Trust Magazine

New Naloxone Laws Seek to Prevent Opioid Overdoses

In this Issue:

  • Summer 2019
  • Three Perspectives, One America
  • Out of Reach
  • America’s Digital Divide
  • Different, but the Same
  • The Big Picture: A Window on America's Parks
  • Noteworthy
  • Most Americans Take Supplements; FDA Should Know Something About Them
  • How People View Religion's Role
  • New Naloxone Laws Seek to Prevent Opioid Overdoses
  • How Ken Lum Became an Artist and What Motivates Him Most
  • In Antarctic Scientists Capture a Penguins-Eye View to Study Eating Habits
  • Lessons for Governments From Amazons Headquarters Search
  • How Bloomberg Philanthropies Is Transforming Public Health
  • Benchmarking Questions Keep Surveys Accurate
  • Return on Investment
  • Improving Public Policy
  • Informing the Public
  • Invigorating Civic Life
  • Federal Defense Spending Across the States
  • View All Other Issues
New Naloxone Laws Seek to Prevent Opioid Overdoses

Stateline, an initiative of The Pew Charitable Trusts, is a team of veteran journalists who report and analyze trends in state policy with a focus on fiscal and economic issues, health care, demographics, and the business of government. More stories are available at

Naloxone is an overdose-reversal drug that comes in a variety of formats. New naloxone laws in a handful of states require doctors to offer prescriptions for the drug to high-risk patients.
G-Jun Yam The Associated Press

It’s increasingly likely that someone you know has the opioid overdose rescue drug naloxone in their pocket or medicine cabinet. In fact, a new mobile app, NaloxoFind, will tell you whether anyone nearby is carrying the lifesaving drug.

In the past five years, at least 46 states and the District of Columbia enacted so-called good Samaritan laws, allowing private citizens to administer the overdose-reversal medication without legal liability. And all but four states—Connecticut, Idaho, Nebraska, and Oregon—have called on pharmacies to provide the easy-to-administer medication to anyone who wants it without a prescription, according to the Network for Public Health Law.

But a handful of states are going even further by requiring doctors to give or at least offer a prescription for the overdose rescue drug to patients taking high doses of opioid painkillers.

New naloxone co-prescribing laws in Arizona, California, Florida, Ohio, New Mexico, Rhode Island, Vermont, Virginia and Washington state also call on doctors to discuss the dangers of overdose with these high-risk patients. Tennessee lawmakers this year passed a similar bill, which is awaiting the governor’s signature.

Patients are free to decide whether to fill the naloxone prescription. But pain doctors who endorse the initiative say that even if patients don’t fill their prescriptions for naloxone, the offer of a rescue drug underscores the dangers of long-term opioid use and creates a “teachable moment.”

“By offering a naloxone prescription to a patient, the physician is saying, ‘I’m so concerned this medication might kill you that you need an antidote in the house, so a family member can rescue you.’ That gets their attention,” said Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University and director of Physicians for Responsible Opioid Prescribing, an organization that promotes safe painkiller prescribing.

Legal experts say these new laws—which have been endorsed by the federal government as well as the medical community—are likely to spread.

Last April, U.S. Surgeon General Jerome Adams recommended widespread use of naloxone, and since then, the U.S. Department of Health and Human Services has called on physicians to co-prescribe naloxone to patients taking relatively high doses of opioid painkillers and to educate patients on the risk of overdose.

In 2016, the U.S. House of Representatives passed a bill, the Co-Prescribing to Reduce Opioid Overdoses Act, that ultimately was included in the Comprehensive Addiction and Recovery Act of 2016. Although never funded, it would have provided $5 million in federal grants to support co-prescribing naloxone.

In addition, an advisory committee to the U.S. Food and Drug Administration voted in December to recommend that all physicians co-prescribe naloxone for patients on high doses of opioid pain medications.

People taking more than the equivalent of 50 mg of morphine a day are more than twice as likely to overdose compared with those taking lower doses, according to the U.S. Centers for Disease Control and Prevention.

Even physicians, who typically object to government-mandated medical rules, have signed on to the initiative. Following the surgeon general’s directive last year, the American Medical Association announced that it also encouraged physicians to co-prescribe naloxone for all patients at risk of overdose.

