• Written by Tarlise Townsend, Joint PhD Student, Health Policy and Sociology, University of Michigan

Forty-seven thousand Americans died of opioid-related overdoses[1] in 2017 – similar to the number of deaths from car accidents[2] and gun violence[3].

That number could have been much lower[4] had more people received naloxone, a medication that reverses opioid-related overdose.

Naloxone is safe, non-addictive and highly effective[5]. And it does more than save lives: When used shortly after overdose[6], naloxone reduces the likelihood of long-term brain damage from diminished blood flow.

Available as an injection or nasal spray, naloxone can be administered[7] by anyone trained to do so[8] - assuming, that is, that someone has it on hand at the scene of the overdose.

Restricted access

Police[9], firefighters and medical first responders are increasingly equipped with naloxone[10].

However, the true first responders to an overdose often aren’t professionals but the friends, family and peers of people who use heroin and other opioids[11]. Relatively few of these “laypeople” have access to naloxone, which is available via community distribution[12], a doctor’s prescription or, in states that allow naloxone to be sold without a prescription[13], from a pharmacy.

While at least 41 states[14] allow pharmacists to dispense the medicine without a prescription, many pharmacies fail to actually stock it[15]. In California, only a quarter of all pharmacies[16] carried naloxone last year.

As opioid-related deaths have soared, there’s been an increase[17] in programs working to get naloxone into the community. Health centers like Prevention Point Pittsburgh[18], for example, train people likely to witness overdose on how to recognize the signs and give them free naloxone.

However, the most recent available data suggest[19] that relatively few communities with high rates of opioid-related deaths actually have such programs.

Even emergency medical personnel, or EMS, may not have naloxone when they need it.

Most U.S. states only authorize[20] intermediate- and advanced-level EMS to carry and administer the drug. But in many parts of the country – particularly rural and tribal areas[21] – EMS with basic training are often the only medical first responders[22] immediately available in emergencies.

‘Moral hazard’

One impediment to increased naloxone access is the argument that reviving overdose victims will encourage opioid use.

Naloxone critic Dr. Harold Jonas, founder of the website, has warned health care providers[23] that naloxone creates a safety net, making people think “they don’t need treatment for substance abuse and … continue using at will.”

The fear that life-saving interventions encourage reckless behavior – a concern historically used to oppose everything from condoms[24] to seat belts[25] – is called “moral hazard[26].”

There is no peer-reviewed, empirical evidence[27] that naloxone use encourages opioid use. But this argument remains pervasive[28].

Often, politicians combine moral hazard with budgetary arguments to oppose broader naloxone distribution.

The prices of some naloxone products have been rising[29]. Between 2009 and 2016, naloxone manufactured by Amphastar almost doubled[30] in price, from US$20.34 to $39.60 per dose.

In 2017, the city of Middletown, Ohio, spent[31] almost $35,000 on naloxone administered by EMS in 966 opioid overdose calls – up from[32] $11,000 and 532 calls in 2016.

Citing cost, Middletown Councilmember Dan Picard[33] has said the city should refuse to resuscitate people who overdose repeatedly.

This overdose-reversal medicine could reduce opioid deaths – so why don't more people carry it? Tess Nishida, a pain pharmacist at the University of Washington, holding a vial of naloxone, Oct. 7, 2016. AP Photo/Ted S. Warren[34]

Naloxone is cost-effective

Since the opioid crisis disproportionately hurts low-income communities[35] like Middletown, our team of health policy[36] and epidemiology[37] researchers at the University of Michigan conducted a study to determine whether naloxone is a good use of the scarce resources available to reduce opioid-related deaths.

Our study, published in International Journal of Drug Policy[38], found that naloxone is extremely cost-effective.

We analyzed the cost-effectiveness of giving naloxone to three different groups: laypeople, police and firefighters and EMS.

When all three groups have naloxone, it costs about $16,000 per year of “high-quality” year of life saved. We accounted for quality of life as well as quantity, since problematic substance use increases the risk of hepatitis, HIV and other health serious illnesses[39].

As life-saving interventions go, $16,000 per high-quality year of life is an excellent deal[40]. The public defibrillators used to revive people in cardiac arrest come out to around $53,797[41]. And a breakthrough class of new cancer drugs run $100,000 to $150,000[42] per high-quality year of life saved.

