Transcript Utilizing the State Attorneys General Offices in Public Health

Law as Barrier to and Facilitator of
Opioid Overdose Prevention
Corey Davis, JD, MSPH
Cross-System Collaboration to Respond to the
Prescription Drug Epidemic
November 12, 2012
Required Disclosure
I have no disclosures to report.
Objectives

Provide an overview of legal and regulatory barriers
to naloxone access

Describe interventions to reduce opioid overdose
death via
 Increased access to naloxone (“naloxone access
laws”)
 Increased access to emergency responders (“Good
Samaritan laws”)
 Other promising legal and regulatory strategies
Overview

Fatal opioid overdose is at epidemic levels

Opioid overdose death is largely preventable


Long period in which reversal is possible
Reversal easily accomplished w/ naloxone

Law and regulation are a barrier to naloxone access

Amending law and regulation to improve naloxone access is
an effective and cost-effective intervention
Law as barrier to naloxone access

Barrier 1: Civil/Regulatory

Prescription status




Not a controlled substance
No abuse potential
Extremely good risk profile
Patients can only receive prophylactically
from professional w/ prescription privileges


Prescribers are in short supply
Physician visits can be prohibitively expensive,
particularly for uninsured/underinsured
Law as barrier to naloxone access

Barrier 1: Civil/Regulatory

In Ohio, patients in acute overdose can
receive only from AEMT or EMT-Ps


EMR or EMT-Bs may be first
responders, particularly in rural areas
Lack of availability may increase stigma and
reduce knowledge
Law as barrier to naloxone access

Barrier 1: Civil/Regulatory

Prescriber concerns re: civil and professional
liability


Evidence suggests risk is extremely low, but
perceived risk is real barrier
Samaritan concerns re: civil liability

In general, existing Good Samaritan laws
provide protection, but perceived risk may
affect action
Law as barrier to naloxone access

Barrier 2: Criminal

Bystanders w/ naloxone may fear criminal sanctions for its use

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Unauthorized practice of medicine
Possession of prescription drug (naloxone) w/o prescription
Bystanders w/o naloxone may fear calling 911

Fear arrest for drug possession, outstanding warrants or other reasons


Lots of evidence that this fear is both real and justified
Existing evidence mainly from heroin, but no reason to believe any different
for prescription opioids
Removal of law as barrier

All of these legal/regulatory barriers are unintended
consequences of attempts to address other problems

Unfortunately, they have an extraordinarily severe side effect:
thousands of preventable deaths per year

Luckily, they can be easily modified to remove that side effect
while maintaining original intent of laws/regulations
Critical Opportunity: Increase access

Remove the possibility of civil and professional penalties for
prescribers and administrators acting in good faith

Remove the possibility of criminal penalties for prescribers and
administrators acting in good faith

Explicitly endorse 3rd party prescription

As of Oct. 15, 2012, 8 states (NM, NY, IL, WA, CA, RI, CT and
MA) have explicitly amended law to increase access
Example Language

Naloxone or other opioid antagonist may lawfully be
prescribed and dispensed to a person at risk of experiencing
an opiate-related overdose or a family member, friend or other
person in a position to assist a person at risk of experiencing
an opiate-related overdose. For purposes of this chapter and
chapter 112 [governing professional licensing and registration],
any such prescription shall be regarded as being issued for a
legitimate medical purpose in the usual course of professional
practice.
2012 Mass. Acts 192 (2012)
Example Language

(a) A person may administer an opioid antagonist to another
person if: 1) He or she, in good faith, believes the other person
is experiencing a drug overdose; and (2) He or she acts with
reasonable care in administering the drug to the other person.
(b) A person who administers an opioid antagonist to another
person pursuant to this section shall not be subject to civil
liability or criminal prosecution as a result of the
administration of the drug.
2012 R.I. Pub. Laws 251 (2012)
States w/ naloxone access laws
Critical Opportunity: Good Sam

Existing Good Samaritan laws provide protection from civil
liability
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Enter the overdose Good Samaritan law
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But overdose bystanders are mainly
worried about criminal penalties
Modeled after alcohol Good Sam policies
now enacted on many college campuses
As of Oct. 15, 2012, ten states (NM, WA,
NY, CT, IL, CO, RI, FL, MA and CA) have passed overdose
Good Sam laws
Example Language

(1) A person acting in good faith who seeks medical assistance for an individual
experiencing a drug-related overdose may not be charged, prosecuted, or penalized
pursuant to this chapter for possession of a controlled substance if the evidence for
possession of a controlled substance was obtained as a result of the person’s
seeking medical assistance.
(2) A person who experiences a drug-related overdose and is in need of medical
assistance may not be charged, prosecuted, or penalized pursuant to this chapter for
possession of a controlled substance if the evidence for possession of a controlled
substance was obtained as a result of the overdose and the need for medical
assistance.
(3) Protection in this section from prosecution for possession offenses under this
chapter may not be grounds for suppression of evidence in other criminal
prosecutions.
2012 Fla. Laws 36 (2012)
States w/ drug overdose Good Sam laws
Discussion

Changes are popular and have seen rapid uptake

Almost no organized opposition, good deal of law enforcement support
Discussion

“[Good Samaritan] laws are cost effective because they save investigative
resources in the long run…The fact is that when most people witness
an overdose, they’ll try all kinds of bizarre, dangerous ways to revive a
person, sometimes based off things they saw on TV. We want them to
call 911 and Good Samaritan laws remove the fear of calling for help in
most cases…Addiction can happen to anyone – your brother, daughter,
sister, son…if we can save one life, it’s worth it.”
 - Det. Gary Martin, Palm Beach County Sheriff's Office

"Let's say two teens are sniffing spray paint and one has adverse reaction
and goes into shock. Do you want that other child to ignore them for
fear of arrest because of sniffing misdemeanor? Allowing them to call 911
[through Good Samaritan laws] is not condoning their behavior, it's just
letting them get help."
 – Assistant Chief Jim Pugel, Seattle Police Dep’t.
Discussion

Related promising regulatory changes
 Permitting EMT-Bs to carry and administer naloxone

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Standing orders for lay dispensing

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Currently in place in CA, MA
Co-prescription as standard of care
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Talk about low-hanging fruit!
State medical/pharmacy board
Changing law is not magic bullet

Change requires engagement with and action from public health and
elected officials, the medical and treatment communities, law
enforcement, clergy, community groups, etc.
Conclusion

Common sense and emerging evidence suggest that laws that
make it easier for lay people to access naloxone, administer
naloxone, and summon emergency assistance in the event of
overdose can save lives and resources

Since such laws have possibility to save thousands of lives
annually and no readily apparent downside, they should be
enacted widely and with haste

As with all policy interventions, results should be
independently and rigorously evaluated
Questions?
Corey Davis, JD, MSPH
Staff Attorney
Network for Public Health Law
[email protected]