Deregulating Naloxone to Combat Opiod-Related Overdoses in British Columbia: The Potential Moral Hazard of a Progressive Harm Reduction Policy
Bibliographic record
Abstract
British Columbia fully unscheduled the opioid overdose-reversing drug known as naloxone on 21 September 2016 in an attempt to reduce opioid overdose-related mortality.Having a large population of injectable drug users, the move represents just one harm reduction initiative out of many the province has executed over the years.The change was intended to remove any regulatory barriers to the drug, thereby granting users, their peers, and public health organizations greater access.Given the devastating impacts of the opioid crisis in North America, particularly the Western coast, the political climate favoured the quick and unopposed implementation of this reform.The move was supported by physicians and pharmacists alike, who recognized the importance of harm reduction strategies alongside the availability of proper training.While no evaluation has been completed, anecdotal evidence from paramedics has suggested that illicit, off-label uses of naloxone are on the rise, posing a potential moral hazard of increased availability.La Colombie-Britannique a rendu la naloxone, un antagoniste d'opiacés, disponible en vente libre le 21 septembre 2016, dans l'objectif de réduire le taux de mortalité par surdose d'opiacés.Cette décision ne représente qu'une parcelle de l'initiative de réduction des méfaits déjà enclenchée par la province au cours des dernières années, compte tenu du vaste nombre d'utilisateurs de drogues injectables.Ce changement avait pour objectif premier de faciliter l'accès au médicament, tant pour les utilisateurs que pour leurs pairs ou encore les organisations de santé publique.Considérant les conséquences importantes de la crise des opiacés en Amérique du Nord, particulièrement sur la côte ouest, le climat politique était favorable à la mise en place rapide et sans ambages de cette réforme.Cette dernière a autant été appuyée par les médecins que par les pharmaciens, qui reconnaissent l'importance des stratégies de réduction des méfaits, ainsi que d'une formation adéquate des utilisateurs.Malgré l'absence d'évaluation formelle de cette réforme, une augmentation de l'utilisation illicite et non-indiquée de la naloxone a été rapportée par les premiers répondants, ce qui pourrait poser un risque moral quant à son accessibilité. Deregulating Naloxone to Combat Opioid-Related Overdoses in BC Crowell Key Messages• In September of 2016, the opioid antagonist naloxone was removed from British Columbia's Drug Schedules Regulation, permitting the sale of naloxone outside of pharmacies without a prescription.• Increasing access to naloxone is an easy-to-implement harm-reduction policy that can reduce the incidence of opioid-related hospitalizations and opioid overdose-related deaths.• Unscheduling naloxone presents a possible moral hazard insofar as off-label misuses of the drug may lead to riskier behaviour and a lack of appropriate training may diminish the drug's efficacy. Messages-clés• En septembre 2016, la naloxone, un antagoniste des opiacés, a été retirée du Règlement sur les listes de médicaments de la Colombie-Britannique, permettant ainsi la vente de naloxone en dehors des pharmacies sans ordonnance.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.004 |
| Scholarly communication | 0.005 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".