Increase Access to Overdose Reversal Medications

Introductory Paragraph

Naloxone (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 an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now 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. It is either injected or administered in a nasal spray.

While Naloxone is not readily available for ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, 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. Although the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them.

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.

Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of its existence, and its power to reverse overdose is a benefit unlike any other. Narcan will allow victims of substance abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem.
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.

Key Information

Opioid overdose education and naloxone distribution programs aimed at opioid users and individuals likely to be near people who overdose 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. More research is still needed to confirm these benefits. 

Researchers believe that communities that have programs aimed at training bystanders to respond to opioid overdoses have experienced a reduction in opioid overdose death rates quicker than communities without these programs. 

Those 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 identify an overdose and can tell when naloxone is appropriate as accurately as medical experts. Some studies have found that opioid users who participate in only a brief 5-minute training or learned about naloxone administration through social networks can 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.

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.
CADCA: Narcan Awareness 

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; it can only help.

Impactful Federal, State, and Local Policies

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

Press Release for Adapt Pharma and Public Interest Pricing.pdf  (230 KB)

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

Free Narcan Nasal Spray and Education for High Schools.pdf  (164 KB)

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), Mongomery 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

TR - Improve Access to Treatment that Prevent Overdose Deaths
SAMHSA- Opioid Overdose Prevention Toolkit - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

 

Actions to Take

Actions for Coalitions

Actions for Individuals

Promising Practices

CP - Improve Access to Treatments that Prevent Overdose Deaths

Waive Copays

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.