Taylor Darlene Pomeranz, MPH Candidate 2022, University of Arizona
Digital - April 2022
When it comes to the opioid epidemic, there is no one size fits all due to the complexity and wide array of systems involved. The opioid epidemic impacts public health, as well as, social and economic welfare and does not discriminate. The opioid epidemic has been declared a public health emergency and due to its complexities, it is important that there are multiple policies to fight this ongoing battle. In the United States, “136 people die every day from an overdose” (CDC, 2021). With new policies and regulation around prescriptions, the process for opioid-based medication can make it difficult for an individual to obtain pharmaceutical grade medication. As a result, it may force them to turn to the illicit and dangerous drug market.
The Naloxone Access Laws allow for the medication Naloxone, also known as Narcan, to be administered in order to rapidly reverse the effects of an opioid overdose. Due to opioids depressing the central nervous system and respiratory system, Naloxone binds to the opioid receptors and therefore blocks the effects of other opioids, allowing the individual to be able to resume breathe properly. The dosage for this reversal strongly depends on the person who is going through an overdose. With proper drafting and execution of these laws, they have the ability to help those who misuse legal and illegal substances, ultimately saving countless lives.
Although the Naloxone medication has been available for decades, state laws and regulations make it difficult for an individual to be able to obtain (Bazazi et al., 2010). Price has placed a significant barrier for community and governmental organizations as they do not have enough funds to keep up with the cost. It is important that insurance systems start a discussion around Naloxone. When looking at Naloxone and cost, it needs to be at a supportable level where those who are uninsured and insured, along with organization and other agencies can all afford. Currently, there is a strong stigma associated with the use of Naloxone and distribution and or use of it due to the idea of it promoting an increase in drug use. The stigma associated with Naloxone has been a significant barrier to the acceptance in correlation with the word “overdose” for patients, physicians, community members and more.
Many state that those who have established their recovery from opioids may consider having naloxone as a reminder of their past drug use identify and conflicting with their sober behaviors and goals they have strived to reach (Bowels, et al., 2021). With this in mind, researchers suggest in order to reduce stigma, it is important to reframe the meaning associated with naloxone. One idea is the idea that having naloxone on an individual is a way to commit to group safety, support and wellbeing to those who are still in their addiction (Bowels, et al., 2021). It is also recommended to use the terminology of first aid and the lifesaving impact it can have (Bowels, et al., 2021). Currently, the existing data does not support the claim of naloxone distribution with increased drug use, along with no serious adverse effects or increased risky behaviors (Bazazi et al., 2010). The United States could see potential problems with limiting access to Naloxone with the growing opioid epidemic, due to this; laws are being modified to implement this strategy. “It is unethical to allow a narrow focus on the harms of drug use to overshadow an opportunity to save human lives” (Bazazi et al., 2010). There are many opportunities for individuals to seek help and Naloxone distribution programs are one of them, as they provide additional services to compliment the Naloxone medication.
Naloxone distribution programs can connect individuals with a substance abuse disorder with a variety of resources and services. “... recent evaluation of 6 Naloxone training and distribution programs showed that trained laypersons were as adept as are medical experts in overdose recognition and treatment at recognizing an opioid overdose and knowing when Naloxone use was necessary” (Kim, Irwin & Khoshnood, 2009, pg. 405). Family members also benefit from learning, noticing signs of an overdose, existing programs and obtaining Naloxone in the event of someone they know going through an overdose. “...as of 2016, 48 states have authorized some variant of a Naloxone access law (NAL), and 37 states have passed a drug overdose good samaritan law (GSL)” (Ayres & Jalal, 2018). A good samaritan law offers protection when an individual helps another person in an emergency situation. In Arizona, under A.R.S § 36-2266, any individual can administer Naloxone in the event of an overdose occurring. The law also states "A person who does this in good faith and without compensation is not liable for any civil or other damages as the result of the act.” Arizona Revised Statutes, n.d.). In conjunction, Arizona has a Naloxone standing order, which is another legal avenue to fight the epidemic. This is just one example of a state's policies regarding Naloxone and many others make access to Naloxone even easier.
Not only is the change to Naloxone access laws important as shown above, it is one of the most important aspects when discussing the relationship amongst access and control. With the expansion of these laws, more overdoses can be reversed thanks to first responders, family members and others in the community.
Arizona Revised Statutes. (n.d.). https://www.azleg.gov/arsDetail/?title=36
Ayres, I., & Jalal, A. (2018). The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions. The Journal of Law, Medicine & Ethics, 46(2), 387–403. https://doi.org/10.1177/1073110518782948
Bazazi, A. R., Zaller, N. D., Fu, J. J., & Rich, J. D. (2010). Preventing opiate overdose deaths: examining objections to take-home Naloxone. Journal of health care for the poor and underserved, 21(4), 1108–1113. https://doi.org/10.1353/hpu.2010.0935
Bowles, J. M., Smith, L. R., Mittal, M. L., Harding, R. W., Copulsky, E., Hennessy, G., Dunkle, A., Davidson, P. J., & Wagner, K. D. (2021). “I wanted to close the chapter completely… and I feel like that [carrying naloxone] would keep it open a little bit”: Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity. International Journal of Drug Policy, 94, 103200. https://doi.org/10.1016/j.drugpo.2021.103200
Kim, D., Irwin, K. S., & Khoshnood, K. (2009). Expanded access to Naloxone: options for critical response to the epidemic of opioid overdose mortality. American journal of public health, 99(3), 402–407. https://doi.org/10.2105/AJPH.2008.136937