NO REALLY, IT’S THE NARCAN SAVES
Naloxone administrations to prevent opioid overdose deaths have increased steadily and dramatically while high-risk use and the crisis worsen, and incidence of deaths at best slows slightly. That can mean only one thing.
by Clark Miller
Published March 23 , 2024
While data appear to be scarce for national trends, it is apparent that over past years and decades legal and policy changes, clinical practices and broad-based community and regional campaigns have successfully and significantly increased availability, dispensing, training, and use of the opioid overdose (OD) lethality reversing drug naloxone (Narcan).
Most importantly and beneficially, that has saved lives. Additional effects include changes in how opioid users evaluate risk and make choices in their use of licit and illicit opioids; in how we evaluate and understand changes in incidence of opioid overdoses and OD deaths; and ways in which the confounding effects of emergency naloxone saves on trends in opioid related deaths are interpreted, spun, and used to generate healthcare misinformation.
In multiple posts over the past several years, data on naloxone campaigns by regions and locales including temporal trends in use and differential availability and provision to research groups, as well as comparison to appearances of slowing or reversing trends in OD deaths have revealed:
1) From the earliest reports and research on medical treatments (MAT, MOUD) for the opioid crisis, differential effects of naloxone have confounded causal links to problem opioid outcomes and treatment effects, invalidating attributions of benefit to addiction medications buprenorphine and methadone
2) Magnitudes of naloxone saves directly measured as the prevention of an otherwise lethal high-risk opioid use outcome have consistently been more than large enough to account for any temporal or comparison apparent moderations or slowing of opioid OD deaths.
Let’s consider the public healthcare jurisdiction of the state of Utah as an example, featured in a recent post, where there has been a documented, intentional naloxone campaign and where opioid overdose deaths have decreased.
From the recent post:
But let’s take a look at a state with one of the most remarkable decreases in incidence of lethal opioid overdoses – Utah.
In the last decade, Utah went from having one of the country’s highest rates of opioid overdose deaths to one of the lowest, bucking the national upward trend that came to a head in 2022, likely the deadliest year for overdoses in the U.S. ever.
In 2012, the Beehive State had 16.1 deaths from opioid overdoses per 100,000 people, tied with New Mexico for second highest rate in the country, according to data analyzed by the Kaiser Family Foundation. Only West Virginia was higher, at 27.1.
“They referred to Utah as Appalachia West,” said Jen Plumb, a physician who started the nonprofit Utah Naloxone after her brother died of an overdose in the late 90s.
By 2021, the most recently available public data compiled by the Centers for Disease Control and Prevention, Utah had 14.1 deaths per 100,000 people, falling to 40th overall, and well below the national average of 24.7. . . .
But perhaps the easiest explanation for the drop in deaths, according to Plumb, is the amount of naloxone in Utah, a life-saving opioid overdose reversal drug that can be administered via nasal spray or syringe.
Between 2017 to 2021, the state recorded 297,881 doses of naloxone distributed, according to Department of Health and Human Services, or DHHS, data. A whopping 80% of those doses came from Utah Naloxone, and the rest came from DHHS programs.
“I’m going to say most of that — going from fourth to 42nd — was Dr. Plumb flooding Utah with naloxone,” said Riley Drage, who teaches naloxone training classes for Utah Naloxone.
That’s the nonprofit’s mission — flood the state with naloxone.
“Give out as much naloxone as possible, especially for people who are currently in their addiction or using, unsheltered people — really try to get it into the places where it’s going to be used,” Drage said to a class on Tuesday.
Since the nonprofit started, Plumb says there has been nearly 10,000 overdose reversals. That’s 10,000 second chances.
“If you die from an overdose, you don’t have a chance to get into recovery,” Plumb said.
Let’s do the math.
The population of Utah in 2020 was 3.27 million. The 16.1 lethal opioid overdoses per 100,000 people translates to an approximation of 161 per million X 3.o million = 483 overdose deaths in 2012 if we guess that total population may have been closer to 3 million then. For 2021, at 14.1 deaths per 100,000, an approximation might be 141 per million X 3.27 million = 461 deaths.
We would not expect the difference of about 20 deaths per year to be constant over those years, instead gradually increasing as incidence of lethal ODs declined. Let’s err on the side of decreased deaths and estimate that over the 9 years, lethal ODs were about 9 X 20 = 180 fewer than if lethal OD rates had not changed.
Dr. Plumb cites a figure of 10,000 potentially lethal opioid overdose deaths reversed by use of naloxone increasingly distributed and used in Utah’s naloxone campaigns. That is to say, reversals of opioid OD deaths by naloxone saves more than account for moderation Utah’s opioid-related death trend
A couple of points.
That figure of 10,000 reversals is almost certainly an underestimate, as policy, legislation, and implementation have increasingly made naloxone easily available not just to first responders and health care professionals, but also to individuals, family members, and peers, anyone in a community, predictably increasing saves that are not reported anywhere.
And – research on naloxone campaigns evidences that figures like these from Utah are the norm across locales and states.
Naloxone (Narcan) saves are directly observed, measured and reportable. Each naloxone save accounts for the prevention of an opioid-related death, directly.
