Increase Access to Overdose Reversal Medications

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Return to Opioid Top-Level Strategy Map or Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse) or ZOOM MAP - Improve Access to Treatment that Prevent Overdose Deaths

Naloxone (Narcan)

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 by 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 a third party other than whom the drugs will be given to, 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 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 it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of 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.[1]
 

Evidence of Effectiveness

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration adn overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

A recent study in Massachusetts found that cities that have naloxone distribution programs have lower overdose death rates than those that don’t. Similarly, the North Carolina Harm Reduction Coalition has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported.
CADCA: Narcan Awareness[2]
 

Educate about 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 along; the majority are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids; the next best thing is to avoid drug mixing entirely. If you insist on mixing drugs in spite of the inherent dangers, then it is imperative to take extra safety precautions to not die 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 on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.[6]

Waive Copays

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.[7]
  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 "increase access and remove possible financial barriers to the lifesaving drug."[8]

Legislation & Policy

Good Samaritan Laws

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million going toward a pilot program that will engage law enforcement officers and public health professional 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.[9]

In 2006, New Mexico passed a "Good Samaritan Law" that "granted limited immunity from prosecution on simple possession chargers 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.[10]

 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.[11]
    University of Washington study
  • After New York state passed its Good Samaritan law in 2011, for example, 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.
    Example Cards
    Example Posters

Federal Changes to Address Problem

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to 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.[12]

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), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.[13]
  • EI - Librarians & Access to Overdose Treatment 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.[14]

 

Database of State Legislative Efforts

This site has many examples of policy efforts that have been attempted or passed.

Prevent Overdose strategies

This link 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

Engaging Diverse Community Partners

CP - Improve Access to Treatments that Prevent Overdose Deaths

Tools & 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


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Reviewer Date Comments
     

Sources


  1. Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
  2. CACDA Administration of Narcan. 2017  [1]
  3. 100 Million Healthier Lives City, Town-Wide, and Regional Efforts.https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_
  4. 100 Million Healthier Lives City, Town-Wide, and Regional Efforts https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_
  5. 100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[2]
  6. http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/
  7. https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/
  8. https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/
  9. http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html
  10. http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf
  11. http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html
  12. http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf
  13. Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services.
    https://ric-zai-inc.com/Publications/cops-p356-pub.pdf
  14. https://www.bjatraining.org/tools/naloxone/Liability-and-Risk