Primary Submission Category: Policy
Change is not an event, it is a process: Reviewing the effect of Naloxone Access and Good Samaritan Laws on opioid overdose mortality with an implementation lag
Authors: Jonathan Burke, Katherine Wheeler-Martin, Magdalena Cerdá, Charles DiMaggio,
Presenting Author: Jonathan Burke*
Background: To reduce Opioid Overdose Deaths (OODs), states have enacted Naloxone Access Laws (NALs) and Good Samaritan Laws (GSLs). While there have been systematic evidence syntheses of the impact of these policies, none have incorporated a lag in evaluation to account for time needed to disseminate policy knowledge and implement the policy with infrastructure development and training.
Methods: We conducted a systematic review of studies assessing the effect of NALs or GSLs on OODs in the United States without time restrictions, searching Ovid Medline, Ovid Embase, CINAHL, Criminal Justice Abstracts, PsycINFO, and Cochrane Library. We included studies that used a minimum one-year lag and without a critical risk of bias, assessed using Cochrane tools. The primary outcome of interest was the rate ratio of OODs after a one-year lag, with secondary syntheses using two-year lags, overdose deaths from fentanyl, and OODs by region and race. The review was registered with PROSPERO (CRD42023420056).
Results: Of 4,579 studies screened, 4 met inclusion criteria for primary analysis for NALs and 4 for GSLs. 2 of 3 studies assessing any NAL and 3 of 3 assessing any GSL had results compatible with no effect on OODs after a one-year lag. But after 2 years, 2 of 3 studies of any NAL showed fewer OODs (IRRs 0.82 and 0.74). The one study examining types of NALs found that states that allowed naloxone distribution at pharmacies without prescriptions had reduced OODs (IRR 0.73, 95% CI: 0.58-0.87), with a larger effect after two years (IRR 0.66, 95% CI: 0.43-0.90). The one study assessing types of GSLs found that stronger protections from arrests had no effect after one year (IRR 0.97, 95% CI: 0.92-1.02), but fewer OODs after two years (IRR 0.90, 95% CI: 0.85-0.95).
Conclusion: NALs and GSLs may require multiple years to demonstrate effects and this may be driven by measures that facilitate the easiest access to naloxone without a prescription and stronger legal protections from arrest.