Table 3.
Association between naloxone access measures and lifetime heroin and IDU among adolescents aged 15–18 across US states, 2007–2019
| Lifetime heroin use | Lifetime IDU | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
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| Unadjusted | Adjusted | Unadjusted | Adjusted | |||||||||
|
| ||||||||||||
| Primary exposures | OR | 95% CI | P-value | aOR | 95% CI | P-value | OR | 95% CI | P-value | aOR | 95% CI | P-value |
|
| ||||||||||||
| Any NAL | 0.81 | (0.79, 0.95) | <0.01 | 0.82 | (0.65, 1.04) | 0.10 | 0.89 | (0.75, 1.07) | 0.21 | 1.10 | (0.78, 1.53) | 0.59 |
| Pharmacy dispensingA | 0.94 | (0.90, 0.98) | 0.01 | 0.95 | (0.92, 0.99) | 0.01 | 1.02 | (0.99, 1.04) | 0.23 | 1.07 | (1.02, 1.11) | 0.01 |
|
| ||||||||||||
| Secondary exposures | ||||||||||||
|
| ||||||||||||
| Any NAL | 0.84 | (0.68, 1.05) | 0.12 | 0.75 | (0.70, 1.04) | 0.19 | 0.69 | 0.56, 0.86 | <0.01 | 1.08 | (0.85, 1.38) | 0.51 |
| NAL, prescriber or dispenser immunity | 0.75 | (0.59, 0.96) | 0.02 | 0.96 | (0.77, 1.19) | 0.69 | 0.72 | 0.61, 0.85 | <0.01 | 1.15 | (0.86, 1.55) | 0.35 |
| Any NAL | 0.81 | (0.66, 0.99) | 0.04 | 0.88 | (0.71, 1.09) | 0.24 | 0.67 | 0.57, 0.78 | <0.01 | 1.18 | (0.92, 1.51) | 0.20 |
| NAL, layperson immunity | 0.74 | (0.58, 0.96) | 0.02 | 0.83 | (0.65, 1.05) | 0.11 | 0.79 | 0.64, 0.97 | 0.02 | 1.03 | (0.78, 1.36) | 0.82 |
| Any NAL | 1.00 | (0.81, 1.22) | 0.96 | 1.36 | (0.99, 1.70) | 0.06 | 1.05 | 0.82, 1.35 | 0.69 | 1.13 | (0.84, 1.51) | 0.41 |
| NAL, third party prescribing | 0.76 | (0.60, 0.95) | 0.02 | 0.80 | (0.66, 0.96) | 0.03 | 0.66 | 0.57, 0.77 | <0.01 | 1.11 | (0.87, 1.43) | 0.40 |
| Any NAL | 0.84 | (0.69, 1.03) | 0.09 | 0.89 | (0.73, 1.08) | 0.25 | 0.7 | 0.61, 0.81 | <0.01 | 1.24 | (0.98, 1.56) | 0.07 |
| NAL, Non-patient-specific dispensing | 0.63 | (0.46, 0.86) | <0.01 | 0.78 | (0.61, 0.99) | 0.05 | 0.73 | 0.58, 0.91 | 0.01 | 0.83 | (0.62, 1.13) | 0.24 |
| Any NAL | 0.83 | (0.68, 1.00) | 0.05 | 0.84 | (0.69, 1.03) | 0.09 | 0.72 | 0.61, 0.84 | <0.01 | 1.22 | (0.97, 1.55) | 0.09 |
| NAL, decriminalized possession | 0.72 | (0.54, 0.97) | 0.03 | 0.89 | (0.70, 1.14) | 0.35 | 0.7 | 0.58, 0.83 | <0.01 | 0.91 | (0.63, 1.31) | 0.61 |
Abbreviations: OR, odds ratio; aOR, adjusted odds ratio; 95% CI, 95% Confidence Interval; IDU, injection drug use; NAL, Naloxone access law.
Pharmacy dispensing refers to the number of naloxone prescriptions in IQVIA LRx dispensed at retail pharmacies per 1,000 population in a given state-year. Secondary exposure models coded NAL provisions using a 3-level variable comparing a NAL excluding the specific provision, and a NAL including the specific provision to no NAL. NAL primary and secondary exposure models excluded Good Samaritan law co-implementation states (AL, AR, GA, HI, MS, NC, ND, NV, PA, UT, WI, WV), however sensitivity models including all states and states with co-implementation are presented in Supplemental Tables 3 and 4; lifetime IDU models excluded WI and RI which did not assess IDU in the observation period. Unadjusted models excluded potential confounders but included state and year fixed effects. All models include clustered standard errors.