Naloxone as a Harm Reduction Initiative: Misinterpretations of Research
Richard R. Massatti
DOI : 10.3844/amjsp.2016.1.2
American Medical Journal
Volume 7, Issue 1
In the American Medical Journal, Annahita Beheshti and colleagues reviewthe literature on naloxone use for opioid overdose in West Virginia (Beheshti etal., 2015). The authorscite several of my publications in support of their views on naloxone(Massatti, 2013; Massatti et al.,2014), but many of these citations misinterpret my work by using it to presenta counterargument against the drug. Specifically, the authors make falseassumptions when they imply the availability of an antidote might lead toincreased opioid use. Beheshti et al.(2015) say, “the availability of an antidote may encourage drug use byproviding a sense of security in users” (in page 11, para. 4, lines 1-8); however,there is no citation except for my work. While it is true Massatti (2013)suggests there is anecdotal evidence that persons abusing opioids travel toareas more likely to have naloxone (e.g., hospital parking lots and communitieswhere EMTs are more likely to carry naloxone; in page 18, para. 2, lines 1-8;in page 18 para. 3, lines 1-8), there is no evidence that increased accessleads to increased use. Simply put, location may change in some cases, butincidence does not. Beheshti et al.(2015) also generally overstate the link between naloxone availability andopioid use when they say, “there is little evidence supporting theeffectiveness of naloxone in deterring illegal use of opioids” (in page 10,para. 1, lines 4-6). The purpose of making naloxone more accessible is toreduce the number of unintentional overdose deaths, not to deter illicit use ofopioids. As is oft said when discussing naloxone, “Dying is not a good way torecover.”
Beheshti et al. (2015) continuetheir line of reasoning and erroneously suggest that increased availability ofnaloxone raises the likelihood of overdose episodes. Beheshti et al. (2015) correctly cite my workthat EMTs report persons fearing prosecution have abandoned overdose victims,but then they follow up that point with a speculation about use of 911services. Beheshti et al. (2015)explain, “If naloxone were to be available over the counter, sufficient use of911 emergency could diminish and the incidence of overdose will likely continueto increase” (in page 12, para. 2, lines 24-27). My work cannot be used to drawthose conclusions because it does not discuss a relationship between Over-The-Counter(OTC) use of naloxone and 911 emergency services. Moreover, the literature doesnot support the assertion that increased availability of naloxone leads to morefrequent overdose episodes.
Furthermore, the authors mistakenly suggest that legal changes may lead toincreased use. Beheshti et al. (2015)state,“Additionally, the rate of naloxone use has increased for every age groupfrom 2003-2012 in Ohio suggesting that relaxed laws governing the use ofnaloxone may lead to increased use ” (in page 11, para. 2, lines 8-11). Theauthors are confusing cause and effect because they are not placing events inthe correct temporal order. Ohio’s scope of practice statements and formalhouse bills expanding the use of naloxone were not enacted until late 2013(ODPS, 2014; OLSC, 2014); therefore, it wasimpossible that “relaxed laws” had anything to do with the relationship betweenincreased opioid use and increased naloxone administration from 2003 to 2012.
In another example, Beheshti et al.(2015) claim that my work advocates for OTC use because visiting with aphysician hinders the potential success of naloxone (in page 11, para. 3, lines10-13). Once again, Massatti (2013) does not reference OTC prescription ofnaloxone, nor does it ever indicate that visiting with a physician hinders thepotential success of the drug. Massatti etal. (2014) merely discuss Ohio House Bill 170 that allows physicians andother health care professionals to furnish or prescribe naloxone to friends andfamily members of those at-risk of opioid-related overdose (in page 7, para. 3,lines 3-6). Recommendations are also made for naloxone’s prescription toat-risk groups (e.g., persons leaving or in outpatient substance abusetreatment for opioid abuse or dependence) and co-prescription of naloxone for certainindividuals (e.g., individuals receiving ≥80 morphine equivalent doses; in page 8, para. 2, lines 1-9).
The misrepresentationof my work by Beheshti et al. (2015)is dangerous because naloxone is used to save lives. It is difficult to imaginewhat would have happened if naloxone had notbeen used over 154,000 times by emergency medical technicians in 2014 (NEMSIS,2015). No empirically based argumentcurrently exists to limit access to naloxone and my body of work supportsaccess to this life-saving drug to all professionals and laypersons who couldsave the life of an overdose victim. Naloxone is desperately needed now morethan ever to save the lives of persons impacted by opioid addiction and anyconflation of the facts with fiction may create a narrative that could costpeople their lives.
Beheshti, A., L. Lucas, T. Dunz, M.Haydash and H. Chiodi et al., 2015. Anevaluation of Naloxone use for opioid overdoses in West Virginia: A literaturereview. Am. Med. J., 6: 9-12. DOI:10.3844/amjsp.2015.9.13
Massatti, R., 2013. Naloxone(Narcan®) Administration in Ohio, 2003-2012. Ohio Department of Mental Healthand Addiction Services, Columbus, OH.
Massatti, R.,C. Beeghly, O. Hall, M. Kariisa and L. Potts, 2014. Increasing heroin overdosesin Ohio: Understanding the issue. Ohio Department of Mental Health andAddiction Services, Columbus, OH.
NEMSIS, 2015. Create a report(NEMSIS cube). National EMS Information System.
ODPS, 2014. Local Naloxoneeducation assistance training. Ohio Department of Public Safety.
OLSC, 2014. Sub. H.B. 170.
© 2016 Richard R. Massatti. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.