Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use

Study Author(s):

Emilie Bruzelius, Magdalena Cerdá, Corey S. Davis, Victoria Jent, Katherine Wheeler-Martin, Christine M. Mauro, Stephen Crystal, Katherine M. Keyes, Hillary Samples, Deborah S. Hasin, Silvia S. Martins

Journal Name:

International Journal of Drug Policy

Publication Date:

April 2023

Study Objective
The research aimed to assess whether laws that expand access to naloxone—an opioid overdose-reversal medication—lead to increased heroin use or injection drug use (IDU) among adolescents. Some policymakers and critics have argued that making naloxone more available could encourage riskier drug use behaviors (a concept known as "moral hazard"), but this study seeks to test that claim using empirical data.

Data & Methodology

• Timeframe: 2007–2019
• Geographical Scope: 44 U.S. states
• Data Source: The study used self-reported data from high school students, obtained from the Youth Risk Behavior Surveillance System (YRBSS).
• Key Variables Analyzed:
  • Lifetime heroin use among adolescents
  • Lifetime injection drug use (IDU) among adolescents
• Policy Variables Considered:
  • Whether the state had Naloxone Access Laws (NALs)
  • Whether naloxone was available under pharmacy distribution policies (allowing pharmacists to dispense it without a prescription)
  • Specific provisions such as third-party prescribing (allowing someone to obtain naloxone for another person) and non-patient-specific dispensing (allowing naloxone to be distributed without identifying a specific recipient).
• Statistical Approach:
  • The researchers used difference-in-differences analysis, a statistical method that helps compare trends before and after policy changes while accounting for state-specific factors.

Key Findings

1. No Increase in Adolescent Heroin or Injection Drug Use
   • The study found no evidence that expanding naloxone access laws led to increased rates of heroin use or IDU among adolescents.
   • This directly challenges concerns that naloxone availability might encourage drug use by reducing the perceived risks of overdose.
2. Some Naloxone Access Provisions Were Linked to Decreased Heroin Use
   • In states with third-party prescribing and non-patient-specific dispensing, adolescents reported lower rates of heroin use.
   • This suggests that easier access to naloxone may be part of broader harm reduction strategies that reduce risky drug behaviors rather than encourage them.
3. No Statistical Association Between Pharmacy Naloxone Distribution and Adolescent Drug Use
   • States that allowed pharmacists to dispense naloxone without a prescription did not see any significant increases or decreases in adolescent heroin use or IDU.

Policy Implications

• The study provides strong evidence against the "moral hazard" argument, suggesting that expanding naloxone access does not lead to riskier drug use among youth.
• The findings support continued expansion of naloxone access as part of harm reduction policies without fear of unintended negative consequences.
• Policymakers may consider broadening naloxone distribution efforts, as some provisions were linked to reduced adolescent heroin use.

Conclusion
The research concludes that naloxone expansion does not lead to increased heroin or injection drug use among adolescents. Instead, provisions that make naloxone more widely available may actually contribute to lower rates of heroin use. These findings reinforce the idea that harm reduction strategies—like naloxone distribution—can be implemented without increasing drug-related risks among young populations.