Naloxone actually saves society money when we take the lost economic productivity from fatal overdoses into account, we found. Hard-hit communities may see naloxone as an expense – but they’re actually saving the city money by keeping more of its workforce alive.

This finding holds even when we add in a city’s criminal justice costs associated with opioid use.

Naloxone would remain cost-effective even if the “moral hazard” concerns were true. We found that overdose rates would have to rise 20% for lay distribution of naloxone to cease being cost-effective – a large margin of error for an unsubstantiated[43] worry.

This overdose-reversal medicine could reduce opioid deaths – so why don't more people carry it? Surgeon General Jerome Adams, right, directs a session on naloxone administration, Jackson, Mississippi, May 17, 2018. AP Photo/Rogelio V. Solis[44]

Moral imperative

Our research determined that the most cost-effective strategy is to distribute naloxone to all three groups: laypeople, police and firefighters, and EMS.

If low-income communities can’t afford that much naloxone, however, the next-best scenario is to give the medicine to laypeople plus at least one first responder group – either police and fire or EMS.

Getting naloxone into lay hands is so critical because many overdose witnesses hesitate to call 911 due to fear of arrest[45], stigma or loss of government benefits like subsidized housing. No matter how many first responders have naloxone, the victims in those cases cannot benefit from it. They need someone close by, like another person using opioids, to revive them.

But emergency responders should have naloxone as well since overdose witnesses may not always have naloxone or be able and willing to use it[46].

Sometimes, a single naloxone dose can save two lives.

In 2018, clinicians in North Carolina treated a pregnant patient[47] who had recently overdosed. Friends had used naloxone to reverse the overdose, allowing her to enter treatment for substance use.

A few months later, she gave birth to a healthy baby.

[ Like what you’ve read? Want more? Sign up for The Conversation’s daily newsletter[48]. ] Screen reader support enabled.


  1. ^ died of opioid-related overdoses (
  2. ^ car accidents (
  3. ^ gun violence (
  4. ^ could have been much lower (
  5. ^ safe, non-addictive and highly effective (
  6. ^ shortly after overdose (
  7. ^ be administered (
  8. ^ anyone trained to do so (
  9. ^ Police (
  10. ^ equipped with naloxone (
  11. ^ use heroin and other opioids (
  12. ^ community distribution (
  13. ^ in states that allow naloxone to be sold without a prescription (
  14. ^ at least 41 states (
  15. ^ fail to actually stock it (
  16. ^ only a quarter of all pharmacies (
  17. ^ been an increase (
  18. ^ Prevention Point Pittsburgh (
  19. ^ most recent available data suggest (
  20. ^ only authorize (
  21. ^ rural and tribal areas (
  22. ^ are often the only medical first responders (
  23. ^ warned health care providers (
  24. ^ condoms (
  25. ^ seat belts (
  26. ^ moral hazard (
  27. ^ no peer-reviewed, empirical evidence (
  28. ^ pervasive (
  29. ^ rising (
  30. ^ almost doubled (
  31. ^ spent (
  32. ^ up from (
  33. ^ Middletown Councilmember Dan Picard (
  34. ^ AP Photo/Ted S. Warren (
  35. ^ disproportionately hurts low-income communities (
  36. ^ health policy (
  37. ^ epidemiology (
  38. ^ International Journal of Drug Policy (
  39. ^ hepatitis, HIV and other health serious illnesses (
  40. ^ an excellent deal (
  41. ^ come out to around $53,797 (
  42. ^ run $100,000 to $150,000 (
  43. ^ unsubstantiated (
  44. ^ AP Photo/Rogelio V. Solis (
  45. ^ fear of arrest (
  46. ^ able and willing to use it (
  47. ^ treated a pregnant patient (
  48. ^ Sign up for The Conversation’s daily newsletter (

Authors: Tarlise Townsend, Joint PhD Student, Health Policy and Sociology, University of Michigan

Read more

Metropolitan republishes selected articles from The Conversation USA with permission

Visit The Conversation to see more

Entertainment News

REBECCA “DAWGGONE" DAVIS” Weight of the World

When people hear my song “Weight of the World” for the first time, they always wonder if I somehow knew 2020 would be a year like no other in our history. Was there any conscious thought predictin...

