SMALL STEP, BIG PAYOFF IN SB 459
Can A Little-Known Law Solve Nevada’s
Opioid Overdose Epidemic?
By John Seeland, JD, MBA, MHS
In May 2015, Nevada Governor Brian Sandoval signed into law what was expected to be a pivotal piece of legislation for Nevada’s addiction-recovery community: (SB) 459, otherwise known as the Good Samaritan Drug Overdose Act.
The two-part law granted further access to an overdose antidote, naloxone, while extending legal protection to those who inform the authorities about a suspected drug overdose. Under the new law, law enforcement responding to an overdose distress call cannot criminally penalize “good Samaritans” for any low-level criminal offenses they may discover at the scene. This includes supervision violations, alcohol law violations, simple drug possession, drug paraphernalia possession, and being under the influence. (It should be noted, however, that the law does not protect good Samaritans from more serious offenses, such as selling or trafficking drugs.)
A Law for Saving Lives
Advocates of the law had hoped that immunity from prosecution would encourage drug users or overdose witnesses to seek immediate help for themselves or others rather than wasting crucial minutes or hours fretting over the potential legal consequences.
To date, 35 U.S. states have enacted similar Good Samaritan Overdose Immunity Laws…and many considered Nevada long overdue to initiate its own. Nevada’s drug overdose mortality rate is the fourth highest in the nation, according to a 2013 report by Trust for America’s Health (TFAH). Between 2009 and 2011, the drug poisoning fatality rate in Nevada was 20.7 per 100,000 people. This represents an 80-percent increase from where the death rate stood in 1999, when 11.5 people per 100,000 fatally overdosed.
Naloxone: Effective Overdose Antidote
Many in the addiction-treatment industry were equally enthused about the law’s expanded access to naloxone, the medication that reverses the effects of an opioid overdose. Naloxone is considered incredibly effective at treating accidental overdoses; so effective, in fact, that some have labeled it a “silver bullet.” It’s also favored for its reputation of being safe and non-habit forming.
“One of the benefits of naloxone is that it has no adverse side affects,” stated Mel Pohl, MD, DFASAM opioid specialist and medical director at Las Vegas Recovery Center (LVRC). “This effectively eliminates the risk of someone causing harm by administering the medication to someone who may not need it to reverse opioid overdose. It’s also fast acting and easy to use. It can be administered through an auto–injector or through a nasal spray—no training is needed. It is truly a life-saving medication.”
The new law allowed physicians to prescribe the overdose antidote to friends and family members of opioid users, a practice that was previously discouraged due to restrictions on third-party prescriptions. Community members who regularly come into contact with opioid abusers, such as first responders (law enforcement and fire fighters), were also granted access.
An Unsung Hero: Where the Law Stands Now
Although it has been 15 months since the law was passed in Nevada, relatively few people have been made aware of its existence, including those with the potential to be most affected, like law enforcement officers and the friends and family members of opioid abusers.
“The intent of the law was to save lives,” says Foundation for Recovery (FFR) Recovery Advocate Heidi Gustafson. “And that hasn’t happened.”
According to Gustafson, an advocate for naloxone, there was no “post-passage plan”.
“The law was passed and then that was it,” she explained in an interview. “There was no education component or marketing plan to accompany it, and that has resulted in a lot of confusion.”
One example Gustafson cited was insurance coverage. “On paper, naloxone is covered by Medicaid, but many pharmacies and consumers aren’t aware of this,” she said.
In other states where similar laws have been enacted, the overdose fatality rate has been successfully reduced. As of 2014, over 150,000 people across the United States have received naloxone kits and training, and over 26,000 overdoses were reversed, according to reports from the Centers for Disease Control and Prevention.
Doctors Hesitant to Prescribe
Another roadblock to the law’s success in Nevada has been doctors’ hesitancy to prescribe naloxone. Though naloxone is not harmful and poses no risk for abuse, it could be rendered ineffectual if it isn’t administered properly. Doctors are concerned that if the drug fails to work in an emergency, they’ll be held liable and could face malpractice lawsuits.
Physicians also worry that recommending an anti-overdose medication will offend their chronic pain patients. Some also believe the law places an unfair burden on doctors to determine which of their chronic patients are at risk of overdose and which aren’t. Pharmacists also face a similar dilemma. While they are sympathetic to the opioid addiction epidemic, as Gustafson explains it, “doctors and pharmacists don’t want to be interventionists.”
The recovery community has struggled to correct the public’s perception that naloxone enables and allows addicts to use more successfully. Mental health experts view addiction as a brain disease and believe people who misuse opioids have little control over their actions. Despite years of published research supporting this claim, however, misinformation and stigma surrounding addiction still persists. “We need to keep people alive long enough for them to seek a new way of life through recovery,” says Gustafson.
Is a Standing Order the Solution?
Gustafson and other local advocates have been rallying to remove individual physicians from the equation entirely, opting instead for a standing order signed by Nevada’s State Health Officer. The standing order would allow pharmacists to distribute naloxone without a prescription and grant anyone the ability to easily access naloxone, in much the same way they do a flu shot. Instructions are included with each naloxone kit that detail how to administer the drug in the event of an emergency and many organizations, such as the Foundation for Recovery, offer trainings for those looking for a more in-depth education.
Most states have enacted statewide standing orders with great success and it is the hope of Gustafson that Nevada will soon follow suit.
The Need for Education
Although a standing order and education for healthcare workers may be a good first step, a community outreach that extends beyond the medical industry is vital if this law is to have a life-saving effect.
“It typically takes two to three hours to die from an overdose,” states Gustafson. “If everyone carried naloxone with them, can you imagine how many deaths we’d be able to prevent?”
Gustafson then recounts a story of a woman she knew who suffered from an opioid addiction. A few months ago, the woman overdosed and rather than calling 911, her friends drove her to a bus stop and abandoned her there. Laying there unconscious, she died of her overdose.
“If they’d have known about the Good Samaritan Drug Overdose Act, maybe they would have driven her to the hospital instead,” said Gustafson with a shake of her head. “And maybe she’d still be alive today.”
As of July 21, 2016, the Nevada Pharmacy Board unanimously adopted naloxone regulations. These regulation were necessary to implement certain provisions of the states SB 459. These regulations clarify for Nevada pharmacists’ procedures for dispensing naloxone to patients, including those with third-party prescriptions. Final approval is needed by Legislative Commission. In the meantime, advocates will continue to work toward full implementation of the law.
For those interested in learning how to administer naloxone and prevent an opioid overdose, please contact Foundation for Recovery at 702-257-8199. Foundation for Recovery, located in Southern Nevada, offers a comprehensive one- and two-hour training for groups of 20 or more.
Las Vegas Recovery Center (LVRC) also offers help to those wishing to seek recovery from an opioid use disorder. With campuses in northwest Las Vegas and Henderson, LVRC is equipped to help chronic pain and addiction sufferers across the Las Vegas Valley. Visit http://lasvegasrecovery.com/ or call 702-515-1373 to learn more.