The opioid overdose crisis has taken approximately 450,000 lives since 1999 and may be worsening because of the COVID-19 pandemic. Laws that increase access to naloxone, a medication that reverses the respiratory depression caused by an opioid overdose, are associated with a decrease in opioid overdose deaths in the jurisdictions where they are enacted. States should consider a range of policies to expand the availability of naloxone throughout the country and curb the rising number of fatal overdoses.
Naloxone can be safely administered—not only by medical professionals but by laypeople who witness an overdose—to prevent injury and death from prolonged oxygen deprivation. In light of evidence that increasing the availability of naloxone reduces opioid overdose deaths and does not increase nonmedical opioid use, state policymakers are enacting laws and regulations that amend prescribing, dispensation, and distribution of naloxone to reach people in many settings: in traditional health care, emergency medical services, law enforcement and corrections, and communities. Several strategies can help make this happen.
Enact policies that put naloxone in the hands of people most likely to witness or experience an overdose
States should require that naloxone be co-prescribed with any high-dose opioid prescriptions. Although naloxone co-prescribing is generally increasing in line with Centers for Disease Control and Prevention guidelines, states with regulations requiring co-prescribing are seeing the highest increases in these prescriptions. A study of five states with required co-prescribing found that naloxone dispensation grew by 255% in the 90 days following the mandate’s implementation compared with the 90 days prior. Additionally, states should pass laws permitting medical professionals to prescribe naloxone to friends and family of people who use opioids (known as third-party prescribing); 45 states have passed third-party prescribing laws.
States should also allow pharmacies to dispense naloxone without a patient-specific prescription through standing orders, protocol orders, or collaborative practice agreements that can be authorized by state medical professionals or boards of health. As of December 2018, 48 states had enacted such laws so that anyone who might witness an overdose could get naloxone from a pharmacist without first going to a doctor.
Through a standing order, states should also permit naloxone distribution through nonpharmacy locations such as community-based organizations, referred to as overdose education and naloxone distribution (OEND) programs. From 1996 through June 2014, at least 644 OEND sites in 30 states were providing naloxone to people in their communities, and program managers documented nearly 26,500 overdose reversals. States are also working with jails and prisons to provide OEND to people being released from incarceration who are at high risk of experiencing an overdose. In the first few years of a pilot program in New York, more than 6,000 individuals released from Queensboro Correctional Facility received naloxone kits, with at least 14 documented overdose reversals.
People being discharged from emergency departments and treatment facilities for opioid-related illness and injury are also at high risk of experiencing an overdose. States should develop standards of care to increase hospital provision of naloxone for these patients, which include dispensing or prescribing naloxone prior to discharge—and require publicly funded treatment facilities to do the same. The cost of naloxone can typically be covered by insurance as part of treatment.
Enhance law enforcement and bystander response at the scene of an overdose
Law enforcement officers often respond to 911 calls indicating possible overdoses. State policymakers should require local police departments to carry and administer naloxone through a standing order. In Massachusetts, the health department worked with the Quincy Police Department to develop a naloxone program; and in the year after its implementation, the city’s overdose death rate decreased by 66%.
Knowing that law enforcement officers are often first responders, people who witness an overdose might feel uncomfortable calling for help if they were also using drugs. States should enact 911 Good Samaritan laws to provide immunity from criminal charges for both the person overdosing and any bystanders. Such laws effectively encourage people at the scene of an overdose to call for help and are associated with a 15% reduction in the incidence of opioid overdose deaths. Although most states have passed a 911 Good Samaritan law, the level of immunity varies widely. Vermont’s law—which includes limited immunity for any crime under the Controlled Substances Act for any bystander at the scene or within close proximity of someone at the scene of an overdose—is a model for other states.
Increase access to naloxone: considerations for states
Some states have implemented creative funding approaches to increase the dispensation and distribution of naloxone. Although all state Medicaid programs currently cover naloxone, states can also take legislative action to mandate insurance coverage of naloxone in any health plan with prescription coverage. Additionally, they can negotiate with manufacturers to bulk-purchase naloxone at lower prices and set aside state funds to help with purchasing naloxone and offset costs to municipalities, as Massachusetts did.
States can also anticipate increased emergency department visits for nonfatal overdoses as more people are revived with naloxone—and should adopt policies that encourage emergency departments to initiate medication for OUD and provide referrals to treatment for patients who have experienced an overdose.
Removing barriers to naloxone accessibility should be a main priority for states in order to reduce opioid overdose deaths throughout the country. Policymakers should look to successful state legal and regulatory initiatives as a guide to further expand access to naloxone.
Beth Connolly is the director and Jenna Bluestein is a senior associate for The Pew Charitable Trusts’ substance use prevention and treatment initiative.