Theme: Epidemiology & Public Health Research Year: 2024
Background: During the COVID-19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, particularly among Black and Hispanic/Latinx populations, with no compensatory increase in naloxone distributed to these groups. We evaluated two community-based naloxone expansion strategies aiming to identify approaches that could mitigate mortality and racial and ethnic disparities in OODs.
Methods: We adapted a previously developed, individual-based simulation model to assess incidence of OODs and costs of increasing community-based naloxone availability among White, Black, and Hispanic/Latinx people at risk for opioid overdose in Massachusetts. We measured availability via naloxone kits per OOD per year, and we evaluated scenarios of achieving higher benchmarks (i.e., 40, 60, and 80 kits per OOD) from the 2022 levels. We compared two naloxone distribution strategies: (1) achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (proportional distribution), and (2) achieving the benchmark ratio among each racial/ethnic group (equity-focused distribution).
Results: Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across racial/ethnic groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5%, and 7.1% reduction in annual OODs in 2025 among White, Black, and Hispanic/Latinx populations, respectively. In contrast, equity-focused distribution achieved a reduction of 5.7%, 11.3%, and 10.2% in the respective groups (Figure). In all scenarios, the cost per OOD averted was lower than generally accepted thresholds for cost per life saved.
Conclusion:
An equity-focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could substantially improve health equity while potentially improving overall population health at lower healthcare costs per OOD averted than a proportional distribution strategy.