State Naloxone Access Laws

Description

State naloxone laws allow the prescribing and dispensing of naloxone (an opioid receptor antagonist that reverses opiate overdose) to substance users with documented risk factors for overdose, or to lay administrators (including nonmedical first responders, potential overdose bystanders, and family and friends of opioid users). 

Objective(s)

To increase access to opioid overdose antidotes among high-risk populations

Typical Elements

Naloxone access laws vary by state and can include some or all of the following provisions (Davis, 2015; National Alliance for Model State Drug Laws [NAMSDL], 2015):

  • Permission for naloxone “standing order” prescriptions for individuals who are at risk for overdose and who have not been physically examined by a prescriber (Davis, 2015, p. 1)
  • Permission for “third-party prescriptions” that allow doctors and pharmacists to prescribe and dispense naloxone to someone who is not directly at risk for an overdose
    • Currently, 24 states—California, Colorado, Connecticut, Delaware, Georgia, Indiana, Kentucky, Maine, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Washington, Wisconsin—and the District of Columbia allow this (Davis, 2015, p. 1).
    • Generally third-party prescriptions are written to friends or family of at-risk users, or to other laypersons who may have contact with at-risk users.
  • Permission for pharmacists to dispense naloxone to individuals without a prescription
    • Eight states—California, Kentucky, New Hampshire, New Mexico, New York, Rhode Island, Vermont, and Washington state allow this.
    • States can also remove criminal or civil penalties for individuals who possess naloxone without a prescription (California State Board of Pharmacy, 2015).
  • Removal of prescribers’ civil, criminal, or professional liability in instances when naloxone is administered to an individual other than the patient to whom they prescribed the drug (Heller & Stancliff, 2007)
  • Removal of healthcare providers’ civil, criminal, or professional liability for the provision of naloxone
    • Ten states—California, Colorado, Delaware, Maine, New Jersey, Ohio, Pennsylvania, Rhode Island, Tennessee, and Wisconsin—have removed all liability.
    • Five states—Connecticut, Minnesota, New Mexico, North Carolina, and Utah—have removed criminal and civil liability.
    • Three states—Illinois, Massachusetts, and New York—have removed criminal and professional liability.
    • Three states—Kentucky, Maryland, and Washington—have removed only professional liability.
    • One state—Georgia—removed civil liability only.
  • Removal of first responders’ civil, criminal, or professional liability for administering naloxone according to specific guidelines
    • Six states—Delaware, Louisiana, Michigan, Ohio, Pennsylvania, and Wisconsin—have removed all liability.
    • Three states—Georgia, Indiana, and Oklahoma—have removed civil liability only.
  • Removal of lay administrators’ civil, criminal, or professional (such as Unauthorized Practice of Medicine penalties) liability for administering naloxone
    • Five states—California, Delaware, Maryland, Oregon, and Virginia—and the District of Columbia require lay administrators to receive training prior to administrating naloxone.
      • Note: As of 2010, 188 community programs nationwide provided access to naloxone (U.S. Department of Health and Human Services, 2013). 
  • “Good Samaritan” provisions, which encourage bystanders to administer naloxone and to summon emergency responders in a timely manner, without fear of arrest or other negative legal consequences (Burris et al., 2009)
    • These provisions can include immunity from charges related to causing the victim’s death, and the possession or distribution of drugs or drug paraphernalia.
    • The provisions can apply even if the individual sold the drug to the victim.
  • Implementation of state- or local-level naloxone access programs (such as the Lazarus Project), which educate providers about naloxone access law, provide overdose response education, and train personnel to administer naloxone (Enteen et al., 2010)

Naloxone access programs are required to register with the state. Common characteristics of naloxone access programs include the following (Burris et al., 2009):

