THE DISTRIBUTION OF NALOXONE TO HEROIN USERS

Overdose deaths are a manor contributor to excess mortality among hero in users. It has been proposed that opioid overdose morbidity and mort ality could be reduced substantially by distributing the opioid antago nist naloxone to heroin users. The ethical issues raised by this propo sal are evaluated from a utilitarian perspective. The potential advant ages of naloxone distribution include the increased chance of comatose opioid users being quickly resuscitated by others present at the time of an overdose, naloxone's safety and its lack of abuse potential. Th e main problems raised by the proposal are: the medico-legal complicat ions of medical practitioners prescribing a drug that is most likely t o be administered to and by people other than the one for whom it is p rescribed; the economic costs of distributing naloxone sufficiently wi dely to have an impact on overdose morbidity and mortality; and the po tentially greater cost-effectiveness of simpler educational interventi ons. Given the possible benefits of naloxone distribution, it may be w orthwhile considering a controlled trial of naloxone distribution to h igh-risk heroin users.