Opioid over­dose is one of the leading causes of acci­dental death in the U.S. According to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, the epi­demic accounts for some 25,000 deaths per year—or approx­i­mately 68 fatal­i­ties per day.

One way to reduce the nation’s number of opioid-​​related deaths, said North­eastern Uni­ver­sity drug policy expert Leo Beletsky, is through the timely admin­is­tra­tion of naloxone, the life-​​saving over­dose antidote.

His new paper, pub­lished online Thursday by the Amer­ican Journal of Public Health, looked at the quickly expanding effort to equip law enforce­ment offi­cers with the drug. Co-​​authored by Net­work for Public Health Law attorney Corey Davis and his team, the article high­lights law enforcement’s over­dose pre­ven­tion efforts and addresses the legal risks asso­ci­ated with their admin­is­tra­tion of naloxone.

Over­dose is a major public health crisis, and recently there has been a rapid uptake in pro­grams that train police in how to rec­og­nize and reverse these poten­tially deadly events,” noted Beletsky, an asso­ciate pro­fessor who holds joint appoint­ments in the School of Law and Bouvé Col­lege of Health Sci­ences. “When police show up to the scene of an over­dose, there is a poten­tial for them to take on a life-​​​​saving role in addi­tion to being there to pro­vide pro­tec­tion and secu­rity. More and more, they are step­ping up to embrace this new tool.”

The find­ings

Using stan­dard legal research methods, Beletsky and his col­lab­o­ra­tors sys­tem­at­i­cally searched legal data­bases to deter­mine whether naloxone admin­is­tra­tion in the out-​​of-​​hospital set­ting has been the grounds for a law­suit. Their find­ings were unequiv­ocal, revealing that equip­ping offi­cers with naloxone does not raise their risk of being found legally liable for their on-​​the-​​job actions.

We dis­cov­ered no cases brought as a result of naloxone admin­is­tra­tion by [law enforce­ment offi­cers], which is per­haps not sur­prising because that prac­tice is rel­a­tively new,” the researchers wrote, noting that some 220 law enforce­ment agen­cies in 24 states now carry the drug. “How­ever,” they added, “we also did not find any cases regarding the pre­scrip­tion, dis­tri­b­u­tion, or admin­is­tra­tion of naloxone via com­mu­nity dis­tri­b­u­tion pro­grams, which have been oper­ating for more than a decade and have been involved in more than 10,000 reversals.”

The article con­cluded that law enforce­ment offi­cers should be autho­rized to admin­ister naloxone; that adding admin­is­tra­tion of the drug to their duties is unlikely to affect lia­bility risk for either the offi­cers or the agen­cies; and that the pas­sage of laws explic­itly per­mit­ting offi­cers to admin­ister naloxone greatly increase the chances that they will do so.

Law enforcement naloxone administration authority as of September 2014

Law enforce­ment naloxone admin­is­tra­tion authority as of Sep­tember 2014. Graphic cour­tesy of Net­work for Public Health Law.

Beletsky fur­ther noted that the deci­sion by some agen­cies to equip their law enforce­ment offi­cers with naloxone is a key example of their ongoing efforts to shift their approach to drug policing from a puni­tive model to a health-​​based model. “Having cops carry naloxone can be a crit­ical effort in addressing over­dose fatal­i­ties in some areas,” he said, “and rep­re­sents a gen­eral shift in policing the nation’s drug problem away from incar­cer­a­tion, which has proven expen­sive, inef­fec­tive, and deadly for far too many people.”

 Meeting at the FDA

Beletsky—who recently helped the U.S. Depart­ment of Justice’s Bureau of Jus­tice Assis­tance design a naloxone toolkit for police—will dis­cuss the paper’s find­ings at a sci­en­tific work­shop at the Food and Drug Admin­is­tra­tion in July. Con­vened in part by the White House Office of National Drug Con­trol Policy, the meeting will bring together aca­d­e­mics, gov­ern­ment offi­cials, industry experts, and patient advo­cates to dis­cuss the use of naloxone both in and out of con­ven­tional med­ical settings.

The research team’s find­ings are locally rel­e­vant too, released just days before a Mass­a­chu­setts task force is expected to submit a strategy to combat the statewide opioid crisis. More than 1,000 people in Mass­a­chu­setts died of opioid over­doses in 2014, up 33 per­cent from 2012.

I was really sur­prised how many people told me sto­ries related to opioid addic­tion,” Mass­a­chu­setts Gov. Charlie Baker said in Feb­ruary, when he announced the estab­lish­ment of the task force. “I said, ‘You know, this is more than just anec­dote, there’s some­thing deeper going on here.’”

Mass­a­chu­setts, Beletsky said, is one of 11 states that explic­itly per­mits offi­cers to admin­ister naloxone under a standing med­ica­tion order. In their paper, he and his col­leagues explain that it is par­tic­u­larly impor­tant for such states with large rural or tribal regions to encourage or explic­itly allow offi­cers to admin­ister the drug.

In areas in which [law enforce­ment offi­cers] are typ­i­cally the first emer­gency respon­ders to arrive at an over­dose, equip­ping them with naloxone can reduce time to over­dose rescue, pos­sibly low­ering mor­bidity and mor­tality by decreasing the amount of time the victim remains in res­pi­ra­tory depres­sion,” they wrote. “Adop­tion of such mea­sures by those states should be a high priority.”