Federal Policymakers Should Urgently and Greatly Expand Naloxone Access

Since March 2020, the US federal government has invested tremendous public health effort in COVID-19 responses by expediting the availability of vaccines and have therapeutics. Meanwhile, addiction care providers, public health workers, and people who use drugs have been sounding alarms about the pandemic's collateral damage, which has contributed to the ongoing surge of unintentional fatal overdoses. Reduced access to addiction treatment and services combined with fentanyl infiltrating drug supplies resulted in an estimated 100000 fatal overdoses in 2020 alone.1 Although the Centers for Disease Control and Prevention iCDC; has released official health advisories2 and the US Department of Health and Human Services (HHS) has supported widespread implementation of expanded distribution and use of naloxone in high-risk populations, there is not enou ugh naloxone in the hands of those who need it most. Only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions nationwide.3 In communities that experience disproportionate rates of overdose from illicit opioids, a recent study suggests that nonurban areas have lower naloxone distribution relative to overdose deaths than urban areas do.4 Given the pervasiveness of this national crisis, it is critical to saturate our communities now with naloxone. The 2021 Model Expanded Access to Emergency Opioid Antagonists Act is a first step in aiming for uniform naloxone access because it provides a legislative template that states could eventually choose to implement.5 We call on federal policymakers and regulators to take one step further to increase naloxone availability by (1) making naloxone available over the counter (OTC), (2) increasing funding for community-based programs focusing on harm reduction, (3) permanently eliminating insurance oope.iyments and prior-authorization requirements, and (a) mandating coprescribed and codispensed naloxone with all higher-risk opioid prescriptions and medications for opioid use disorder.