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 and prevents breathing and heart rates to slow down 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 allows victims of substance use 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 legal prosecution. 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 which 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.

Personal Impact of Overdose Survival of an overdose has lasting physical, psychological, and personal health implications for the individual that increase in likelihood and severity of each overdose. These include:

• Opioid-Induced Respiratory Depression (OIRD) - most dangerous health consequence; acute respiratory compromise, dizziness, confusion, and ineptness.
• Brain injury - hypoxia-related brain injuries, complications caused by the OIRD
• Hypoxia injuries can contribute to:
• short-term memory loss,
• changes in cognitive and physical functioning,
• increased risk of stroke, mental disorientation,
• loss of bodily movement or lower-extremity paralysis,
• gait changes,
• incontinence,
• slow reaction time,
• reduced motor skills,
• kidney failure,
• cardiac complications,
• neurological consequences and seizures,
• nerve damage,
• fluid buildup in lungs and pneumonia, and
• temporary motor paralysis
• Increased risk of comorbid mental illness
• Interruptions in education or career goals
• Family and relationship conflicts

The Dangers of Dual Use

The extent of fatalities associated with opioids 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 someone knows what drug combinations you have taken
• Have a plan in place in case something goes wrong
• Have Narcan on hand

Relevant Research

• This Massachusetts study found that cities which have Naloxone distribution programs have lower overdose death rates than those without a program.

• A University of Washington study evaluated the initial results of the state’s Good Samaritan policy. Drug users who were aware of the law were found to be 88 percent more likely to call 911 in the event of an overdose than before the policy took effect.

• This article was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians.

Impactful Federal, State, and Local Policies

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. Various federal organizations have come 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 laws make it difficult for citizens to obtain prescriptions for injection Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. 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. There are a variety of cases in which the complexity of Naloxone policies are advancing:

• The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies.

• 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. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

• In 2023, 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 removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose.

• The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws.

Available Tools and Resources

• SAMHSA provides an overdose prevention and response toolkit.

• SAFE Project:
  • "Have A Safety Plan" is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.
  • "Keep the Seats Filled: Learn How to Save a Life with Naloxone and Take the #NoShame Pledge" is a SAFE Project resource that explores what Naloxone is, where it can be purchased, how to use it, the signs of an overdose, and information on the #NoShame Pledge.
  • SAFE Project Online Courses are SAFE Project original online trainings that focus on harm reduction techniques such as: Narcan administration and navigating Fentanyl use safely.
  • SAFE Workplaces provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.
  • See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services.
  • See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival.

• CDC provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws.

• 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.

• The National Association of Drug Diversion Investigators, Inc. (NADDI) provides a resource titled "Overdose and Prevention Strategies" which has every state's strategy in 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 allows communities to identify the most effective strategies for them to implement.

Promising Practices

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

• Connecticut. Several communities have made it mandatory for first responders to receive overdose training.

• New York. The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan 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.

• North Carolina. The NC 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.

• 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), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support.