ArticleDrug and alcohol dependence2022
Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin.
Article in Drug and alcohol dependence, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- A GWAS Meta-meta-analysis and In-depth Silico Pharmacogenomic Investigations in Identification of APOE and Other Genes Associated with Pain, Anti-inflammatory, and Immunomodulating Agents in Opioid Use Disorder (OUD) Derived from 14.91 M Subjects.Cellular and molecular neurobiology · 2025Pooled it
- Fentanyl use among people who inject drugs in two large Pacific Northwest metropolitan areas.Harm reduction journal · 2026Article
- Fentanyl, Amphetamine-type Stimulants, Heroin, and xylazine in drug residues in two Northern border Mexican cities.Harm reduction journal · 2025Article
- Emergency medical system response, emergency department visits, and hospital admissions in response to non-fatal opioid overdoses reported by a cohort of overdose survivors in San Francisco and Boston, 2019 - 2022.Drug and alcohol dependence reports · 2025Article
- The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany.Harm reduction journal · 2025Article
- Take-Home Naloxone in Opioid Dependency: An Intervention to Reduce Opioid-Related Deaths.Deutsches Arzteblatt international · 2025Review
- Article
- Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution.JAMA network open · 2024Article
- Price Sensitivity and Information Barriers to the Take-Up of Naloxone.American economic journal. Economic policy · 2024Article
- Comparison of theThe Journal of pharmacology and experimental therapeutics · 2024Article
- Analysis and mapping of harm reduction research in the context of injectable drug use: identifying research hotspots, gaps and future directions.Harm reduction journal · 2024Article
- Bystanders Saving Lives with Naloxone: A Scoping Review on Methods to Estimate Overdose Reversals.The western journal of emergency medicine · 2024Article
- Ventilatory Effects of Fentanyl, Heroin, andThe Journal of pharmacology and experimental therapeutics · 2024Article
- Synaptic Structure and Transcriptomic Profiling of Reward and Sensory Brain Areas in Male Mice of Fentanyl Addiction.Substance abuse and rehabilitation · 2024Article
- Solving the Global Opioid Crisis: Incorporating Genetic Addiction Risk Assessment with Personalized Dopaminergic Homeostatic Therapy and Awareness Integration Therapy.Journal of addiction psychiatry · 2024Article
- "There's No Heroin Around Anymore. It's All Fentanyl." Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study.JMIR formative research · 2022Article
- The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State.Addiction science & clinical practice · 2022Article
- Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach.Harm reduction journal · 2022Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundFentanyl has replaced most other non-prescribed opioids in much of North America. There is controversy over whether a hypothetical reduced efficacy of naloxone in reversing fentanyl is a major contributor to the coincident rising overdose mortality.
methodsWe modified an existing Markov decision analytic model of heroin overdose and naloxone distribution to account for known risks of fentanyl by adjusting overdose risk, the likelihood of death in the event of overdose, and the proportion of cases in which available naloxone was administered in time to prevent death. We assumed near-universal survival when naloxone was administered promptly for heroin or fentanyl overdose, but allowed that to decline in sensitivity analyses for fentanyl. We varied the proportion of use that was fentanyl and adjusted the modified parameters accordingly to estimate mortality as the dominant opioid shifted.
resultsAbsent naloxone, the annual overdose death rate was 1.0% and 4.1% for heroin and fentanyl, respectively. With naloxone reaching 80% of those at risk, the overdose death rate was 0.7% and 3.6% for heroin and fentanyl, respectively, representing reductions of 26.4% and 12.0%. Monte Carlo simulations resulted in overdose mortality with fentanyl of 3.3-5.2% without naloxone and 2.6-4.9% with naloxone, with 95% certainty. Positing reduced efficacy for naloxone in reversing fentanyl resulted in 3.6% of fentanyl overdose deaths being prevented by naloxone.
conclusionsHeightened risk for overdose and subsequent death, alongside the time-sensitive need for naloxone administration, fully account for increased mortality when fentanyl replaces heroin, assuming optimal pharmacologic efficacy of naloxone.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.