Study: Lack of naloxone linked to high rates of overdose deaths in rural areas

Study: Lack of naloxone linked to high rates of overdose deaths in rural areas

Pennsylvania has one of the highest rates of opioid overdoses in the country, and according to Penn State researchers, the chances of surviving that overdose depend on where the person lives.

Using 2018-20 data from the Pennsylvania Overdose Information Network and 2015-19 American Community Survey data, Penn State geography researchers examined the prevalence of overdoses in the state and found that the anti-overdose therapeutic drug naloxone is a key factor in overdose survival. The results were published in the Journal of Drug and Alcohol Dependence.

The data showed that people who received at least one dose of naloxone were nine times more likely to survive an overdose. Naloxone was administered in approximately 75% of survival cases and only 29% of fatal overdose cases.

However, drug availability at the time of overdose ranged from 41% to 47% in the lowest counties, such as nearby Clinton and Huntingdon counties, and 92% in Philadelphia County, the highest. Broadly speaking, less populated counties had less access to life-saving treatments, with the exception of Center and Mercer counties, which fared better than similarly populated counties.

One of the primary goals of this research is to inform public health practitioners and policymakers who are able to take action on the distribution of naloxone, which is clearly effective. It gives leaders a purpose to combat the opioid epidemic by saving lives.”

Louisa Holmes, assistant professor of geography at Penn State, member of the Penn State Social Science Research Institute's Consortium on Substance Use and Addiction (CSUA) and lead author of the study

The data showed that 82% of adults in Pennsylvania survived an opioid overdose. There were 4,314 opioid-related deaths in the state in 2020, a 16% increase from 2019, according to the Pennsylvania Department of Health.

According to the Centers for Disease Control and Prevention, opioid overdose deaths rose steadily from 1999 to 2018 before spiking in 2020 after a decline in 2019, resulting in the first multi-year decline in life expectancy in more than 50 years.

The increase in overdose deaths coupled with naloxone's effectiveness prompted the Office of the Surgeon General in 2018 to call for increased distribution. Similarly, Pennsylvania issued standing orders in 2015 and updated them in 2022 to authorize anyone to obtain naloxone, although it leaves the decision to stock the drug up to pharmacists. A recent survey of Pennsylvania pharmacies found that 55% did not stock naloxone, and the majority of pharmacists were unclear about policies related to standing orders. The survey also found that out-of-pocket prices for naloxone ranged from $50 to $400 in 2017.

Using data for 16,673 unique overdose incidents in Pennsylvania, researchers found that 13,724 people survived while 2,949 did not. About 70% of deaths were male, 53.5% were between 25 and 39 years old and 90% were white. About 33% of victims lived in the most rural parts of the state, compared to 28% in the most populated areas.

Researchers say the data points to the need for more comprehensive and consistent access to naloxone for emergency responders, authorities, patients with opioid use disorders and their families, citing the effectiveness of programs such as community distribution of naloxone kits, which reduced overdose deaths by 42%. . Measures such as expanding take-home naloxone programs, overdose response training and training pharmacists could also save lives, the researchers said.

Although Pennsylvania law allows first responders such as EMTs and police officers to administer naloxone, researchers say such training is less common in rural areas.

This research is related to broader efforts at CSUA, a large collective of substance-based addiction researchers, practitioners and educators across Penn State campuses who work on everything from opioids to e-cigarettes to alcohol. Holmes was hired in 2019 to join a research team focused on addiction research.

“The increasing research being conducted by CSUA on these topics further positions Penn State as a leader regionally and nationally,” said Brian King, head of the geography department and co-author of the study. “It is a testament to how research at this institution directly impacts the residents of the Commonwealth of Pennsylvania.”

Source:

Pennsylvania

Reference:

Holmes, L.M., et al. (2022) Disparities in survival from opioid overdose and naloxone administration in Pennsylvania. Drug and alcohol addiction. doi.org/10.1016/j.drugalcdep.2022.109555.

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