Funding/Support: Dr Pacula received funding through grant R21DA041753-01 from the National Institute on Drug Abuse. This approach permits us to test for preexisting trends in the outcome. © 2020 American Medical Association. Exposures  Quiz Ref IDIn 3 or more years post adoption, opioid-related ED visits per quarter increased by 45.446 (95% CI, 2.189-88.709; P = .045) per 100 000 people, representing a 15% increase compared with the mean in nonadopting states in 2016. © 2020 American Medical Association. Reviewing state-mandated training requirements for naloxone-dispensing pharmacists.  MR, Weaver There are limitations to this study.  et al. Volkow Since 2010, states have made legal changes aimed at expanding access to naloxone and increasing its use by laypersons.7,8 For example, as of 2017, 49 states and the District of Columbia had enacted a naloxone access law authorizing pharmacists to dispense or distribute naloxone without a patient-specific prescription from another medical professional.7 However, recent data show that, despite these legal interventions, overall naloxone dispensing remains low.  D, Pacula Hubbard Our website uses cookies to enhance your experience.  RL, Jacobson  SS.  CJ, Simon  D, Haegerich 5-Point strategy to combat the opioid crisis. In addition to the covariates described above, census region (Northeast, Midwest, South, and West) and time, expressed as the number of months from the beginning of the observation period, were adjusted in the regression analysis.  M.  Do medical marijuana laws reduce addictions and deaths related to pain killers? Number of naloxone prescriptions dispensed. All values in the figure were estimated jointly, along with state fixed effects, time fixed effects, and factors associated with policy variables and other covariates discussed in the Methods section. Rates of monthly fatal overdoses were high between 2005 and 2016 (0.59 per 100 000 people each month), as were opioid-involved ED visits (mean [SD], 198.3 [93.65]) (Table 2). For this reason, we specified the working covariance structure as the first-order autoregressive process. We replicated our analysis separately for overdoses involving natural and semisynthetic opioids, heroin, methadone, and synthetic opioids. Dr Lofwall reported receiving grants and personal fees from Braeburn Pharmaceuticals, and personal fees from Indivior and CVS Caremark outside the submitted work. The association for 3 types of NALs was associated: NALs providing direct authority to pharmacists to prescribe, NALs providing indirect authority to prescribe, and other NALs. Centers for Disease Control and Prevention. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. Frank As such, naloxone dispensing is likely correlated with an individual’s access to coverage for the naloxone prescription. First, the strength of association reported in this study reflects the short-term assessment of the legal requirements for naloxone coprescription (<10 months).  AK, Wilder Effects of NAL Policies on Opioid Overdose Deaths, NVSS 2005-2016, eTable 4. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA’s national prescription audit, which represents 90% of all retail pharmacies in the United States. Given the high cost of naloxone,26 suggestive evidence of an association with distribution for Medicaid is important since Medicaid is responsible for a large share of these high costs. The natural logarithm of state population was included as an offset term. To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone.  KA. For example, using data from Symphony Health’s Pharmaceutical Audit Suite Prescription Monthly data, Xu et al9 showed that, in 2016, a total of 147 457 naloxone prescriptions were dispensed from retail pharmacies, which is approximately 46 per 100 000. Fatal and nonfatal overdoses in states that adopted NAL laws were compared with those in states that did not adopt NAL laws. © 2020 American Medical Association.  J, Tuleu Meriwether We examined all opioid-involved deaths (T40.1-T40.4), and in sensitivity analyses also considered deaths for natural and semisynthetic (T40.2), methadone (T40.3), other synthetic opioids (T40.4), and heroin (T40.1) separately.  NL, Further consideration was given to the type of NAL passed in terms of its association with these outcomes. Naloxone. The RAND Corporation Institutional Review Board determined that this research was exempt from approval and acquiring written or oral informed consent. States have implemented different types of naloxone access laws (NALs) and there is controversy over which of these policies, if any, can curb overdose deaths. Opioid-overdose laws association with opioid use and overdose mortality. 329. To assess whether state laws enabling pharmacy distribution of naloxone are associated with pharmacies distributing the drug, we used quarterly data from the 2010-2016 State Drug Utilization Data, which record outpatient drug use information for covered drugs paid for by state Medicaid agencies, including Medicaid managed-care organizations. A systematic review of community opioid overdose prevention and naloxone distribution programs. Each indicator is equal to 0 for nonadopters. This approach assumes that adopting states would have followed the same trends as the nonadopting states if they had not passed the policies of interest. doi:10.1001/jamanetworkopen.2019.6215. The effect sizes for fatal overdoses grew over time relative to adoption of the NALs.