State-expanded naloxone distribution needed for polysubstance users, says Pew expert

State-expanded naloxone distribution needed for polysubstance users, says Pew expert

States should expand naloxone distribution in order to reach polysubstance users and abusers, says Beth Connolly, project director of The Pew Charitable Trusts’ substance use prevention and treatment initiative.

Polysubstance, or polydrug, users and abusers are people who simultaneously take more than one drug, such as stimulants (i.e. cocaine) and depressants like opioids. In fact, Connolly said that data indicates more than half of stimulant-involved overdose deaths in 2017 — about 15,000 deaths — also involved opioids. 

“We’ve also seen that the rise in stimulant-involved deaths is being driven by co-use with synthetic opioids, either intentionally or unintentionally from fentanyl contamination of stimulant drug supplies,” Connolly said in an interview. 

While polysubstance abuse often refers to the abuse of multiple illicit drugs, it’s also inclusive of prescription medications used in nonmedical circumstances, according to the recent report, Opioid Overdose Crisis Compounded by Polysubstance Use, released last month by The Pew Charitable Trusts.

Therefore, it’s critical to make naloxone available to people who use stimulants and may have unintentional exposure to opioids, said Connolly. “Ultimately, given the vast number of overdose deaths that involve both stimulants and opioids, individuals who use both substances should have ready access to naloxone in the event of an overdose — it could save a life,” she said.

The Pew report also recommends that states expand naloxone distribution to reach people who use stimulants because it reverses the respiratory depression effects of opioids to safeguard against a fatal overdose and remains effective when people use opioids in combination with other drugs.

“Considering that opioids are frequently implicated in cocaine and methamphetamine overdose deaths, people who primarily use stimulants are recognized as an at-risk population for opioid overdose,” according to the report. “Laws that allow for increased community distribution of naloxone can help safeguard against polysubstance use overdoses.”

Such state-expanded naloxone distribution is but one new strategy that may reduce the risks from using more than one drug, according to the Pew report, which points out that during the first half of 2018, nearly 63 percent of opioid overdose deaths in the United States also involved cocaine, methamphetamine, or benzodiazepines, signaling the need to address polysubstance use as part of a comprehensive response to the opioid epidemic.

Fentanyl, a highly potent synthetic opioid, has been identified as a driver of overdose deaths involving other opioids, benzodiazepines, alcohol, methamphetamine, and cocaine, according to the Pew report.

“For years, policymakers have talked about the opioid crisis, and the devastation it’s wrought on communities across the country,” said Connolly. “But what the data are showing now is that we’re facing more than just an opioid crisis — overdose deaths increasingly involve other substances, like other depressants, such as alcohol and benzodiazepines, and stimulants, such as cocaine or methamphetamine.”

Efforts to reduce opioid overdose deaths should incorporate strategies to prevent, mitigate and treat the use of multiple substances, Connolly said, adding that state policymakers should be thinking now about how best to address polysubstance use to reduce opioid-related overdose deaths. “State laws allowing for increased community distribution of naloxone could help safeguard against polysubstance use overdoses,” she said.

Connolly also said that “research shows that increasing the availability of naloxone reduces the rate of opioid overdose deaths.” 

Additionally, she said community organizations that aim to help people who use drugs, opioids or otherwise, are well positioned to not only distribute naloxone, but also provide education about overdose risk and refer people to treatment, which can all help reduce polysubstance overdoses.

And while first responders who administer naloxone to patients who overdose are certainly needed, Connolly said that making the medication readily available to friends and family who may witness an overdose is equally as important. 

“These friends and family members can potentially save a life before emergency services arrive,” she said. “Community distribution of naloxone supports that aim.”

Strengthening policy efforts across the continuum of prevention, harm reduction and treatment to address the risks of polysubstance use can slow the rates of drug overdose deaths in the United States, the Pew report concludes.