Monica CA 90407 dpowellrand.org 2
- I. Introduction 3
- II. Background 9
- Naloxone and Opioid-Related Policies 9
- Narcan 11
- III. Data 13
- Pharmacy Prescription Claims Data 13
- Mortality Data 14
- Policy Data 15
- Opioid Use Disorder Treatment Episode Data 16
- Summary Statistics 17
- IV. Empirical Strategy 18
- V. Main Results 21
- Naloxone Claims 21
- Non-Synthetic Opioid-Related Overdose Mortality Rates 23
- Synthetic Opioids 25
- Placebo Outcomes 26
- Treatment Episodes 26
- VI. Heterogeneity 27
- Demographics and Geography 27
- Insurance and Costs 30
- VII. Discussion and Conclusions 33
- References 38
- JAMA Internal Medicine 179 38
- American Economic Journal Economic Policy 16 38
- The Quarterly Journal of Economics 137 38
- American Economic Journal Economic Policy 10 38
- JAMA Network Open 6 38
- New England Journal of Medicine 388 38
- Comparing and Evaluating Substance Use Treatment Utilization Estimates from the National Survey on Drug Use and Health and Other Data Sources. 38
- Econometrica 80 38
- Review of Economic Studies 38
- Opioid overdose among persons who inject drugs in philadelphia 38
- Witnessed overdose responses prevention program diffusion and environmental risks 38
- Health Affairs 39 39
- American Journal of Epidemiology 190 39
- Drug and Alcohol Dependence 236 39
- JAMA Internal Medicine 181 39
- Journal of Economic Perspectives 35 39
- Health 39
- Affairs 20 39
- Journal 39
- The Journal of Law and Economics 65 39
- Journal of the American Pharmacists Association 60 39
- FDA Approves First Over-the-Counter Naloxone Nasal Spray 39
- The 39
- American Journal of Medicine 129 39
- JAMA Netw Open 1 40
- Journal of Policy Analysis and Management 38 40
- Journal of the American Pharmacists Association 57 40
- U.S. Department of Health and Human Services Overdose Prevention Strategy Issue Brief. 40
- American Economic Journal-Economic Policy forthcoming National Bureau of Economic Research Working Paper 40
- JAMA 40
- Washington Post 40
- Journal of the American Pharmacists Association 40
- Annals of Internal Medicine 169 40
- Forum for Health Economics and Policy 16 40
- Journal of medical toxicology 15 41
- The ANNALS of the American Academy of Political and Social Science 41
- Addictive behaviors 86 41
- American Journal of Health Economics 4 41
- Available at SSRN 4704757 41
- Importing the Opioid Crisis International 41
- Trade and Fentanyl Overdoses 41
- Pharmacy 10 41
- JAMA Health Forum 41
- The Labor Supply Consequences of the Opioid Crisis 41
- Dual markets Comparative approaches to regulation 41
- Am J Health Econ 7 41
- The Journal of Law and Economics 62 41
- JAMA internal medicine 175 42
- Journal of Health Economics 76 42
- Addiction 116 42
- Journal of Health Economics 42
- JAMA Network Open 2 42
- BMC Public Health 22 42
- Addiction 100 42
- International Journal of Drug Policy 75 42
- JAMA 322 42
- Tables 43
- Figures 48
- Appendix Tables 52
- Appendix Figures 56