The opioid crisis continues to affect communities across the United States, claiming the lives of tens of thousands of individuals each year. One potential solution is the distribution of naloxone, a medication that can reverse the effects of an opioid overdose. However, effectively distributing naloxone to those who need it most can be challenging.

In a recent study published in JAMA Network Open, researchers from the Brown University School of Public health and collaborating institutions evaluated the effectiveness and cost-efficiency of different strategies for distributing naloxone in Rhode Island. The team developed a model to simulate the distribution of 10,000 additional naloxone kits issued by the state in 2021 through partnerships with community-based organizations.

“It is crucial for us to understand not just how many more naloxone kits can be obtained, but who needs them and where they are needed,” said lead author Xiao Zang, a postdoctoral fellow in epidemiology at Brown during the study and current assistant professor of health policy and management at the University of Minnesota. “This research provides an opportunity to examine how naloxone can be distributed more efficiently, effectively, and equitably across all regions.”

The study, “Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island, compared two primary methods of distributing naloxone in Rhode Island: a supply-based approach, which relies on existing programs, infrastructure and distribution patterns, and the demand-based approach, which more precisely targets naloxone to areas with high concentrations of people who inject or use illicit drugs.

The results demonstrate a clear advantage to the demand-based approach, which prevented an estimated 25.3% of opioid overdose deaths at an incremental cost of $27,312 per opioid overdose death (OOD) averted over a three-year period. The supply-based approach, in contrast, prevented an estimated 18.9% of opioid overdose deaths at a cost of $44,185 per OOD averted.

The findings show that giving out extra kits to the people who are most at risk, based on where they live and what drugs they use, was the most effective way to reduce the number of overdose deaths. It also lowers costs and improves equitable access to the medicine.

“Rhode Island is a national leader in community-based naloxone distribution thanks to the extraordinary work of our state’s harm reduction, recovery, and public health communities,” says Brandon Marshall, co-author of the study and professor of epidemiology at the Brown University School of Public Health. “This research shows that these efforts to further expand access to naloxone are saving lives.”

Undeniably, Rhode Island has one of the most proactive programs for naloxone distribution in the US, with laws to increase access to the medication and a settlement with opioid-producing Teva Pharmaceuticals which will supply 50,000 naloxone kits to the state each year for the next ten years. 

The authors of this study highlight the importance of carefully considering strategies and approaches for naloxone distribution to maximize its effectiveness, reduce costs, and save lives. Otherwise, Zang cautions, “historically underserved jurisdictions will continue to be underserved.”