ArticleThe International journal on drug policy2023
Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states.
Article in The International journal on drug policy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 25 citations in OpenAlex.
- Using the HPV vaccine as a public health case study for identifying potential barriers to a Fentanyl vaccine.Harm reduction journal · 2026Article
- How population-level drug supply data are integrated into health outcomes research: a scoping review.Epidemiologic reviews · 2026Article
- Article
- Prevention and Management of Opioid use Disorder and Overdose in Adolescents and Young Adults.Current psychiatry reports · 2025Review
- Increasing opportunities for community input in harm reduction program development using iterative engagement.Harm reduction journal · 2025Review
- 'I Don't Know How to Live Real Life Sober'-Identifying Needed Supports Through the Voices of Pregnant and Parenting People Seeking Recovery.International journal of mental health nursing · 2025Article
- The Call for a School-Based Approach to Opioid Overdose Prevention.American journal of public health · 2024Article
- Price Sensitivity and Information Barriers to the Take-Up of Naloxone.American economic journal. Economic policy · 2024Article
- Youth and young adult knowledge of and access to opioid harm reduction policies and interventions in North Carolina.Drug and alcohol dependence reports · 2024Article
- Addressing Children and Families within the National Drug Control Strategy.Parenting, science and practice · 2024Article
- Effectiveness of direct patient outreach with a narrative naloxone and overdose prevention video to patients prescribed long-term opioid therapy in the USA: the Naloxone Navigator randomised clinical trial.BMJ public health · 2024Article
- Naloxone Access in Schools: A National Survey of School Nurses in the United States.Substance use : research and treatmentArticle
- Opioids and Youth Athletes.Sports healthReview
- Barriers and Facilitators to Naloxone Access for Adolescents: A Narrative Review.Substance use : research and treatmentReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundNaloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated.
methodsWe examined relationships between naloxone access laws and pharmacy naloxone distribution with lifetime heroin and injection drug use (IDU), 2007-2019. Models generating adjusted odds ratios (aOR) and 95% confidence intervals (CI) included year and state fixed effects, controlled for demographics and sources of variation in opioid environments (e.g., fentanyl penetration), as well as additional policies expected to impact substance use (e.g., prescription drug monitoring). Exploratory and sensitivity analyses further examined naloxone law provisions (e.g., third-party prescribing) and applied e-value testing to assess vulnerability to unmeasured confounding.
resultsAdoption of any naloxone law was not associated with changes in adolescent lifetime heroin or IDU. For pharmacy dispensing, we observed a small decrease in heroin use (aOR: 0.95 [CI: 0.92, 0.99]) and a small increase in IDU (aOR: 1.07 [CI: 1.02, 1.11]). Exploratory analyses of law provisions suggested that third-party prescribing (aOR: 0.80, [CI: 0.66, 0.96]) and non-patient-specific dispensing models (aOR: 0.78, [CI: 0.61, 0.99]) were associated with decreased heroin use but not decreased IDU. Small e-values associated with the pharmacy dispensing and provision estimates indicate that unmeasured confounding may explain observed findings.
conclusionNaloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.
Indexed as
Identifiers
What OpenQuestion holds
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.