Abstract
In the American Medical Journal, Annahita Beheshti and colleagues review the literature on naloxone use for opioid overdose in West Virginia (Beheshti et al., 2015). The authors cite several of my publications in support of their views on naloxone (Massatti, 2013; Massatti et al., 2014), but many of these citations misinterpret my work by using it to present a counterargument against the drug. Specifically, the authors make false assumptions when they imply the availability of an antidote might lead to increased opioid use. Beheshti et al. (2015) say, “the availability of an antidote may encourage drug use by providing a sense of security in users” (in page 11, para. 4, lines 1-8); however, there is no citation except for my work. While it is true Massatti (2013) suggests there is anecdotal evidence that persons abusing opioids travel to areas more likely to have naloxone (e.g., hospital parking lots and communities where EMTs are more likely to carry naloxone; in page 18, para. 2, lines 1-8; in page 18 para. 3, lines 1-8), there is no evidence that increased access leads to increased use. Simply put, location may change in some cases, but incidence does not. Beheshti et al. (2015) also generally overstate the link between naloxone availability and opioid use when they say, “there is little evidence supporting the effectiveness of naloxone in deterring illegal use of opioids” (in page 10, para. 1, lines 4-6). The purpose of making naloxone more accessible is to reduce the number of unintentional overdose deaths, not to deter illicit use of opioids. As is oft said when discussing naloxone, “Dying is not a good way to recover.”
Highlights
Beheshti et al (2015) state,“the rate of naloxone use has increased for every age group from 2003-2012 in Ohio suggesting that relaxed laws governing the use of naloxone may lead to increased use ”
Ohio’s scope of practice statements and formal house bills expanding the use of naloxone were not enacted until late 2013 (ODPS, 2014; OLSC, 2014); it was impossible that “relaxed laws” had anything to do with the relationship between increased opioid use and increased naloxone administration from 2003 to 2012
Beheshti et al (2015) claim that my work advocates for OTC use because visiting with a physician hinders the potential success of naloxone
Summary
Beheshti et al (2015) continue their line of reasoning and erroneously suggest that increased availability of naloxone raises the likelihood of overdose episodes. Beheshti et al (2015) correctly cite my work that EMTs report persons fearing prosecution have abandoned overdose victims, but they follow up that point with a speculation about use of 911 services. Beheshti et al (2015) explain, “If naloxone were to be available over the counter, sufficient use of 911 emergency could diminish and the incidence of overdose will likely continue to increase” (in page 12, para. 2, lines 24-27). The authors mistakenly suggest that legal changes may lead to increased use. Beheshti et al (2015) state,“the rate of naloxone use has increased for every age group from 2003-2012 in Ohio suggesting that relaxed laws governing the use of naloxone may lead to increased use ”
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