Rebecca B Naumann1, Christine Piette Durrance2, Shabbar I Ranapurwala3, Anna E Austin4, Scott Proescholdbell5, Robert Childs6, Stephen W Marshall7, Susan Kansagra8, Meghan E Shanahan9. 1. Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA. Electronic address: RNaumann@unc.edu. 2. Department of Public Policy, University of North Carolina at Chapel Hill, 203 Abernethy Hall, CB #3435, Chapel Hill, NC 27599 USA. Electronic address: christine.durrance@unc.edu. 3. Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA. Electronic address: sirana@email.unc.edu. 4. Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA. Electronic address: annaaust@live.unc.edu. 5. Injury and Violence Prevention Branch, Division of Public Health, NC Department of Health and Human Services, 5505 Six Forks Road, Raleigh, NC 27609 USA. Electronic address: scott.proescholdbell@dhhs.nc.gov. 6. Formerly (and at time of this work): Consultant to North Carolina Harm Reduction Coalition, Currently: JBS International, Inc., 5515 Security Lane, Suite 800, North Bethesda, MD 20852 USA. Electronic address: robert.bb.childs@gmail.com. 7. Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA. Electronic address: SMarshall@unc.edu. 8. Chronic Disease and Injury Section, Division of Public Health, NC Department of Health and Human Services, 5505 Six Forks Road, Raleigh, NC 27609 USA. Electronic address: Susan.Kansagra@dhhs.nc.gov. 9. Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA. Electronic address: shanahan@unc.edu.
Abstract
BACKGROUND: In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. METHODS: One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. RESULTS: The rate of OOD in counties with 1-100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95% CI: $1,237, $4882). CONCLUSIONS: Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers.
BACKGROUND: In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. METHODS: One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. RESULTS: The rate of OOD in counties with 1-100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95% CI: $1,237, $4882). CONCLUSIONS: Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers.
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