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Legal Efforts to Reduce Barriers to Accessing the Anti-overdose Medication Naloxone

posted on Tue, Aug 29 2017 4:50 pm by The Network for Public Health Law

Opioid overdose is at epidemic levels in the United States. It is estimated that over 33,000 Americans lose their lives from opioid overdose. Opioid overdose mortality is preventable with the timely administration of naloxone and the provision of emergency medical care. Naloxone is a prescription medication, making it difficult for the drug to be readily available by those who need it. In response, many states have made an effort to reduce barriers to accessing naloxone.

A requestor recently contacted the Network with several questions regarding naloxone access.

How many states have increased access to naloxone via standing order?

A standing order is one strategy for making naloxone more accessible. A standing order can be thought of as a non-patient-specific prescription that permits naloxone to be dispensed to any person who meets criteria specified by the prescriber, as opposed to a named patient. For example, a standing order from a physician might state that workers at a particular drug clinic who have gone through naloxone training may distribute naloxone to those who come to the clinic.

All but four states (Connecticut, Idaho, Nebraska, Oregon) currently permit standing orders or their functional equivalent. In most states, major chain pharmacies have standing orders for naloxone to be dispensed from their stores; in other states standing orders are utilized by health departments, NGOs, and other entities. This Fact Sheet developed by the Network provides the most up to date information.

Have states expressed liability/immunity concerns regarding increased access to naloxone?

Nearly all naloxone access laws provide strong immunity protections, and governmental entities tend to have strong existing immunity protections. This editorial provides a greater discussion on the legal risk associated with prescribing naloxone.

What are the gaps in state laws to providing naloxone access?

Naloxone remains a prescription medication, which necessitates clunky and inconsistent standing orders and other state actions to increase access. There are laws that: a) permit one individual to issue non-patient-specific prescriptions for nearly every individual in the state; b) permit regulatory boards, who have no NPI and no other authority to order medications, to permit naloxone to be dispensed under a "protocol"; c) permit any individual to possess naloxone without a prescription; and d) permit any individual to distribute naloxone. In 2014, Oklahoma passed a law that permits naloxone to be "without a prescription," however, it's not actually being implemented as written.

Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Contact a Network Attorney in your area for more information.

The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.