Anyone who has ever indulged in hero fantasies about saving lives just might get their chance thanks to new drug overdose prevention laws across the country. On Wednesday, June 5th, Vermont became the 13th state to pass a law expanding lay access to naloxone, a medication used to reverse opiate overdose. As of 2008, drug overdose is the leading cause of accidental death in the United States, spurred by a rise in the availability of opiate prescription painkillers such as OxyContin, Fentanyl, and methadone.
Vermont Governor Shumlin signed House bill 533 into law at a day-long conference in Burlington. Now doctors who prescribe naloxone to opiate-using patients and bystanders who administer the drug to an overdose victim will no longer be to subject to civil liabilities resulting from rare adverse reactions to the drug. The new law also launches a pilot program to distribute naloxone to people who use opiates and their loved ones.
Says Tom Dalton of HowardCenter Safe Recovery in Burlington, an advocate for naloxone access, "Vermont is a rural state where emergency response times can be long and fatal opiate overdoses are happening with sickening frequency. When someone has stopped breathing and turned blue, minutes count and we need them to have immediate access to life saving medication."
Naloxone is a safe, effective medication that blocks the effects of opiates to the brain and reverses the respiratory failure caused by overdose. Similar to the EpiPen for allergic reactions, the medication is easy enough to be administered by lay people, such as friends and family of someone experiencing an overdose, and has no addictive qualities. In fact, many public health departments and nonprofit agencies nationwide are encouraging people at risk for overdose and those around them to keep a vial of the drug on hand for emergencies.
Initial results of overdose reversals using naloxone show promise. According to the CDC, lay people have used naloxone to reverse more than 10,000 overdoses nationwide since the first program began in Chicago in 1996. Additionally, a 2013 study on the effectiveness of naloxone distribution programs in Massachusetts reported a 27-46 percent reduction in overdose rates in towns where a program was implemented, even when adjusting for other factors.
But while the case for distribution programs and greater availability of naloxone is gaining momentum, not all states have successfully passed laws. Of the 12 states who introduced naloxone access bills or attempted to improve existing laws this year, only half can claim victory so far: Vermont, North Carolina, Kentucky, Virginia, Maryland and New Jersey. The other six (California, Colorado, Massachusetts, New Mexico, West Virginia and Oregon) suffered opposition or stalled in committees.
Fred Brason, President and CEO of Project Lazarus, a North Carolina-based overdose prevention program, helped advocate for a naloxone access bill along with the North Carolina Harm Reduction Coalition. He also assisted other states to introduce similar legislation.
"The main objective for anyone trying to pass naloxone laws should be to provide legislators with appropriate education about what naloxone is, what it does, and what it doesn't do," says Brason. "If left unanswered, myths that naloxone enables drug use and worries about untrained people administering a medication might cause legislators to oppose a good bill. They need to know that naloxone is safe and simple to administer and how little formal training is necessary for effective results."
Brason cites Maryland as a prime example of a state in which lack of adequate education for legislators resulted in a law that was far from ideal. Enacted in May, the bill allows lay people to possess and administer naloxone provided they complete a certified training on naloxone administration. Apart from being unnecessarily burdensome for families, "certified training" is not currently provided. In contrast, North Carolina used a strong advocacy network, effective education for legislators, and support from the medical community and law enforcement to pass a comprehensive overdose prevention law that according to Brason is "the closest we have to ideal." Signed in April, the law provides protections for doctors prescribing naloxone and lay people administering it, standing orders for third party prescribing (allowing a nurse or other non-physician to dispense naloxone under a doctor's orders), and freedom of access that allows for naloxone distribution programs. Still, work remains to be done in North Carolina and across the nation.
"We need to change our views on how we treat people who use drugs," says Leilani Attilio, nurse and naloxone advocate with the North Carolina Harm Reduction Coalition. "In addition to saving thousands of lives, these overdose bills will help put the country on a path towards approaching addiction as a public health issue, not a criminal one."