Improving health equity and naloxone access among people at risk for opioid overdose: a distributional cost-effectiveness analysis of community-based naloxone distribution strategies in Massachusetts

Presented by
Xiao Zang, PhD
Assistant Professor
Division of Health Policy & Management

Opioid overdose mortality has grown exponentially in recent decades in the US, with a pronounced increase during the COVID-19 pandemic. In 2022, nearly 83,000 people died due to drug overdose involving an opioid – deaths driven largely by a highly potent drug supply (fentanyl in particular) and structural barriers to overdose prevention services. Across the US, the rate of opioid overdose death (OOD) has grown most rapidly among Black individuals. In Massachusetts, while the age-adjusted rates of OOD among non-Hispanic White residents remained steady from 2019 to 2022, these rates increased by 134% and 41% among non-Hispanic Black and Hispanic residents, respectively. Widespread naloxone distribution is a key component of the public health response to the opioid overdose epidemic, as the timely administration of naloxone can prevent opioid overdoses from becoming fatal. However, there are systemic barriers that limit naloxone access for racial and ethnic minority individuals. Reducing overdose-related health disparities is critical for an equitable and effective federal, state, and local response to the overdose epidemic. Distributional cost-effectiveness analysis (DCEA) is a novel analytical framework that combines the dual objectives of maximizing population health and reducing health inequities in evaluating public health strategies. This study aims to adapt a previously developed simulation model (PROFOUND) and apply a DCEA framework to estimate the distribution of health gains of different naloxone distribution strategies in Massachusetts and to identify one that may best mitigate opioid overdose mortality and address racial and ethnic disparities in OODs.

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