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Comment & Response
October 2019

State-Level Approaches to Expanding Pharmacists’ Authority to Dispense Naloxone May Affect Accessibility—Reply

Author Affiliations
  • 1William Paterson University, Wayne, New Jersey
  • 2RAND Corporation, Arlington, Virginia
  • 3National Bureau of Economic Research, Cambridge, Massachusetts
JAMA Intern Med. 2019;179(10):1443. doi:10.1001/jamainternmed.2019.3646

In Reply We appreciate the comments by Hill and colleagues concerning the way we categorized naloxone access laws (NALs) in our article.1 We acknowledge the oversimplification issue in our investigation of the effect of NALs on opioid overdose deaths. The fact is that all NALs are different in some manner, whether it is by statute or by implementation. It would be paralyzing to study every dimension of every state policy independently because it would be difficult to determine what common features appear to be most effective. Some type of aggregation is necessary if we are trying to learn about these laws, what they do in practice, and what works. This trade-off likely resonates with many researchers. Studying too many dimensions at once reduces power and makes it difficult to learn about the effects of potential common features across policies. On the other hand, aggregating too much masks the effects of dimensions that matter and dimensions that do not. Our article was motivated by concerns that the literature has often aggregated too much and that the details of NALs matter. Hill and colleagues have suggested that some other dimensions not captured in our models may strengthen or diminish the effects that we estimated, which could certainly be the case. Given our focus on the direct dispensing dimension, we replicated our analysis while dropping California to evaluate the implications of Hill and colleagues’ point. We observed California in its first and second full years of adoption in the data. Our estimated effect in the published article using all states for the second year postadoption was −0.313. When we exclude California, we estimate a nearly identical effect of −0.309, suggesting that California is not driving the main result of the article, but also not attenuating it.

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