  • Providing education and training to injection drug users and other individuals who are likely to witness an opioid overdose
  • Forming an advisory group to provide guidance during program implementation (McAuley, Best, Taylor, Hunter, & Robertson, 2012)
  • Cultivating a practitioner network to increase opportunities for networking, peer support, and best practices dissemination (McAuley et al., 2012)
  • Requiring participant responders to call 911 when witnessing an overdose
  • Requiring responders to report the name, address, and phone number of the overdose victim and the status of the naloxone injection

Populations

Opioid users, physicians, emergency responders, police, policymakers, the general public

Outcomes

  • Among opioid users, awareness of naloxone access laws was associated with greater use of 911 in the event of an overdose (Banta-Green, Kuszler, Coffin, & Schoeppe, 2011).
  • A meta-analysis of 12 evaluations of naloxone access programs found that the programs were associated with (1) successful training of both individuals at high risk of an overdose and their friends and family to recognize an opioid overdose and appropriately administer naloxone, and (2) no increase in drug use or high-risk behavior (Haegerich, Paulozzi, Manns, & Jones, 2014).

Guidelines

Implementing an Overdose Good Samaritan Law: The Example of Seattle, Washington.

Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws.

State Naloxone and Good Samaritan Legislation as of July 15, 2014.

Acknowledged by

National Conference of Insurance Legislators. Best Practices to Address Opioid Abuse, Misuse and Diversion

U.S. Department of Health and Human Services. Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities

Office of National Drug Control Policy. Good Samaritan Overdose Response Laws: Lessons Learned from Washington State

Substance Abuse and Mental Health Services Administration. Opioid Overdose Toolkit: Facts for Community Members. 

References

Banta-Green, C. J., Kuszler, P. C., Coffin, P. O., & Schoeppe, J. A. (2011). Washington’s 911 Good Samaritan drug overdose law—Initial evaluation results. Seattle, WA: Alcohol and Drug Abuse Institute, University of Washington. Retrieved from http://stopoverdose.org/evaluation-of-washington-good-samaritan-law/

Burris, S., Beletsky, L., Castagna, C., Coyle, C., Crowe, C., & McLaughlin, J. M. (2009). Stopping an invisible epidemic: Legal issues in the provision of naloxone to prevent opioid overdose. Drexel Law Review, 1(2), 273–339.

California State Board of Pharmacy. (2015). Overdose rescue drug now available without prescription: Pharmacists can furnish naloxone for opioid overdose. Retrieved from http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf

Davis, C. S. (2015). Legal interventions to reduce overdose mortality: Naloxone access and overdose Good Samaritan laws. Princeton, NJ: Robert Wood Johnson Foundation. Retrieved from https://www.networkforphl.org/_asset/qz5pvn/naloxone-_FINAL.pdf

Enteen, L., Bauer, J., McLean, R., Wheeler, E., Huriaux, E., Kral, A. H., & Bamberger, J. D. (2010). Overdose prevention and naloxone prescription for opioid users in San Francisco. Journal of Urban Health, 87(6), 931–941.

Haegerich, T. M., Paulozzi, L. J., Manns, B. J., & Jones, C. M. (2014). What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug and Alcohol Dependence, 145, 34–47.

Heller, D. I., & Stancliff, S. (2007). Providing naloxone to substance users for secondary administration to reduce overdose mortality in New York City. Public Health Reports, 122(3), 393–397.

McAuley, A., Best, D., Taylor, A., Hunter, C., & Robertson, R. (2012). From evidence to policy: The Scottish national naloxone programme. Drugs: Education, Prevention and Policy, 19(4), 309–319.

National Alliance for Model State Drug Laws. (2015). Naloxone access: Status of state laws map. Retrieved from https://namsdl.org/wp-content/uploads/Naloxone-Access-Status-of-State-Laws-Maps.pdf

U.S. Department of Health and Human Services. (2013). Addressing prescription drug abuse in the United States: Current activities and future opportunities. Retrieved from https://www.cdc.gov/drugoverdose/pdf/HHS_Prescription_Drug_Abuse_Report_09.2013.pdf