Study: Naloxone access laws have not reduced youth opioid deaths

Key takeaways:

• Before naloxone access laws were implemented, opioid overdose deaths in the United States rose 7.8% per year.
• There were no significant reductions in fatal overdoses after states implemented the laws.

Although state laws have expanded access to naloxone, overdose deaths among adolescents and young adults continue to climb, according to data published in JAMA Pediatrics.

“Expanding access to naloxone through naloxone access laws (NALs) has emerged as a key strategy in combating opioid-related overdose deaths,” Michael S. Toce, MD, MS, associate physician in pediatrics in the division of emergency medicine and medical toxicology at Boston Children's Hospital, and colleagues wrote. “The objective of this study was to examine the association of state-level NALs with youth opioid-related overdose deaths.”

The researchers gathered data on overdose deaths that occurred between Jan. 1, 1999, and Dec. 31, 2021, among people aged 15 to 24 years. They identified each state in which a death occurred and what the NALs were in each state. They came up with three categories: patient-specific NALs, where patients must obtain naloxone themselves; patient nonspecific NALs, which allow pharmacists to give naloxone to people like first responders or family members of individuals using opioids; and other NALs, which offer legal protection to those who prescribe, dispense or administer naloxone, or states that have no NALs.

According to the study, 55,878 youth (74% boys and men; mean age, 21.4 years) died from opioid overdoses during the study period. Most overdose deaths occurred among young adults aged 20 to 24 years (79.8%), and illicit fentanyl and other synthetic opioids were responsible for 39% of all overdose deaths, the researchers found.

Before NALs were implemented, opioid-related deaths rose 7.8% per year (95% CI, 6.4%-9.2%), the data showed. Afterward, states with patient-specific NALs saw an increase of 4.7% per year in such deaths (95% CI, –1.6% to 11.5%), and states with patient-nonspecific NALs experienced increases of 8.7% per year (95% CI, 3.7%-13.9%).

States with patient-specific NALs had a slight reduction in overdose deaths compared with states with patient-nonspecific NALs, but the difference was not statistically significant, the researchers reported.

“While prior studies support the benefits of NALs, these laws alone may be insufficient in securing uptake by pharmacies and increasing naloxone distribution and patient access,” the researchers wrote.

As Healio previously reported, naloxone prescriptions rose 600% from 2017 to 2022 among youth aged 10 to 19 years. Last month, the AAP released its first set of guidelines for prescribing opioids to children, which encourages prescribing naloxone as well.

The FDA approved a generic naloxone nasal spray for over-the-counter sale in April 2024, which could increase access further.

“In addition to the persistent stigma of accessing naloxone, the majority of adolescents report using drugs alone, and most fatal overdoses occur among adolescents without a history of opioid use or overdoses,” Toce and colleagues wrote. “These features may diminish naloxone’s potential to play a role in the substantial reduction in overdoses in this population, even if access is expanded.”