Staff to the Joint Commission on Health Care (JCHC) briefed Commission members last week on a study of barriers to public access to naloxone, a medication that reverses opioid overdoses, and the benefits and drawbacks of placing naloxone in publicly accessible places, such as co-locating naloxone kits with Automatic External Defibrillators (AEDs). JCHC staff worked with VACo and VML to survey local governments on their interest in, and concerns about, positioning naloxone in local government facilities that are open to the public. The Commission is accepting public comment until October 25, and will consider and vote on policy options at its November 14 meeting.
In recent years, the state has enacted policy changes and provided funding to enhance access to naloxone, including the passage of several bills to expand the list of professionals who are authorized to possess and administer naloxone, and the issuance of a standing order by the State Health Commissioner, which allows dispensing of naloxone to individuals without a prescription (dispensers are required to provide instruction to members of the general public when dispensing naloxone). Recent media reports have suggested that there may be confusion among some pharmacies about the application of the standing order, and staff suggested that the JCHC may consider requesting the Board of Pharmacy to disseminate information on this topic.
Although naloxone is generally regarded as safe by the Food and Drug Administration and is considered to be relatively easy to administer by individuals without medical expertise, JCHC staff recommended that some form of training still be required for “lay administrators” of naloxone if JCHC members opt to pursue measures to increase the placement of naloxone in public places, because there are some risks to naloxone administration that can be mitigated by training (for example, by learning to expect a person recovering from an overdose to be agitated). Currently, the main avenue for instruction on naloxone administration is the REVIVE! training offered by the Department of Behavioral Health and Developmental Services. Other mechanisms for assistance to the public in responding to overdoses are the 911 call centers (some of those answering points with Emergency Medical Dispatch (EMD) services are incorporating naloxone administration protocols into their EMD services), and regional Poison Control Centers, which are staffed by medical professionals 24/7, but may not be widely known as a source of information for overdose response.
JCHC staff outlined several benefits associated with co-locating naloxone with AEDs, including general public familiarity with where to look for AEDs, and the possibility that an overdose may cause cardiac arrest. Concerns included whether co-location with AEDs was the most cost-effective approach, given that the majority of overdoses do not appear to occur in public places, and that emergency medical providers may be able to respond to the overdose more quickly than lay rescuers, particularly in urban areas where EMS providers’ response time is short. There is also concern about the potential for theft of naloxone, as well as the cost associated with periodic replacement of the naloxone as it reaches the end of its shelf life. Local governments had indicated significant concerns about potential liability, a concern that was shared by several JCHC members. Staff explained that although Virginia Code provides “Good Samaritan” civil liability protection for the administration of naloxone by individuals who receive it through recognized channels, the law is not clear about protections in a scenario in which, for example, “naloxone [is] dispensed to individual A who gives Individual B naloxone to administer on Individual C who is experiencing [an] overdose.” Civil liability protections would not apply to individuals who obtained a drug through unauthorized channels, and because naloxone is a controlled substance (although it is not overseen by the Drug Enforcement Agency, the Food and Drug Administration has approved it by prescription only), according to state law, unauthorized possession is a Class 4 misdemeanor. JCHC staff suggested that JCHC members may wish to consider broadening civil and criminal liability protections to address this type of situation.
Policy options presented for Commission members’ consideration in November are as follows:
- Option 1: take no action
- Option 2: introduce legislation authorizing individuals acting on behalf of public locations who have completed a training program to possess and administer naloxone in the case of a suspected overdose
- Option 3: introduce legislation expanding criminal and civil liability protections for individuals administering naloxone
- Option 4: request that the Board of Pharmacy distribute information to pharmacists about the standing order authorizing dispensing of naloxone without a patient-specific prescription
- Option 5: request the convening of a task force to study the roles of Public Safety Answering Points and poison control centers in providing assistance to the public on opioid overdoses
Written public comments may be provided to the JCHC by close of business October 25 via email (firstname.lastname@example.org), fax (804.786.5538), or US Mail (Joint Commission on Health Care, P.O. Box 1322, Richmond, VA 23218).
VACo Contact: Katie Boyle