Andrew Kolodny, from Phoenix House, supports naloxone distribution but also shares his thoughts on its limits.
I recall, not so long ago, when naloxone distribution was considered cutting edge and controversial. Among its only champions were harm reduction organizations. Not anymore. Health officials, politicians, journalists, drug prevention groups, and the Food and Drug Administration are now singing the praises of naloxone. This, of course, is great news and has made efforts to expand access to naloxone far easier. But I’m worried that we may be expecting more from naloxone than it can deliver. As far as public health interventions to address the opioid addiction epidemic go, naloxone distribution is about as downstream as it gets.
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We should never undervalue the importance of saving even one life, but in the grand scheme, I believe naloxone’s impact on our nation’s historically high overdose death rate will be small. Some counties in the U.S. that have done a nice job of making naloxone more available are still seeing overdose rates climb. For example, in Wilkes County, North Carolina, home of Project Lazarus, a naloxone program funded by Purdue Pharma (the maker of OxyContin), overdose deaths are on the rise. Although Wilkes County initially experienced a decline in deaths after the launch of Project Lazarus, from 2011 to 2013, overdose deaths more than doubled in Wilkes County.
I also support increasing access to naloxone, especially assuring all first responders carry it. However, I share Kolodny’s concern that advocates are often failing to acknowledge just how incomplete the intervention is. I’ve previously likened it to automatic defibrillators being installed in public spaces. They are great and they save lives. However, no one would feel too satisfied with their dissemination if people just went on their way after having their life saved by the defibrillator. We’d insist that it is followed by an ambulance trip to a hospital where they receive good care.
Let’s increase access to naloxone and make sure that every rescue is followed by the kind of care an addicted health professional would get.