What the data seem irrefutably to demonstrate is that at local and national levels, naloxone saves more than account for any moderation or decreases in incidence of opioid -related deaths, and that there are no prevented deaths left to be attributed to treatments of any type.
Back to our current post –
Let’s consider the evidence from Utah a bit further, recognizing that there are multiple unaccounted for factors involved and our estimates are approximations.
Each of the naloxone reversals represents also an incidence of high-risk opioid use, with very few imaginable and low-probability exceptions. That’s 10, 000 instances of high-risk opioid use over approximately the period of about 180 fewer opioid overdose deaths compared to what would have been predicted if OD death rates would have stayed the same. But let’s allow for the possibility that Utah deaths may have otherwise surged as in other parts of the country, West Virginia for example, where death rates nearly tripled over the comparable period.
So, let’s consider that if Utah had not implemented changes and OD deaths tripled as well, then the lives saved appears to be significantly greater over the period, 483 X 3 = 1,449 – 461 = 988, nearly a thousand prevented deaths, about 100 per year saved.
The naloxone saves estimated by by Dr. Plumb, almost certainly an underestimate, were 10,000
That can mean only one thing
Without the emergency revivals OD deaths would been much higher, representing the continuously increasing incidence of high-risk opioid use in Utah. The concerted campaign to “flood the state with naloxone” was desperately needed precisely because high-risk opioid use in Utah was mounting steadily and must still be, as evidenced by the numbers of reversals performed, each a measure of high-risk use. That is, there is no reason to think that the human condition driving the increasingly lethal opioid crisis – opioid users’ compulsive drive to engage in high-risk opioid use – is not remaining as prevalent and powerful or more so, a failure of current treatment approaches.
Each incidence of high-risk opioid use with potential for death is a failure of American Medicine’s gold standard proven addiction medicine treatments buprenorphine and methadone, whose alleged benefit and therapeutic value can only occur by reduction of high-risk opioid use by those receiving the miracle cures.
The roles of buprenorphine and methadone in fueling, rather than treating compulsive opioid use and the crisis, is established, including by the relationship between increasing medical provision of buprenorphine as treatment for opioid use and increasing incidence of opioid injection related infectious diseases, an association representing increase in high-risk opioid use as more medical treatment is provided, not confounded by naloxone saves.
Here’s a more recent example. Note the headline that attributes an apparent decrease in opioid overdose deaths to county healthcare providers successfully treating “addiction”.
Let’s take a look.
Numbers of overdose deaths remain at elevated levels that would have been shocking a decade ago. But in 2023, overdose deaths are on track to decrease for the first time since 2017 – a sign, perhaps, that the county’s social and medical institutions are catching up to the crisis. . . .
The silver bullet to reverse an opioid overdose is naloxone, better known by its brand name Narcan. At NCH, doctors prescribe it to patients who are at risk of overdose, Kouliev said. Rambosk said deputies have used Narcan on patients more than 400 times since it became a standard part of their kit two and a half years ago. And it is also available at pharmacies over-the-counter.
“The fact that there is more awareness about Narcan in the community – there will be more likelihood that somebody on scene has Narcan and can save a life,” Kouliev said.
So there it is again, the same picture,
a naloxone campaign predictably reduces opioid OD deaths, the estimated emergency revivals more than accounting for changes in incidence of deaths, and media attribute the changes to medical treatments making gains on “addiction”.
With no evidence of reductions in high-risk opioid use, the only pathway by which addiction medications can provide benefit.
That medical misinformation is lethal, to the extent that it creates a public perception that the diverted and abused prescription opioids buprenorphine and methadone are effective and not causing harm.
Meanwhile, America’s medical/media collusion predictably uses any opportunity to celebrate any sign that can be distorted to defend against the obvious. In this case, the obvious that while desperately required emergency measures in the form of dramatic surges nationwide in distribution, use, and resulting reversals of opioid OD deaths by naloxone would necessarily moderate opioid deaths, that public health emergency response is a sign of continuing or worsening high-risk opioid use, a worsening of the crisis.
The “promising overall trend” was described this way –
The U.S. recorded 107,941 drug overdose deaths in 2022, according to a new federal report — a total that marks an all-time record but also shows signs that the country’s overdose rate may finally be leveling off after years of steady increase.
The 2022 total marks only a slight increase from the drug death toll of 106,699 the year before, according to the Centers for Disease Control and Prevention. The flattening of drug death rates could provide a rare glimmer of hope amid the bleak U.S. drug crisis, which has seen overdose rates rise inexorably for the past two decades and especially during the Covid-19 pandemic.
The trends we are seeing, long in our sight, are promising in a sense, but not as desired and desperately needed.
They promise things to come, foretell them.
Things ahead foreshadowed by the desperate need for public health campaigns not of prevention or of real, effective treatments, but of daily, incessant emergency measures to revive the dying.
Foretold by more and more sickness and death, the more expert cure is dispensed.
By the predictable emergence of new drugs more potent than the emergency antidote.
Foretold by a house of cards of lethal cures.
