Study suggests anti-overdose med naloxone leads to reckless opioid use
The authors admit that the working paper has yet to be peer reviewed. The study has elicited strong criticism, ranging from professional disagreement to vicious personal attacks on Twitter.
The strongest criticism is that the study shows correlation but not causation. The increase in ER visits could be a result of any number of factors, and the expanded access to naloxone might be a coincidence. If murder rates and ice-cream sales both increase, it doesn’t mean ice-cream causes murder; it’s more likely that higher temperatures cause a spike in murders.
A key component of academic economics is ruling out the possibility of mistaking correlation for causation. The study might not be peer-reviewed yet, but the authors reviewed the findings very thoroughly before putting it online because they knew it would cause a stir.
“We expected some pushback,” Doleac said. “But we didn’t expect all the pushback.”
Someone who uses naloxone to revive an overdose victim is supposed to call 911 before doing anything, which could account for the spike in ER visits. Good Samaritan laws, which grant immunity for possession and paraphernalia offenses when calling 911, could also explain the correlation.
Naloxone laws don’t necessarily mean people actually have the medicine immediately.
“[Doleac and Mukherjee’s] study assumes the passage of these laws lead immediately to everyone having easy access to naloxone when they need it, when this is not the case,” Leana Wen, Baltimore’s health commissioner, told Olga Khazan of The Atlantic.
A 2012 study examined communities where people actually had naloxone kits, and opioid-related death rates decreased. There’s also the argument that the opioid crisis is getting worse in general, and the rate of opioid-related deaths would be much higher if naloxone wasn’t accessible.
The study reinforces one important point related to increased naloxone access: it isn’t a magic bullet that will single-handedly reverse the opioid crisis. Overdose victims still need medical treatment because the effects of naloxone wear off after 30 minutes. Even if it saves someone’s life, that person is still addicted and needs a long-term solution.
The study found that naloxone access had the best outcomes in large cities with treatment programs and fast 911 response times. Doleac thinks this finding is encouraging, and she doesn’t want her study to discourage wider access to naloxone. She just thinks fighting the opioid crisis requires a more thorough solution.
More from Modern Medicine:
Military vets say marijuana can help end opioid crisis
Schools are getting tougher in opioids fight
The booming business of radiation pills in the Trump era
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