Overdose Treatment liability act Author
– Senator Mark Ridley-Thomas (D – 26)
Senate Bill
767
Drug overdose is the second leading cause of accidental
death in the United States and the leading cause of death in California’s
opioid using population. Drug overdose,
which is entirely preventable, is a significant problem in many California
counties and its effects are felt throughout all sectors of our
communities. More than 2,700 people
died in L.A. County between 2002 and 2004 from unintentional drug overdoses. In each year between 1999 and 2004, heroin
and other opiates caused more fatal accidental overdoses than any other drug
(including cocaine and methamphetamines) in L.A. County. Heroin-related overdose is among the leading
causes of accidental death in San Francisco, killing more San Franciscans every
year than gunshot wounds and car accidents combined. In the City and County of San Francisco, paramedics respond to
eight overdose calls per day, and paramedics in L.A. County administer naloxone
around 1,000 times a year.
Unintentional drug overdose is also one of the leading causes of
premature death in L.A. County.
Furthermore, even when a drug overdose is not fatal, there is still a
huge burden placed upon the public’s health and upon the health care delivery
system.
When a
person overdoses on opiates (heroin, morphine, methadone, oxycontin, etc.),
he/she is rendered unconscious and is in danger of dying because the opiates
slow down, and eventually stop, the person's breathing. Opioid antagonists such as naloxone (also
known as Narcan®) are routinely used in hospitals and in pre-hospital settings
(by paramedics in the field) throughout the state on patients who are suspected
to be overdosing on opiates. Naloxone
counteracts life-threatening depression of the central nervous and respiratory
systems caused by an opiate overdose, allowing an overdose victim to breathe
normally. Currently, naloxone can be prescribed only
by licensed health care professionals, but it is not a scheduled drug and has
the same level of regulation as prescription ibuprofen. Naloxone is not addictive, inexpensive, and
has no pharmacologic effect if a person does not have opiates in their
system. Furthermore, there is no data
to suggest that distributing naloxone to drug users leads to increased drug
use.
Studies
indicate that many victims of opiate overdoses never receive proper medical
attention because their friends and other witnesses (who are often drug users
themselves) do not call 911, fearing police involvement (Pollini et al, 2005;
Tobin et al, 2005; Davidson et al, 2003; Seal et al, 2003; Strang et al,
2000). In recent years several
successful overdose prevention programs have been established around the state
and country to provide lay community members (including drug users) with the
training and tools (including a naloxone prescription) necessary to intervene
effectively when they witness a drug overdose.
These programs are providing overdose prevention, recognition, and
response training, including training in calling 911, rescue breathing and
take-home prescriptions of naloxone, to drug users and their loved ones. Such a program in San Francisco has trained
and provided naloxone prescriptions to over 860 individuals since November
2003, and has received over 220 reports of program participants using naloxone
to successfully reverse overdoses (through January 31, 2007. Since New York City’s program was formalized
in March 2005, 1705 clients have been trained and 126 reversals have been
reported (through June 30, 2006).
By
providing people with access to naloxone, these programs have enabled overdose
bystanders to promptly administer naloxone and reverse the overdose. There is no data to suggest that providing
lay people with access to naloxone reduces the rate of overdose bystanders
calling 911. Prescribing naloxone to
lay people allows overdose bystanders to quickly administer this medicine in
the event that emergency medical services are not summoned or are slow to
arrive on the scene.
However,
the L.A. County Department of Public Health has heard from local providers that
they are having difficulty finding clinicians that are willing to prescribe
take-home opioid antagonists, like naloxone, to their patients. The clinicians are afraid of potential civil and
criminal liability if a patient uses his or her naloxone on someone else.
Currently there is only one overdose prevention program in L.A. County
that prescribes take-home naloxone to lay community members. This program is unable to offer access to
naloxone and other overdose prevention services to all of the County’s residents
who are interested in receiving such services.
In California, no law currently exists which would offer civil and criminal liability protection for health care professionals and third parties who are involved in the prescription, distribution, and/or injection/administration of naloxone to someone who is experiencing an opiate overdose.
This bill protects doctors, health professionals, patients, and their friends and family members who provide opiate antagonists, including naloxone, to those who need it.
This proposed legislation would make it easier for health
care professionals to participate in comprehensive drug overdose prevention
programs that prescribe opioid antagonists, thereby removing a large obstacle
to the creation and expansion of such programs in California. This proposed legislation will also make it
easier to get opioid antagonists into the hands of the people who are the most
likely to be bystanders to opiate overdoses, thereby increasing the likelihood
that people overdosing on opiates will receive opioid antagonists promptly.
