Is naloxone co-prescribing driving up costs and utilization?

[drusso]

The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime

67 Pages Posted: 6 Mar 2018

Jennifer L. Doleac
University of Virginia - Frank Batten School of Leadership and Public Policy

Anita Mukherjee
University of Wisconsin - Madison - School of Business

Date Written: March 6, 2018

Abstract
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality. These effects are driven by urban areas and vary by region. We find the most detrimental effects in the Midwest, including a 14% increase in opioid-related mortality in that region. We also find suggestive evidence that broadening Naloxone access increased the use of fentanyl, a particularly potent opioid. While Naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to Naloxone encourages riskier behaviors with respect to opioid abuse.



JEL Classification: I18, K42, D81

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[Ducttape]

my guess is that the naloxone saves the addict a couple of times first, but no change in behavior. that drives up ER visits.

without naloxone, they would just die already and not live to die again

 

[101N]

When you offer the naloxone, also offer the bup...

SECTION 2.
Section 1 of this 2018 Act is repealed on January 2, 2019.
SECTION 3.
(1) The Oregon Health Authority shall establish a pilot project for the purpose of determining
the effectiveness of establishing immediate access to appropriate evidence-based treatment for persons
who suffer opioid and opiate overdoses. The pilot project may include:
(a) Creating a direct link between an emergency department and appropriate treatment
and resources, including the availability of medication-assisted treatment in the emergency
department;
(b) Using peer recovery support mentors to facilitate the link between
an emergency department and appropriate treatment and resources; and
(c) Any other programming aimed at reducing deaths caused by opioid and opiate over-
doses by providing persons who suffer opioid and opiate overdoses with immediate access to
appropriate treatment and resources.
(2) The authority shall implement the pilot project in Coos, Jackson, Marion and
Multnomah Counties.
(3) At least twice each year, the counties listed in subsection (2) of
this section shall report to each other and the authority regarding the pilot project. The counties and
the authority may jointly determine the form and content of the reporting
required under this
subsection.
(4) Not later than December 31 of each year, the authority shall submit,
in the manner provided in ORS 192.245, a report on the efficacy and implementation of the pilot project described
in this section, and may include any recommendations for legislation, to an interim
committee of the Legislative Assembly related to public health.

 

[SeniorWrangler]

I read the article. I think there's a disconnect because doctors are reading it not realizing it's basically an economics paper and so has soft squishy standards of evidence. When they say naloxone is causing increased mortality, what they really mean is "it is correlated with increased mortality and we couldn't think of any confounders."

I also think that it is the nature of life-saving interventions to result in higher costs. Automated defibrillators help resuscitate people who then die expensively in hospital, for example. Very few people getting CPR in the hospital are "fine" afterwards. The examples are legion.

 

[Ducttape]

agreed. sudden death is cheapest.

 

[drusso]

Does naloxone really save lives?

Opinion | The ‘moral hazard’ of naloxone in the opioid crisis

"Sally Satel echoes Doleac and Mukherjee, both on the moral hazard of naloxone and on whether access to it should continue. Satel, a psychiatrist who is also a drug policy scholar at the American Enterprise Institute, says the paper’s findings reinforce what she has heard from patients: “Patients occasionally tell me that having naloxone on hand has served as insurance against overdose. So, in some instances, it enhances risk taking.”

Are We Reviving Too Many Opioid Overdoses? Is This Really the Right Question?

"Most of us are rational actors – even drug addicts. As drug users realize they’re far less likely to die from an overdose, some start using more powerful drugs, in higher doses. Some switch to fentanyl (which is far deadlier than heroin). Some “use” more often. “You wouldn’t think that people caught in the depths of addiction would respond to incentives,” Prof. Doleac says. “But they do.”