Behavioral economic strategies to increase naloxone acquisition and carrying

BackgroundThe opioid overdose crisis claimed over 80,000 American lives in 2019, with opioids implicated in the majority of these deaths. The COVID-19 pandemic has exacerbated the crisis, with challenges arising from the increased use of fentanyl, synthetic opioids, and combined opioid-stimulant substances. Urgent strategies are required to mitigate drug-related harms in the context of an unsafe drug supply. ObjectiveThis paper presents the findings of two consecutive randomized controlled trials conducted in Philadelphia, aiming to assess the effectiveness of behavioral economic interventions in promoting naloxone acquisition and carrying among adults. MethodsThe trials focused on increasing naloxone acquisition (Study A) and promoting naloxone carrying (Study B) among participants who completed community-based overdose recognition and reversal training. Participants were randomized into three arms: those receiving text message nudges, those signing commitment contracts, and a control group receiving only in-person overdose reversal training. Data collection utilized a web-based platform, and participants were compensated upon study completion. ResultsIn Study A, participants were encouraged to acquire naloxone, and the primary endpoint was naloxone acquisition within four weeks post-training. Results showed that around one in five participants acquired naloxone, regardless of the intervention arm, indicating limited effectiveness of behavioral strategies in promoting naloxone acquisition. In Study B, where all participants received naloxone by default, the primary endpoint was the consistency of naloxone carrying. Participants had naloxone on hand at approximately half of the eight unannounced check-ins, with no significant differences between intervention groups and the control group. ConclusionNaloxone distribution by default emerges as a promising strategy to increase naloxone possession and save lives amidst the opioid overdose crisis. Addressing structural barriers, including cost and pharmacy availability, is essential. Additionally, interventions should consider leveraging motivations such as altruism and regret aversion to encourage naloxone carrying.