Increase Access to Overdose Reversal Medications

Introductory Paragraph

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent breathing and heart rates from slowing to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. Narcan will allow victims of substance abuse to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible prosecution against them. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

Key Information

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. Research documents that communities that have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs.

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished.

The Dangers of Dual Use

The extent of fatalities associated with opioid is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

• Don't use alone
• Limit the amount of drugs you have available
• Stick to less lethal combinations of drugs
• Use smaller amounts of each drug
• Use the least impairing drug first
• When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
• When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
• Make sure your friends (or at least someone) knows what drug combinations you have taken
• Have a plan in place in case something goes wrong
• Have Narcan on hand

Relevant Research

A recent study in Massachusetts found that cities that have naloxone distribution programs have lower overdose death rates than those without a program. Similarly, the North Carolina Harm Reduction Coalition has given out 52,000 naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported.

Educate About the Dangers of Dual use

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids and avoid knowingly mixing opioids with other drugs. It is imperative to understand the risk when opioids are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

• Don't use alone
• Limit the amount of drugs you have available
• Stick to less lethal combinations of drugs
• Use smaller amounts of each drug
• Use the least impairing drug first
• Have Narcan on hand
• When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
• When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
• Make sure your friends (or at least someone) knows what drug combinations you have taken
• Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case of a non-opioid overdose. So if there's any question as to what a person took, use Narcan.

Impactful Federal, State, and Local Policies

State laws have made it difficult for citizens to obtain Narcan prescriptions, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician.

Good Samaritan Laws

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other forms of punishment. In August of 2015, the White House announced a treatment-based initiative. The $2.5 million budget would go towards a pilot program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and train first responders on when it is adequate to administer Naloxone.

In 2006, New Mexico passed a "Good Samaritan Law" that "granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.

Drug Overdose Immunity and Good Samaritan Laws for minimizing the fears of calling for help in the case of an overdose.

Increasing Awareness of Law

• A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.
  University of Washington study
• After New York state passed its Good Samaritan law in 2011, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

Federal Changes to Address Problem

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State Law Passage

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming have passed laws to improve ordinary person naloxone access.

Pharmacists

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.

New in 2016: Improved Access to Nasal Narcan

New Public Interest Pricing $37.50 per dose)

Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016).

Law Enforcement Use of Naloxone

• A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Montgomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration, and support.
• The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.

Database of State Legislative Efforts

The National Conference of State Legislatures site has many examples of policy efforts that have been attempted or passed.

Prevent Overdose strategies

The National Association of Drug Diversion Investigators, Inc. (NADDI) overdose and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

Overdose Prevention Strategies

Available Tools and Resources

CDC Reverse Overdose to Prevent Death Resources

Emergency Physicians & Opioid Overdoses Aid

Promising Practices

• According to a report by Community Anti-Drug Coalitions of America (CADCA), a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness.

• Aetna.

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.
Having insurers eliminate the co-pay is one strategy to help address that. Aetna is currently the first national payer to waive copays for Narcan for its fully insured commercial members. This will improve access by eliminating potential financial barriers to the lifesaving drug.