Narcan Legal Issues

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As the need for naloxone grew, so did overdose immunity laws, such as the Good Samaritan Act, to protect pharmacists and physicians from lawsuits for life-saving activities. Currently, 37 states and the District of Columbia have some form of “911 Drug Immunity Act” (Figure 2 online). As with many state statutes, different approaches are included as to the scope of the violation in terms of protection, the violations covered by the provisions, and when immunity applies.15 In the various approaches to delegating prescribing powers to pharmacists for the use of naloxone, whether through a standing order or a cooperation agreement, Pharmacists must act in good faith with an ethical approach to patients. The same goes for third-party prescription, where the drug is administered to a caregiver, family member or friend to help the patient in case of overdose. Montana and South Dakota do not allow naloxone to be administered to third parties without a prescription. These jurisdictions only restrict direct administration of the drug to the patient.16 As discussed in this article, pharmacists need to be aware of many legal issues related to expanding access to naloxone. In particular, pharmacists have up-to-date detailed resources that can be very helpful in determining the applicable laws in a pharmacist`s state of practice. Pharmacy Times is home to the Naloxone Pharmacist Resource Center, which includes an interactive map that pharmacists can use to review naloxone laws in their state (www.pharmacytimes.org/resource-center/opioid-overdose-rescue). In addition, the Prescribe to Prevent (prescribetoprevent.org/) document contains the information needed to begin prescribing and dispensing naloxone, including information on legal issues. Finally, the LawAtlas policy monitoring portal provides information on naloxone overdose prevention laws by state and related resources (lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone). Pharmacists should consult these resources if questions arise about the proper prescribing, dispensing and administration of naloxone.

The authors searched a legal database to find all laws and regulations (i.e., laws) related to layman access to naloxone in all 50 states and the District of Columbia. In this study, Davis and Carr describe recent changes to state policies and regulations that have improved access to naloxone and identify areas that still need to be addressed. However, the laws on Narcan are not uniform across the country. Whether you are legally responsible if you administer Narcan to someone who has overdosed on heroin depends on your state laws, perhaps even your city`s laws, and sometimes, unfortunately, the whims of court officials. There may be concerns about liability when prescribing or dispensing naloxone. As a result, 32 states grant immunity from civil liability (i.e., protection from lawsuits by another person for bodily injury by another person) to prescribers, 30 to donors, and 36 to lay administrators. Some states also provide immunity from criminal liability (i.e., protection from state prosecution) to address concerns about the risks associated with their use. Thirteen states have laws that explicitly state that possession of naloxone without a prescription is not a criminal offense. While people at the scene of an overdose may be reluctant to call 911 for fear of being arrested for illegal drugs, 35 states have Good Samaritan laws that encourage people to seek medical help by protecting them and the overdose from prosecution for minor drug possession.

The adoption of Good Samaritan laws at the state level is another important legal issue related to improving access to naloxone. People who witness an opioid overdose are often reluctant to get involved and report the situation because they fear being arrested for a drug-related crime themselves.6 As a result, the majority of states have now amended their laws to encourage people who witness an overdose to call emergency responders. Most of these laws provide protection from prosecution for minor drug possession to a person who calls emergency responders in good faith, and many also protect the appellant from arrest for these crimes. Almost all of these laws extend protection to the overdose victim, as well as to the person who requested emergency intervention. Some Good Samaritan laws go even further, protecting individuals from probation or probation violations, or even other drug-related offenses. Narcan is an effective drug that reverses overdose and has already saved the lives of several thousand people. However, there are still legal questions on this issue and there is no single answer to these questions for everyone in the United States. The risk of liability to a law enforcement officer or his or her employer arising from the administration of naloxone is low. From a legal perspective, it would be extremely difficult to win a case against a public servant who administers naloxone in good faith and in the course of employment.

Overdose response is no different from other bona fide efforts to provide emergency assistance. Another legal change concerns standing orders for the distribution of naloxone, which allow physicians to allow other employees, such as pharmacists or nurses, to dispense naloxone to anyone who meets certain criteria. While this is common in pharmacy, these laws may also allow for an expansion of naloxone distribution beyond the pharmacy to facilities such as addiction treatment centres and community agencies that reach a population that would not otherwise have access to naloxone.