Corey Davis

Drug overdose continues to claim the lives of tens of thousands of people in the U.S. every year. Opioids, both prescription painkillers and street drugs such as heroin and illicitly manufactured fentanyl, are responsible for the majority of these deaths. In response, states have passed legislation to increase access to the opioid overdose reversal medication naloxone, including provisions that allow for the distribution of naloxone through pharmacies. Some states have gone further and now require that naloxone be prescribed or offered to some patients. This fact sheet describes those requirements and links to the relevant laws.

The “War on Drugs” could better be described as a “War on People.” In addition to obvious negative impacts such as incarceration and increases in drug-related harm, this “War” also leads to collateral consequences that can last for years —or even a lifetime. Collateral consequences are legal barriers resulting from a person’s conviction in addition to incarceration, parole or probation, and fines and fees.

This resource summarizes the characteristics of naloxone access and Good Samaritan laws in 50 states and the District of Columbia.

Unlike how they regulate the far more deadly drug products tobacco and alcohol, states overwhelmingly continue to treat individuals who use illicit drugs as criminals, and state law is oriented towards arresting, prosecuting, and incarcerating them. A few states, however, have made more significant changes, and some have made less drastic but still important changes.

Variations among jurisdictions in determining and reporting causes of death and delays in obtaining and reporting fatality data often result in an incomplete and out-of-date view of the overdose epidemic in the U.S. It is imperative that health departments, harm reduction organizations, and people who use drugs are provided with accurate, timely and actionable information on drug-related overdose. This fact sheet provides a snapshot of current laws, regulations, and sub-regulatory sources governing mandatory disease reporting and a description of the laws and regulations governing reporting of overdoses in the jurisdictions that require or explicitly permit it as of March 31, 2023.

This fact sheet details the state laws that require private insurers to cover at least one formulation of naloxone and those that reduce barriers to access naloxone where it is covered. Because these laws were written during a time when no over the counter (OTC) naloxone formulations were available, none explicitly require coverage for OTC naloxone.

In May 2021, Washington state passed a law that, among other changes, re-classified drug possession from a felony to a misdemeanor and required law enforcement officers to refer individuals to treatment at least twice before making an arrest. The law, which expires on July 1, 2023, also created the Substance Use Recovery Services Advisory Committee (SURSAC) to research best practices, create a statewide plan, and advise state lawmakers. Lawmakers are now considering whether to implement SURSAC’s 17 recommendations.

Between May 2020 and April 2021, 64% of overdose deaths in the nation involved synthetic opioids, primarily illicitly manufactured fentanyl, which is 50 to 100 times more potent than morphine. A low-cost, high-impact harm reduction strategy for reducing the risk of overdose due to fentanyl contamination comes in the form of fentanyl test strips (“FTS”).At the price of approximately one dollar per disposable strip, FTS can detect the presence of fentanyl and many fentanyl analogs in drug samples dissolved in water. This fact sheet briefly discusses the emerging evidence that supports the broad distribution of FTS as one tool to reduce fentanyl-related harm.

Equipping people who use drugs, as well as their friends and family members, with the overdose reversal medication naloxone can significantly reduce the number of opioid overdose deaths. This fact sheet discusses laws in California that protect those who respond at the scene of an overdose emergency, including by administering naloxone to a person experiencing an overdose. These laws show a clear intention by the state to encourage laypersons to respond to overdose and increase access to and use of naloxone to reduce preventable overdose death and disability.

Although it’s been shown to reduce many of the harms associated with opioid use disorder, including overdose deaths, access to the medication buprenorphine has been hampered by several legal restrictions.  The recently passed 2023 Consolidation Appropriations Act includes a provision that removes a key barrier: the X-waiver requirement, which will increase access to buprenorphine, as well as improve provider knowledge of evidence-based substance use disorder treatment, and address disparities in access to care.

On December 29, 2022, President Biden signed the 2023 Consolidation Appropriations Act (“the Act”) into law.1 Among many other provisions, the Act included substantial regulatory changes to remove barriers and promote access to evidence-based treatment of substance use disorders (“SUD”). In particular, the Act removed legal barriers to the prescription of buprenorphine for opioid use disorder (“OUD”). It also requires almost all prescribers to obtain training in the identification and treatment of SUD. Although it will add a small educational burden to most providers who prescribe controlled substances, these changes should make it easier for all prescribers to provide buprenorphine treatment to individuals with OUD and significantly expand the base of prescribers who receive at least some training in identifying and treating individuals with SUD.

States have been rapidly modifying their laws to increase access to drug checking equipment. Between August 1, 2021, and August 31, 2022, laws that permit drug checking equipment to be possessed, distributed, or both went into effect in ten states (Alabama, Arizona, Connecticut, Louisiana, Maine, New Jersey, New Mexico, Tennessee, West Virginia, and Wisconsin). An additional two states (California and Georgia) passed laws in that time period that will go into effect in 2023. Additionally, Louisiana and Texas added drug checking equipment to their overdose Good Samaritan laws.