Rebecca Davis - avatar Rebecca Davis

WENDY MOTEN I’ve Got You Covered

WENDY MOTEN may have launched her career as a pop/R&B artist and taken cool detours into jazz along the way, but her heart clearly belongs to NashvilleWendy Moten may have launched her career ...

News Company - avatar News Company

Smooth Jazz Music Legend “Dr. Dave” Releases An Homage To The Tonight Show

Writing and recording smooth jazz albums and performing live over the past 25 years, I’ve learned that people react most powerfully to a song’s rhythms. If you’ve got a great beat that they can mo...

Dr. Dave - avatar Dr. Dave

Singer/Songwriter Darrell Kelley Talks Music and Social Relevance

I feel very blessed that two of my songs, “The Coronavirus” and “Because of You,” are currently in the Top Five on the World Indie Music charts and continue to grow in influence, with over 100,0...

Darrell Kelley - avatar Darrell Kelley

How to Create a Melody on the Piano

Have you ever wondered what it would be like to be able to write a song? Maybe you’ve wondered how anybody goes about writing a song? Once you understand how music works, you can use building b...

News Company - avatar News Company


In the midst of the devastating COVID-19 pandemic, the release of “In the Morning” on Pure Mission Entertainment – the label he partners on with Aaron Emig - follows on the heels of the global s...

Tom Estey - avatar Tom Estey

Expert Advice: Indie Record Producing and Engineering

My career as an independent artist evolved out of my career as an entrepreneur and restaurant owner. I moved to from my hometown of Boston Atlanta in 2013 and opened my soul food restaurant Soul D...

Darrell Kelley - avatar Darrell Kelley

Weight of The World

When the calm of the world is at stake, and every message of hope is crucial to our collective peace of mind and the endurance of the human spirit, it’s not only possible, but essential to present any...

Tom Estey - avatar Tom Estey

DARRELL KELLEY “The Coronavirus”

Even though I have been releasing tracks and albums since 2018, I never considered myself an artist until I started getting responses from people telling me that my songs were resonating with them. ...


Metropolitan Business News

New Research Highlights Opportunities for Sports Betting

Revenue Stream for Sports’ Post-COVID-19 Recovery Strategies New Rochelle, NY, June 1, 2020— Twenty-four states have now legalized sports betting, with more states considering legalization la...

Len Stein - avatar Len Stein

How to make overseas transfers easier?

Mainstream banks can charge as much as $20 just to process a basic international money transfer. Fortunately, today people are not doomed to handling personal finances only through mainstream gl...

News Company - avatar News Company

The flourishing international market of fragrance and perfume

There is something special and unique about the art of fragrance. This is a big world and there are quite literally a lot of smells around at any given time. In fact, as one of the five human senses i...

News Company - avatar News Company

Impact of good marketing on sales

Sales and marketing are brothers as they go hand and in hand. The job of both of these departments is to generate revenue so that an organization can make money. A company that does not generate rev...

News Company - avatar News Company

7 effective tips for increasing sales in retail

It seems that retailers have drawn a difficult lot in the 21st century: competition from online retail is growing steadily. After all, Internet retailers can sell your products at significantly lowe...

News Company - avatar News Company

10 Reasons to Use Labels

People cannot stop biting their nails, considering the messy condition of their homes. You open your kitchen drawer to grab some utensils, but instead, you take a glance at toys lying inside that dr...

News Company - avatar News Company



Are you planning to go on a trip? Possibly, you do not know what things are most necessary on a trip. In this article, we will guide you through some important tips. These tips help you to...

News Company - avatar News Company

New Baggage Regulations to Help Aussie Parents Travel with Infants

Travelling around the globe has never been easy, especially when infants tag along for the trip. One of the main issues that parents often have to deal with is the need to bring extra item...

News Company - avatar News Company

Maya Beach Opens to Tourists

Despite recent reports that Southern Thailand's famous Maya Beach will close for three months this year, in fact no decision to this effect has been made by Thai authorities. Phi Phi Nati...

Maevadi Rosenfeldt - avatar Maevadi Rosenfeldt


Breaking News & Opinion