From 1999 to 2017, nearly 218,000 people died in the United States from overdoses related to prescription opioids. (See related story on Page 18.) And in more than 40 percent of those deaths, bystanders were present, yet naloxone was rarely administered by a layperson, the CDC reported based on medical examiner reports.

Ensuring that naloxone gets into the hands of people who are most likely to witness an overdose, namely, the family and friends of people taking long-term, high doses of pain medications, could change that, Kolodny said.

Most often sold as a nasal spray known as Narcan, naloxone was approved by the FDA in 1971. Local drugstores in 2017 sold about 800,000 doses of naloxone to individuals who wanted to be prepared if someone close to them lost consciousness and a drug overdose was suspected.

And thousands of doses have been given away free to anyone who signs up for a quick training session at local health departments, community health centers and harm reduction centers.

Police and fire departments, emergency medical services, schools, harm reduction centers and other nonprofits receive the drug at no cost from manufacturers and purchase additional supplies as needed. The federal government also offers grants to purchase naloxone.

But most naloxone doses go to hospitals, nursing homes, health management organizations, community clinics, prisons and universities, which purchased roughly 5 million units of the drug in 2017, according to market research data analyzed by the FDA.

Requiring all doctors to prescribe naloxone to everyone who takes prolonged high-dose opioid medications would sharply increase the number of naloxone doses in the hands of bystanders and potentially inflate the cost of U.S. health care substantially, some critics have said.

Mary Ellen McCann, a member of the FDA advisory board and associate professor of anesthesia at Harvard Medical School, voted against the co-prescribing proposal. She described co-prescribing as “an expensive way to saturate the population with naloxone,” according to news reports from Reuters and other media outlets.

“I’m concerned about a person going in with a broken arm and ending up with $30 of a codeine product and a [naloxone] autoinjector at $4,000-plus,” she said.

Rather than purchasing an autoinjector, people can choose to buy the much less expensive nasal spray.

Americans filled more than 190 million prescriptions for opioid painkillers in 2017, according to the CDC. If even a fraction of those patients were to fill a prescription for naloxone and give the drug to a designated family member or friend, the number of doses in the hands of average people would skyrocket.

An FDA advisory panel estimated that 48 million more doses of naloxone would be needed if all states required doctors to co-prescribe naloxone for patients on high doses of opioids.

Thom Duddy, vice president of corporate communications for Emergent Biosolutions, the maker of Narcan, said the company is prepared to meet that demand. Already, the company has seen a spike in sales in the states that have enacted co-prescribing laws, he said.

In California, for example, retail sales of the drug more than quadrupled in the first four weeks after the law took effect, according to company sales data.

A two-pack of Narcan costs $125; an off-label nasal spray that requires some assembly costs around $40; and an EpiPen-like dispenser sold as Evzio costs $4,100.

Christine Vestal is a staff writer for Stateline.

This article was previously published on and appears in this issue of Trust Magazine.

How Ken Lum Became an Artist and What Motivates Him Most How People View Religion's Role
America’s Overdose Crisis
America’s Overdose Crisis

America’s Overdose Crisis

Sign up for our five-email course explaining the overdose crisis in America, the state of treatment access, and ways to improve care

Sign up
Quick View

America’s Overdose Crisis

Sign up for our five-email course explaining the overdose crisis in America, the state of treatment access, and ways to improve care

Sign up

The Next Step States Need to Take to Combat the Opioid Crisis

Quick View

Despite billions of federal dollars flowing into states to help fight the opioid epidemic—which was responsible for nearly 48,000 deaths in the United States in 2017, or approximately 130 each day—this public health crisis continues to grow.

Composite image of modern city network communication concept

Learn the Basics of Broadband from Our Limited Series

Sign up for our four-week email course on Broadband Basics

Quick View

How does broadband internet reach our homes, phones, and tablets? What kind of infrastructure connects us all together? What are the major barriers to broadband access for American communities?

What Is Antibiotic Resistance—and How Can We Fight It?

Sign up for our four-week email series The Race Against Resistance.

Quick View

Antibiotic-resistant bacteria, also known as “superbugs,” are a major threat to modern medicine. But how does resistance work, and what can we do to slow the spread? Read personal stories, expert accounts, and more for the answers to those questions in our four-week email series: Slowing Superbugs.