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Opiod Overdose Prevention with Naloxone

Opioid Overdose Prevention Programs with Take-home Naloxone in West Virginia and Other Central Appalachian States

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WVU-ICRC Injury Prevention Topic Synthesis: 
Opioid overdose prevention programs with take-home naloxone (OOPPs/THN) in West Virginia and other Central Appalachian[1] states
 
Executive Summary
Prescription painkiller overdose (OD) deaths have been on a steep rise in the US for more than a decade, and show no signs of abating. From 2001 to 2010, unintentional poisonings in West Virginia (WV) more than tripled, largely due to this epidemic of fatal painkiller ODs. In 2010, WV had the highest unintentional poisoning death rate in the US—26.5 deaths per 100,000 people. Other states in Central Appalachia also have high and increasing unintentional poisoning rates, including Kentucky (2nd highest) and Tennessee (7th highest).

In the 1990s, many US cities faced a similar epidemic of heroin overdoses. To address increasing OD deaths, harm reduction programs in Chicago, New York, San Francisco, and other cities, initiated prevention programs in the early 2000s that featured the distribution of the prescription drug naloxone (NARCAN®), a highly effective OD antidote, directly to drug users. These programs were instrumental in reversing fatal overdose trends, and as a result have been replicated in other cities, states, and counties across the US. However, despite the identification of nearly 200 programs by CDC in 2010, none were identified in West Virginia, Kentucky, Ohio, Tennessee, or Virginia (in Central Appalachia), nor in other states facing high-risk of prescription painkiller overdose. One such program has since been initiated in Scioto County, OH.

Although there are differences between inner city heroin addicts at risk for overdose, and prescription painkiller users in largely rural Appalachia, it is likely that similar OD prevention programs, that include naloxone distribution, can effectively prevent OD deaths among rural prescription drug users. Ongoing research is examining the feasibility and acceptability of such programs in several rural WV communities.

Several legislative actions could facilitate the initiation of opioid overdose prevention programs with take-home naloxone in West Virginia and in other states in Central Appalachia, including:

1. Law Legalizing Opioid Overdose Prevention Programs with Take-Home Naloxone
To date, 8 states  (NM, NY, IL, WA, CA, RI, CT and MA) have passed laws that remove liability and legality issues for OOPPs/THN.  As this report was being prepared, legislatures in Colorado, Kentucky, and New Jersey were considering similar legislation. 

2. Law Providing Immunity for Good Samaritan 911 Callers
To encourage OD witnesses to call 911, 10 states (CA, CO, CT, FL, IL, MA, NY, RI, and WA) as well as the District of Columbia, have passed 911 “Good Samaritan” laws that offer immunity to callers (and victims) from arrest and prosecution for possession and use (though not for more serious offenses, such as drug trafficking).  As this report was being prepared, the Missouri legislature was considering similar legislation.*

 


[1] Central Appalachia, in this report, refers to the north central, central, and south central sub-regions of Appalachia, as mapped by the Appalachian Regional Council, including parts of WV (all but the northern panhandle), OH, KY, TN, VA, and NC. See map at:  http://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=31.



*[Addendum:  North Carolina passed a Good Samaritan/Naloxone Law April 9, 2013.]