142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

First Responder Naloxone Access: A National Systematic Legal Review

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Corey Davis, JD, MSPH , Network for Public Health Law, Carrboro, NC
Alex Walley, MD, MSc , Boston University School of Medicine, Boston
Michael Dailey, MD , Albany Medical Center, Albany, NY
Jessica Southwell, MPH , North Carolina Institute for Public Health, Chapel Hill, NC
Virginia Niehaus, JD, MPH , Network for Public Health Law, Carrboro, NC
 Background: Fatal opioid overdose in the United States is at epidemic levels. Naloxone, a safe and effective opioid antidote, is commonly administered by some Emergency Medical Services (EMS) personnel to reverse opioid overdose. States are rapidly expanding access to naloxone for community bystanders, but nationwide the EMS system remains the primary source for pre-hospital naloxone access.

Purpose: To systematically review the authority of EMS personnel to administer naloxone for the reversal of opioid overdose. 

Methods: All relevant laws, regulations, and policies from the 50 US states, the District of Columbia, Guam, and Puerto Rico were identified, reviewed and coded to determine the authority of EMS personnel at various levels (EMTs, mid-level personnel, and Paramedics) to administer naloxone. Where available, protocols governing route and dose of administration were also analyzed. 

Results: All 53 jurisdictions license or certify EMS personnel at the Paramedic level, and all permit Paramedics to administer naloxone. Of the 48 jurisdictions that utilize mid-level EMS personnel, all but one authorize those personnel to administer naloxone. Only twelve jurisdictions explicitly permit EMTs to administer naloxone. Protocols regarding administration vary widely between states.

Conclusions: Naloxone administration is the standard of care for Paramedic and mid-level EMS personnel. Changing the national model and state laws, regulations, and protocols to permit EMTs to administer naloxone may improve overdose response. Research to inform best practice regarding route and dose of naloxone administration may be warranted.

Learning Areas:

Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Explain how increased access to naloxone may reduce fatal opioid overdose Describe current expert opinion regarding benefits of first responder access to naloxone Compare differences in naloxone access among first responders in 50 U.S. states and the District of Columbia Identify statutory and regulatory means by which first responder naloxone access may be increased

Keyword(s): Drug Abuse Prevention and Safety, Law

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been an investigator on a number of grants focusing on the effect of law on health outcomes, and am an expert on the role of law in mediating overdose risk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.