How much can Narcan and treatment prevent overdose death?
Answer: Less than you think
The state’s wholesale pharmacy, run by Ohio Department of Mental Health and Addiction Services, distributes naloxone (Narcan) kits to Project DAWN sites, mental health boards, local health departments, law enforcement, emergency responders, treatment providers and others. In short, it provides most — but not all — naloxone distributed in Ohio. (Harm Reduction Ohio received 12,868 Narcan kits from the state pharmacy in 2020.)
This charts shows the volume of Narcan has grown dramatically since 2018. The naloxone is paid for by federal grants, local mental health boards, local health departments, hospitals, foundations and others.
What does this chart tell us?
It shows that naloxone may mitigate overdose death, but it cannot drive it substantially down. 2018 was a relatively low overdose death year — and naloxone distribution was low, an average of 3,200 kits per month. 2020 had a record-breaking number of overdose deaths — and the most naloxone distribution in Ohio history, an average of 11,500 kits per month.
Why hasn’t more naloxone reduced total death?
Answer: Because the overdose death epidemic is caused by adulteration of the drug supply, which is caused by drug prohibition. Ohio does not have high levels of drug use. We rank No. 31 in drug use and No. 2 in overdose death. The problem is the horrific rate at which people who use drugs die in our state.
To reduce overdose death significantly, we must understand this fundamental principle: Changes in the chemical composition of the drug supply is what drives overdose death, up and down. A recent study found that 93% of changes in overdose death — both up and down — from 2009 through 2018 in Ohio was explained by changes in the chemical composition of the illegal drug supply. In other words, “Tell me what’s in the drug supply and I’ll tell you how many people will die.”
Big picture: What can Narcan do?
On the flip side, this means we can only influence 10% (maybe less) of total drug overdose deaths by naloxone, treatment, prevention efforts, recovery housing, etc. — in other words, what we spend spend nearly 100% of our overdose prevention money on. These overdose prevention efforts — treatment, naloxone, etc. — matter because 500 deaths (10% of Ohio’s overdose death toll in 2020 — is worth preventing and, you could argue, all that is politically possible in the middle of a drug war with no end. But our failed, multi-billion dollars efforts to reduced the overall overdose death toll shows that we’re doing nothing to prevent 90% of overdose deaths.
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Harm Reduction Ohio believes in naloxone distribution. We are Ohio’s largest naloxone distributor. We gave out 18,000 naloxone kits and reversed more than 1,000 overdoses last year. But we must not deceive ourselves. Naloxone is a bandage on the fundamental cause of overdose death. Drug prohibition results in widespread overdose death by creating an adulterated, unpredictable, unknowable drug supply. Plain and simple: Drug prohibition kills. Always has. Always will. Is doing so now in a horrific cost of human life.
What should be done?
As soon as possible, we must acknowledge that the belief that treatment or naloxone or public health measures generally can end the overdose death is magical thinking. The overdose epidemic is an economic phenomenon with public health consequences — not the other way around. Drug prohibition bad regulation that has created an unregulated, uncontrolled, distorted market in consumer goods. It has turned potentially risky products into extraordinarily risky and deadly products.
Drugs became more dangerous if not properly and professionally diluted, measured and labeled. What we’ve done is create a polluted consumer market and what’s happening now is the natural, inevitable, unpreventable result of these bad regulation: mass death. The overdose-reversing magic of naloxone can save a small share of the poisoned, but the drug war’s effort to poison the drug supply is succeeding and causing mass casualties among the many beautiful people who use drugs. Today, it’s conventional wisdom to blame victims for their own deaths and salute drug warriors for “burning the village to save it,” as the Vietnam saying went. The judgment of history will say otherwise. For us in the present, it’s time to recognize the true cause of mass overdose death — and do something about it.
By Dennis Cauchon, President, Harm Reduction Ohio
Dennis Cauchon, a former national reporter at USA TODAY newspaper, founded Harm Reduction Ohio in 2017. He is the father of two boys and lives in Granville, Ohio.