Legal regimes surrounding naloxone access: considerations for prescribers

Background: Since the late 1980s, opioid-related morbidity and mortality in the United States has dramatically increased. This serious epidemic requires a coordinated medical, public policy, and social response. It is becoming readily apparent that widespread provision of naloxone may help to address this problem. However, because naloxone access laws vary between states, the extent of antidote dissemination may be limited by a given provider's geographic location. Objective: This review targets a physician or prescriber audience, in hopes of providing evidence for the safety and utility of naloxone, education on the baseline legal liability of naloxone provision and protections afforded by access laws, and resources for the proposal of statewide legislation to promote antidote distribution. Conclusion: Evidence suggests that naloxone administration by laypersons, pursuant to physician prescription or standing order, is safe and effective for reversal of opioid overdose. As of July 2015, 44 states and the District of Columbia have passed naloxone access laws, offering varying degrees of protections for prescribers. Although the likelihood of naloxone-related legal action may parallel that inherent to the usual practice of medicine, providers should be mindful of potential scenarios, exercise methods to mitigate risk, and appreciate the utility of comprehensive naloxone access legislation in orchestrating a coordinated response to the opioid overdose epidemic.