Distributing naloxone to heroin users to use to reverse overdose may be a cost-effective strategy to reduce overdose-related mortality. Opioid overdose is a leading cause of accidental death in the United States and accounts for half of the mortality among heroin users. Naloxone is a short-acting opioid antagonist that can reverse opioid overdose.
Researchers developed computer models to estimate the cost-effectiveness of distributing naloxone to heroin users for use at witnessed overdoses. In the simulation, researchers compared the cost-effectiveness of distributing naloxone to 20 percent of heroin users with no distribution. Cost-effectiveness was expressed in terms of costs, quality-adjusted life-years (QALY), and incremental costs per QALY gained.
The researchers found that naloxone distribution prevented 6.5 percent of all overdose deaths for each 20 percent of heroin users that received a naloxone kit, or one overdose death would be prevented for every 164 naloxone kits distributed. The computer model suggests that the death prevention effect was greater among younger heroin users.
According to the authors of an accompanying editorial, naloxone use is limited in the lay population because the U.S. Food and Drug Administration has yet to approve a formulation of naloxone that can be delivered without injection.
According to the authors, making naloxone available to prevent overdose deaths should be a priority, but taking steps to prevent opioid dependence is also an important issue that should not be overlooked.
Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal, Phillip O. Coffin, MD; and Sean D. Sullivan, PhD, Annals of Internal Medicine, 1 January 2013;158(1):1-9