This bill as introduced on February 23rd:
· Provides that any person who, in good faith, believes that another person is experiencing a drug overdose and who acts with reasonable care may administer an opioid antagonist to the person experiencing a drug overdose without being subject to civil liability for damages or criminal penalties as a result of that act.
· Defines an opioid antagonist as naloxone hydrochloride or any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of a drug overdose.
· Encourages, but does not mandate, counties to establish standards for approval of any opioid overdose prevention program, which may include, but not be limited to, standards for program directors, appropriate clinical oversight, training, record-keeping, and reporting.
· Encourages, but does not mandate, counties to collect and review overdose death rates and other information to ascertain changes in the cause and rates of fatal opioid overdoses and report:
(1) Information on opioid overdose deaths, including age, gender, ethnicity, and geographic location;
(2) Data on emergency room utilization for the treatment of opioid overdose;
(3) Data on utilization of pre-hospital services; and
(4) Suggested improvements in data collection.
This bill as it will be
amended:
·
Provides that
a licensed health care professional who is permitted by law to prescribe
an opioid antagonist shall not be subject to any civil or criminal liability
arising from an administration of an opioid antagonist by any person who, in
good faith, believes that another person is experiencing a drug overdose.
·
Explicitly
states that this bill will not prohibit a health care provider from being sued for
severe negligence
Why do we
need this law?
Although naloxone is a very safe drug and recent studies have proven
that lay people, with appropriate training, can safely and properly administer
it, some clinicians are concerned about prescribing take-home naloxone for use
by lay people. Clinicians voice concerns that patients may use naloxone on a
third party experiencing an overdose and, in the event of an adverse reaction,
the clinician could be held liable. A naloxone liability law will protect
providers, facilitating greater access to lifesaving medicine for people
experiencing opiate overdoses.
In recent years, New York, New Mexico, and Connecticut have enacted
similar legislation protecting licensed health care professionals and third
parties from civil and criminal liability when prescribing and administering
opiate antagonists.
Won’t providing take-home naloxone discourage people from calling 911 in
the event of an overdose?
There is no evidence to suggest that access to naloxone
reduces the rates of people summoning EMS.
Data from San Francisco’s naloxone distribution program indicates that
witnesses with naloxone prescriptions on hand summon EMS at rates similar to
their counterparts without naloxone (Huriaux, 2006).
In cases of nonfatal overdose, there is ample evidence that overdose witnesses without naloxone contact emergency medical services (EMS) one-third to one-half the time (Pollini et al, 2005; Tobin et al, 2005; Davidson et al, 2003; Seal et al, 2003; Strang et al, 2000). Witnesses with naloxone prescriptions do not view the medication as a substitute for EMS, but rather “a sense of security while awaiting an ambulance” (Worthington et al, 2006).
Legislation to remove potential liability will encourage the
diffusion of overdose prevention and response programs that
include naloxone distribution. A key attribute of the curriculum used by these
programs is a module encouraging participants to call 911 when they are
witnessing an overdose, whether or not they have naloxone on hand, and training
them how to talk with dispatch over the phone and police offers on the scene.
Won’t this reduce
consumers’ recourse against health care providers?
This legislation would provide specific immunities to health care providers and third persons who are involved in the prescription, distribution and/or injection of opioid antagonists (such as naloxone hydrochloride) only when they are acting with reasonable care and in good faith. This legislation would only provide civil and criminal liability protection in regards to opioid antagonists and no other type of drug. Furthermore, this legislation would not prohibit a health care provider from being sued for severe negligence.
County of Los Angeles (sponsor)
Harm Reduction Coalition (sponsor)
Los Angeles Overdose Prevention Taskforce (sponsor)
California Association of Alcohol and Drug Program
Executives, Inc.
California Organization of Methadone Providers
Clean Needles Now
Coalition on Homelessness, San Francisco
Common Ground
Drug Policy Alliance
Homeless Healthcare of Los Angeles
Mendocino County AIDS Volunteer Network
San Francisco AIDS Foundation
Tarzana Treatment Centers, Inc.
Tenderloin Health
Bill introduced on February 23,
2007.
Contact: Emalie Huriaux, MPH
Harm Reduction Coalition,
(510) 444-6969 x 16
Contact: Elan Shultz, MPH
Los Angeles County Dept. of Public
Health
(213) 240-8243