Every day in the U.S., more than 40 people die after overdosing on prescription painkillers. Deaths from a more notorious form of opiates — heroin — increased five-fold between 2001 and 2013. Addressing this problem — one that’s often described as a public health crisis — requires action on many fronts, from preventing abuse in the first place to getting those addicted into treatment. But when it comes to overdoses, there’s one answer we know works: naloxone.
Naloxone is a safe prescription medicine that’s highly effective in reversing an otherwise deadly opioid overdose. Typically, emergency first responders administer the drug; however, many state legislatures are expanding access to naloxone in the wake of the painkiller abuse epidemic. Today, according to the Network for Public Health Law, more than 40 states and Washington, D.C., allow health care providers to dispense naloxone to lay administrators, such as family and friends of those struggling with addiction and other potential bystanders to an overdose. A June report from the Centers for Disease Control and Prevention cited a survey of 140 managers working within organizations that distribute naloxone kits to lay administers and which found that between 1996 and 2014, managers received reports of more than 25,400 overdose reversals.
Still, naloxone distribution, similar to other risk reduction strategies such as needle exchange, faces ideological and political challenges. Broadening naloxone access is largely dependent on policymakers who answer to constituents, and that means public support may be a key ingredient in expanding the reach and impact of the life-saving drug. In turn, Colleen Barry, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, dove into the tangled web of public opinion around drug addiction to discover what types of messages could persuade people to support policies that broaden access to naloxone. And like much of public health messaging research, she and her colleagues found that storytelling is key. In other words, people respond positively when the facts and statistics are delivered with a dose of humanity.
“We’re experiencing an epidemic of prescription opioid addition and overdose in this country,” Barry told me. “Overdose deaths have quadrupled and deaths from opioids now exceed motor vehicle crashes. This has become a public health crisis. Naloxone is one of the most important public health tools to prevent overdose deaths…but at the same time, we know there are low levels of support for policies to more broadly distribute it. Our hypothesis was that there could be strategies for increasing public support that could make a difference.”
In the study, which was published earlier this month in the journal PLOS ONE, Barry and research colleagues Marcus Bachhuber, Emma McGinty, Alene Kennedy-Hendricks and Jeff Niederdeppe write:
Although data on public opinion about naloxone distribution programs are lacking, there are many potential reasons why naloxone distribution may have a low rate of public support. Stigma and negative public opinion around drug use and people who use drugs are barriers to support of a wide range of public policies such as insurance parity, housing support, and job support. More specific to naloxone distribution, lack of familiarity with naloxone, concerns about the unintended consequences of naloxone, and lack of compassion or sympathy for people who use drugs may lead to low public support. Previous research shows that public opinion is a substantial contributor to the enactment of public policy.
To conduct the messaging study, Barry and colleagues randomly surveyed nearly 1,600 adults to test the effects of three different types of messaging strategies. The first was simply providing factual information about painkiller overdoses and the safety and effectiveness of naloxone. The second approach offered information that counters two common concerns about naloxone access: that its availability will lead to more overdoses because people believe they can be rescued (note: this assumption is not supported by the data) and that people saved by naloxone will continue their drug use and overdose again (note: while addiction is a chronic illness, getting people into treatment can improve outcomes.) The third messaging strategy was a “sympathetic narrative” about a mother struggling with her daughter’s painkiller addiction and eventual fatal overdose.
Among the survey participants who received no information about naloxone, support for bystander access was pretty low: while about two-thirds supported training first responders in administering naloxone, just one-quarter supported dispensing naloxone to friends and families who might witness an overdose. Also, only about half supported laws that protect people who call for medical help in the event of an overdose, 42 percent supported the passage of laws to protect people from legal prosecution if they administer naloxone, and less than 40 percent supported increased funding for addiction screening and treatment.
But good messaging made a difference — sometimes, a big difference. Researchers found that offering just factual information about naloxone increased support for training first responders to use naloxone, providing naloxone to friends and family as well as for laws that protect those who administer naloxone. Providing just the sympathetic narrative also increased support for all three measures.
However, the biggest impact came from combining factual information with the sympathetic narrative: The combo resulted in significantly higher support for naloxone access policies when compared to survey participants who received no messaging exposure or participants who received only factual information. In fact, the messaging combination actually doubled the number of people who agreed that giving naloxone to friends and family would save lives. On an interesting note, researchers found that while providing only factual information increased support for some naloxone policies, it increased negative beliefs about naloxone at the same time.
Barry noted that researchers didn’t stratify survey participants by political ideology, and so the large shifts in support for naloxone-access policies suggest that the messaging techniques are appealing across political dimensions.
“It’s a good reminder to the policy community that people need the facts, but they also need stories about the people who benefit from these policies,” she said. “Communication is not just about the numbers and in fact, numbers can obscure the human element of many of the public health issues we grapple with in this country.”
Barry added that while the messaging study didn’t test who would be most effective in delivering the facts and stories, previous research has shown that the “messenger matters in a very powerful way.” She suggested that the persuasive power of a potential messenger is largely driven by trust. So, for example, a health care provider might be particularly well suited to delivering messages about naloxone use. However, Barry added that people who’ve experienced addiction either as an individual or through loved ones could be “extraordinarily powerful” messengers as well.
“In particular, stories from individuals who’ve successfully overcome addiction — these success stories are critical because we tend to only hear the other side,” she told me. “The challenge we face is we have increasing rates of addiction, in part driven by prescription painkiller proliferation, and we have very inadequate treatment delivery systems. …Getting out stories about people who’ve benefited from treatment and are doing better could help build public support and get more treatment to those who need it most.”
To download a full copy of the naloxone messaging study, visit PLOS ONE.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.