Distributing Naloxone to Heroin Users Highly Cost Effective

Pam Harrison

January 10, 2013

Distributing naloxone to heroin users in order to reverse accidental overdose could significantly reduce overdose deaths and would be highly cost effective, a new analysis shows.

Phillip Coffin, MD, San Francisco Department of Public Health, in California, and Sean Sullivan, PhD, University of Washington, Seattle, found that depending on the analysis used, naloxone distribution would prevent 6.5% of all overdose deaths for each 20% of heroin users reached by the program.

In this analysis, the number needed to treat to prevent 1 overdose death was 164.

In a second analysis, naloxone distribution would prevent 6.1% of overdose deaths; in that analysis, the number needed to treat to prevent 1 overdose death was 227.

Distribution of naloxone increased lifetime costs by only $53, regardless of the analysis used, for an incremental cost-effectiveness ratio of $438.

And when researchers assumed that heroin users are a net cost to society beyond the scope of any other health condition, they found that distribution of naloxone to reverse lay overdose would result in an incremental cost of $2429 per quality-adjusted life-year (QALY) gained.

"There are few or no scenarios in which naloxone would not be expected to increase QALYs at a cost much less than the standard threshold for cost-effective health care interventions," the authors write.

"This analysis of naloxone distribution to heroin users for lay overdose reversal suggests that the intervention would increase QALYs and be highly cost-effective, even under markedly conservative assumptions."

High Death Rate

In an accompanying commentary, Wilson Compton, MD, National Institute on Drug Abuse, Bethesda, Maryland, and Douglas Throckmorton, MD, US Food and Drug Administration (FDA), Silver Spring, Maryland, applauded the researchers' important contribution to this public health effort and noted that the article "represents a significant step in the evolution of the science in this area."

The editorialists also note that overall, drug overdose deaths increased to more than 38,000 in 2010 — "outpacing deaths from motor vehicle traffic crashes nationally for 2 years running."

Most of this increase is related to prescription opioids and mirrors an increase in opioid prescribing, they add.

Nevertheless, they point out that naloxone is a safe and effective treatment for opioid overdose, and its use is already standard practice in emergency settings.

"A key factor limiting widespread use of naloxone is that the only U.S. Food and Drug Administration (FDA)–approved formulation is injectable," they observe.

However, there are potential alternatives, including formulations that can be delivered intranasally or by autoinjection.

"Ultimately, approval of a naloxone formulation that could be used without a prescription would also help encourage broader use, although additional studies are needed in this area," they add.

The researchers have disclosed no relevant financial relationships. Disclosures for the commentators are available online .

Ann Intern Med. Published online January 1, 2013. Abstract, Editorial