1042: Naloxone’s Impact: Inside New York’s Landmark Study on Lives Saved and Dollars Returned

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, December 15, 2025. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Today, we take a look at the lives saved in the return on investment from New York State's Harm Reduction Initiative to distribute naloxone, the medication that can rapidly reduce an opioid overdose. My guest is Dr. James McDonald ASTHO member and commissioner of the New York State Department of Health.

JAMES MCDONALD: 

When you think about this story, it may be hard to put a value on a human life, but Health and Human Services has a value for a statistical life. It's a data point you can use. If you use the data point and then evaluate the whole program, that's what we did, and that's how we showed this cost-effectiveness. Because, quite frankly, for every dollar spent, saving over $3,219 that's really robust.

SHEEHAN: 

Of course, there's more to the story than dollars and cents, but as Dr. McDonald explains, it's part of the narrative that officials can use when making the case for these harm reduction programs.

Dr James McDonald, welcome to the show.

MCDONALD: 

Thank you. Good to be with you today.

SHEEHAN: 

So, the study shows that naloxone saved more than 6,500 lives over two years in New York. Can you give us some context for these numbers and how other states should sort of think about them in their own harm reduction programs?

MCDONALD: 

You know, when you look at the New York data, what we showed in this study was this was really about naloxone administration. We have over 1,400 opioid overdose prevention programs in New York State. So, what we did is we looked at our over- opioid overdose prevention programs, we just got the data from them, and looked at how many administrations did you do? And what was the outcome? And this is one of the things about this study that I think is really groundbreaking. It's outcome-driven. What we show, what the outcome is, we saved a lot of lives, over 6,500. What we also showed is naloxone was a really important public health tool. It's not the only public health tool in the overdose crisis, but it is a really important public health, too, the cornerstone of harm reduction, if you will.

SHEEHAN: 

And this is one of the first times that a state has, sort of, looked at the economic result of naloxone. And you mentioned, sort of, that it's outcome-driven. Is that an example of how other states could sort of approach this kind of, this kind of analysis?

MCDONALD: 

Yeah, so we looked at the administration. In other words, what we really wanted to know is, it's not- it's not a bad thing to distribute naloxone. It's great to distribute naloxone. But we really wanted to learn is, what were the outcomes? In other words, was it cost-effective? And that's what was different about the program. We didn't just add up the cost of naloxone, but of the entire opioid overdose prevention programs. And so, you know, that's like $27 million in New York State over a two-year period. It's a substantial investment here. But we really saw very cost-effective. And it's really the first time, we know, of a state health department, really anyone doing the administration health economic evaluation. We used Health and Human Services' value for statistical life to do the evaluation. And so, really, we did a robust evaluation to show that this isn't just a good idea, it's really cost-effective.

SHEEHAN: 

Sure, the amount of money versus the number of lives saved and the number of the dollar value on that, how should other state officials- how can they use these, your results, to sort of build their own case to policymakers when making the case for naloxone?

MCDONALD: 

Yeah, so part of why we did the evaluation is just recognizing more and more in public health, people want to see return on investment. They really want to understand, you know, you're doing an activity, it leads to productivity, but what's the positive outcome? And then is there return on investment? And that's how I define work at the New York State Department Health, by the way, is it's an activity, it leads to productivity, leads to a positive outcome. And then what's the return on investment. This is one of those things where, when you think about public health for the future, we need to talk this language a little more clearly to people like in the- in the returned investment, this is substantial. You know, you've heard the expression, ounce of prevention, worth a pound of cure. Well, this is really a pound of prevention worth a ton and a half of cure. Because the cost, you know, when we look at returned investment, we're talking about for every dollar we spent, we saved over $3,200. You know, that $1 to over $3,200, that's a huge returned investment, really, very little like that.

SHEEHAN: 

Yeah, that's very stark. When you put it like that, the case sort of makes itself. You're saving over $3,000 per dollar spent.

MCDONALD: 

Yeah, it's really a good example of just when you do the health economic evaluation, and fortunately, we had people here who could do that. You see the cost-effectiveness. And I'm not sure every state needs to do this study. We did it. I think it's scalable to other states. I think it's extrapolatable to other states. And I think it really underscores the importance of not just naloxone distribution, but training people to use- use naloxone. I think that's really in a critical part of our program, is we train people [to] recognize when to use naloxone and how to use it, and then how to give us the data so we can have the outcome.

SHEEHAN: 

Are there other lessons that you learned through- through the program, or through the analysis that you think would be transferable to other states?

MCDONALD: 

You know, this is not the only solution, right? Like, we need to make sure we prescribe opioids responsibly as health care providers, we need to make sure there's easy access to treatment. We also make sure people have the social service supports they need as they go through the chronic disease of, you know, opioid addiction. I think what it underscores, though, is that harm reduction's a really important part of a comprehensive plan, naloxone is really the cornerstone to that treatment.

SHEEHAN: 

Yeah, and as overdoses continue and as overdose patterns change, what would next steps look like for this program, or for how naloxone gets distributed in the future?

MCDONALD: 

You know, when we look at New York data, we still have over 4,000 overdose deaths per year in New York, so, we still have work to do. When I look at our SUDORS data, 70% of fatal overdoses in New York State occur in a home or an apartment, you know. So, it really underscores the importance of getting the locks on- into people's hands. But the thing we also noticed from our SUDORS data is, for whatever reason, about a third of the persons who experienced a fatal drug overdose there was a bystander nearby. So, it's really important for the bystander to be trained in how to use naloxone. Those are next steps as well. And I think it also just really underscores this is actually a controllable problem. You know, when in New York we talk about this somewhat seriously. We're trying to achieve an overdose-free generation. You know, there's not one tool to solve it, but this is the direction we're hoping to head in in New York State.

SHEEHAN: 

Yeah. And as you say, it's not the only tool, but it's a very effective one, so keep using it.

MCDONALD: 

It's a very effective tool. And I think it underscores, when I look at the future of public health, more and more, what I see is being able to talk to politicians and others about, how do you show return on investment? This is part of why we did this study, because I think return on investment, it's close to a universal language. People understand that.

SHEEHAN: 

Yeah, it's- it's hard to argue with- with the bottom line, as they say.

MCDONALD: 

Indeed.

SHEEHAN: 

James McDonald is an ASTHO member and commissioner of the New York State Department of Health.

Public health can't go it alone. In a time of shrinking budgets and growing community needs, strong cross-sector partnerships aren't just helpful, they're essential. ASTHO's latest blog breaks down how collaborations between health departments, nonprofits, grassroots groups, and community health workers are helping communities tackle the root causes of poor health, rebuild trust, and do more with less, discover how working upstream together is the key to achieving a healthier, more equitable future. Read the full story at astho.org.

ASTHO welcomes new member, Larry Johnson, director of the Iowa Department of Health and Human Services. Prior to his appointment, director Johnson led Iowa's Department of Inspections, Appeals, and Licensing, and also held positions as the state public defender and legal counsel to the governor. Learn more About Director Johnson in the show notes.

Join Manisha Juthani, MD, commissioner [of] Connecticut Department of Public Health and ASTHO president, and John Auerbach, MBA, senior vice president for public health [at] ICF, for a webinar that examines how clear, purposeful leadership strengthens both internal and external trust. Through insights and reflection, we will examine how leaders embody steadiness amid uncertainty, set a sustainable pace,, and provide calm direction that builds trust and drives performance. This conversation aims to inspire participants to recognize their composure and capacity, not as a personal indulgence, but as a fundamental leadership function that shapes the overall tone, focus, and confidence of their organizations.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.