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Investigating the Complexity of Naloxone Distribution: Which Policies Matter for Pharmacies and Potential Recipients

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  • Rosanna Smart
  • David Powell
  • Rosalie Liccardo Pacula
  • Evan D. Peet
  • Rahi Abouk
  • Corey S. Davis

Abstract

Despite efforts to address the opioid crisis, opioid-related overdoses remain a significant contributor to mortality. State efforts to reduce overdose deaths by removing barriers to naloxone have recently focused on pharmacy channels, but the specifics of these laws and the contexts in which they are implemented vary widely. In this paper, we use novel methods robust to heterogeneous effects across states and time-varying policy effects to estimate the effects on naloxone pharmacy distribution of two types of laws: laws authorizing non-patient-specific prescription distribution of naloxone and laws granting pharmacists prescriptive authority for naloxone. We find that both types of laws significantly increase the volume of naloxone dispensed through pharmacies. However, relative to laws authorizing non-patient-specific prescription distribution, effects are significantly larger for pharmacist prescriptive authority laws. These larger effects only partially derive from increased naloxone prescribing by pharmacists. We also estimate large, significant increases in pharmacy dispensation of naloxone prescribed by non-pharmacist prescribers, with particularly large increases among family medicine physicians, with particularly large increases among family medicine physicians. The relative benefits of pharmacist prescriptive authority laws versus non-patient-specific distribution are larger among Non-Hispanic Black individuals, suggesting an important role of these policies for reducing disparities in access to naloxone.

Suggested Citation

  • Rosanna Smart & David Powell & Rosalie Liccardo Pacula & Evan D. Peet & Rahi Abouk & Corey S. Davis, 2023. "Investigating the Complexity of Naloxone Distribution: Which Policies Matter for Pharmacies and Potential Recipients," NBER Working Papers 31142, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:31142
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    1. Evan D. Peet & David Powell & Rosalie Liccardo Pacula, 2024. "Using Policy and Innovation to Improve Life-Saving Access to Naloxone," NBER Working Papers 33105, National Bureau of Economic Research, Inc.
    2. Dércio de Assis & Arpita Ghosh & Sonia Oreffice & Climent Quintana-Domeque, 2025. "Disrupting Violence, Protecting Lives: Strangulation Laws and Intimate Partner Homicides," Discussion Papers 2501, University of Exeter, Department of Economics, revised 03 Dec 2025.
    3. de Assis, Dércio & Ghosh, Arpita & Oreffice, Sonia & Quintana-Domeque, Climent, 2025. "Non-Fatal Strangulation Laws and Intimate Partner Homicides," IZA Discussion Papers 18006, IZA Network @ LISER.
    4. Olivia Yip & Mark Bounthavong, 2025. "Enhancing Naloxone Distribution for Opioid Users in the USA: A Cost-Utility Analysis of Academic Detailing to Clinicians," Applied Health Economics and Health Policy, Springer, vol. 23(6), pages 1115-1130, November.
    5. Cawley, John & Dragone, Davide, 2024. "Harm reduction for addictive consumption: When does it improve health and when does it backfire?," Journal of Health Economics, Elsevier, vol. 98(C).

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    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K32 - Law and Economics - - Other Substantive Areas of Law - - - Energy, Environmental, Health, and Safety Law

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