Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose
69 Pages Posted: 17 Jul 2009 Last revised: 12 Mar 2012
Date Written: July 15, 2009
Opioid drug overdose kills over 16,000 Americans every year. Although some victims are famous - like actor Heath Ledger - the seriousness of the overdose epidemic has still not gotten the attention, or the response, it requires. Many of these deaths are completely avoidable because an overdose incident can be effectively reversed by the administration of naloxone - a safe and inexpensive antagonist. With little funding, some 60 programs operating in 17 U.S. states have begun training drug users and others who are likely to witness an overdose to recognize and reverse opioid poisoning by providing first aid and administering emergency doses of naloxone. There has also been work aimed at making it standard medical practice to prescribe companion doses of naloxone to all patients receiving powerful opioid medications. These efforts have resulted in the reversal of thousands of fatalities, without resulting in increase in risky behavior or other negative consequences trumpeted by the programs’ opponents. Despite their unequivocal success, such programs face a number of critical barriers. Naloxone’s prescription status creates many questions about how the drug can be made available to drug users or others who may be in a position to help. Healthcare providers are rarely informed about, or willing to participate in overdose prevention efforts, including naloxone prescription. Lack of robust research and resources hampers many of the existing programs and prevents their scale-up. Whether real or perceived, concerns about legal liability have discouraged government and clinical professionals from supporting these efforts. Law enforcement and political actors also oppose the initiatives for the fear of enabling or sanctioning illegal drug use, while witnesses of overdoses involving illegally-obtained drugs avoid summoning emergency response. After sketching out the contours of the overdose epidemic, this article systematically examines the constellation of regulatory, legal, and policy issues that are limiting the scale-up of vital efforts to stem the tide of opioid overdose in the US. Well-balanced action that integrates state policy reform, proactive FDA action, targeted public and healthcare professional education, and partnership between public health and law enforcement actors are necessary to assure that society can enjoy the benefits of adequate pain care while minimizing overdose deaths and other problematic and harmful use of these powerful drugs.
Keywords: accident poisoning, heroin drug abuse, public health
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