Have you ever wondered why economics is sometimes called the dismal science? It may have something to do with an article I ran across the other day, “The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime“ (IZA Institute of Labor Economics, 2018).
Nearly 110,000 people died in 2023 from a drug overdose, according to the U.S. Centers for Disease Control and Prevention (CDC). That is around 300 people per day. Opioid abuse and overdose deaths are growing problems in the United States. In recent years fentanyl has flooded the illicit drug market. Virtually all prescription opioids bought off the street are counterfeit with fentanyl as the active ingredient. Many illicit drugs, like cocaine and heroin, are also laced with fentanyl to boost the strength.
The journal article I mentioned above has an interesting premise: it investigates whether life-saving interventions for opioid abuse may increase both drug abuse and crime associated with drug use. From the article:
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to naloxone, a drug that can save lives when administered during an overdose. However, naloxone access may unintentionally increase opioid abuse through two channels: (1) reducing the risk of death per use, thereby making riskier opioid use more appealing, and (2) saving the lives of active drug users, who survive to continue abusing opioids. By increasing the number of opioid abusers who need to fund their drug purchases, naloxone access laws may also increase theft.
Over the years states and cities have passed various laws making naloxone available over the counter. Some have programs to pass it out to suspected drug users. About half of states have legalized fentanyl test strips.
Policymakers have struggled to reduce the lethal effects of this class of drugs. Many have turned to naloxone. Naloxone is a drug that can reverse an opioid overdose if administered quickly; it therefore has the potential to reduce this epidemic’s death toll. Every U.S. state has passed a law that facilitates widespread distribution and use of naloxone. One prominent public health official has even called for naloxone in every medicine cabinet (Shesgreen, 2016), a sentiment recently echoed by the U.S. Surgeon General (Scutti and Jimison, 2018).
States passed so-called Naloxone Laws at different times, creating a natural experiment for the authors to analyze their effects in one region and compare it to another. The old, standard caveat still holds, correlation is not causation, but the results were not good.
We exploit the staggered timing of naloxone access laws to estimate the total effects of these laws. We find that broadening naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality.
We also find suggestive evidence that broadening naloxone access increased the use of fentanyl, a particularly potent opioid. While naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to naloxone encourages riskier behaviors with respect to opioid abuse.
The article is long and technical beyond what I could discuss in a blog post. However, if you need further evidence that fentanyl has gotten worse and naloxone access is not a silver bullet just look at the mortality figures since this journal article was published in 2018. Overdose deaths have nearly tripled compared to what they were back then (301 vs. 115).