Liability Protections for Dispensers of Naloxone

Research SummaryPublished Dec 18, 2023

Provide liability protections for pharmacists who dispense naloxone in accordance with state law. Protections can extend to criminal liability; civil liability; and administrative, licensing, and disciplinary action by the state board of pharmacy (or similar entity).

A panel of experts rated how they expect this type of policy to affect four outcomes: naloxone distribution through pharmacies, opioid use disorder (OUD) prevalence, rates of nonfatal opioid overdose, and opioid overdose mortality. Another panel of experts rated the policy on four implementation criteria: acceptability to the public, feasibility of implementation, affordability from a societal perspective, and equitability in health effects.

Policy Recommendations According to Expert Ratings

Oppose Uncertain Support
No
Yes
No

Summary of Expert Ratings

Outcomes Effect Rating
Harmful Little-to-no Beneficial
Naloxone Pharmacy Distribution
No
Yes
No
OUD Prevalence
No
Yes
No
Nonfatal Opioid Overdose
No
Yes
No
Opioid Overdose Mortality
No
Yes
No
Criteria Implementation Rating
Low Moderate High
Acceptability
No
No
Yes
Feasibility
No
No
Yes
Affordability
No
No
Yes
Equitability
No
No
Yes

Summary of Expert Comments

  • Experts expect this policy to have minimal effects on naloxone distribution and other outcomes because liability concerns are not a major barrier for dispensing naloxone, even if liability protections may make some pharmacists more comfortable dispensing naloxone.
  • Experts think the public generally supports efforts to protect health care providers acting in good faith to address the opioid epidemic.
  • Experts view this policy as feasible and affordable primarily because there are no implementation challenges and ongoing costs once the laws are passed and because liability protection laws regarding naloxone are already well established.
  • Experts generally consider this policy equitable because it would facilitate greater access to naloxone, especially among stigmatized populations.

Outcome Summaries

Naloxone Pharmacy Distribution

Amount of naloxone dispensed through retail pharmacies (e.g., chain pharmacy stores, independent community pharmacies).

Effect Rating Summary of Expert Opinion Representative Quotations
Beneficial Modest positive impact as some dispensers might feel more comfortable dispensing naloxone. "Could be helpful to make pharmacists feel more secure"
Little-to-no
(selected)
 Concerns about liability are not a major barrier to naloxone pharmacy distribution. "Not clear that threat of legal action major hindrance to current dispensing"
Harmful N/A N/A

Opioid Use Disorder Prevalence

Percentage of the general population with a pattern of opioid use leading to clinically and functionally significant impairment, health problems, or failure to meet major responsibilities.

Effect Rating Summary of Expert Opinion Representative Quotations
Beneficial N/A N/A
Little-to-no
(selected)
 No credible mechanism linking liability protections and OUD prevalence. "Does not affect upstream sources related to OUD prevalence"
Harmful N/A N/A

Nonfatal Opioid Overdose

Per capita rates of nonfatal overdose related to opioids, including opioid analgesics (e.g., oxycodone), illegal opioids (e.g., heroin), and synthetic opioids (e.g., fentanyl).

Effect Rating Summary of Expert Opinion Representative Quotations
Beneficial N/A N/A
Little-to-no
(selected)
 No credible mechanism linking liability protections and nonfatal opioid overdoses — especially because liability protections do not impact naloxone distribution. "I don't think it would change the amount of naloxone dispensed and wouldn't change [overdose] rate"
Harmful Potential for revival from overdose could have a small, indirect, and mechanistic impact on nonfatal overdoses due to increased survivorship. "There will be a mechanical increase in non-fatal overdoses (those situations in which a fatal overdose would have occurred absent the policy)"

Opioid Overdose Mortality

Per capita rates of fatal overdose related to opioids, including opioid analgesics (e.g., oxycodone), illegal opioids (e.g., heroin), and synthetic opioids (e.g., fentanyl).

Effect Rating Summary of Expert Opinion Representative Quotations
Beneficial Modest increase in dispensing could lead to modest reductions in fatal overdoses. "Increase in distribution may increase Narcan [naloxone] availability during an overdose, which may have an effect on mortality"
Little-to-no
(selected)
 Liability protections do not impact naloxone distribution sufficiently to impact fatal overdoses. "No impact on distribution and thus no impact on mortality"
Harmful N/A N/A

Implementation Criteria Summaries

Acceptability

The extent to which the policy is acceptable to the general public in the state or community where the policy has been enacted.

Implementation Rating Summary of Expert Opinion Representative Quotations
High
(selected)
 Public supports efforts to protect health care providers acting in good faith to address the opioid epidemic. "Most pharmacists are revered to an extent, so the case can be made that they are looking out for the good of the society"
Moderate Some or all of the general public may be unaware of liabilities or be weary of the potential for liability protections to provide leeway for wrongdoing (due to the stigma around opioid use and belief that naloxone is a moral hazard). "May impact trust if interpreted as giving additional leeway for maleficence"
Low N/A N/A

Feasibility

The extent to which it is feasible for a state or community to implement the policy as intended.

Implementation Rating Summary of Expert Opinion Representative Quotations
High
(selected)
 Little-to-no implementation challenges once passed, especially as liability protection laws regarding naloxone are already well-established. "It is very feasible. There are already liability and/or good Samaritan protections in many states though primarily for laypeople"
Moderate Depends on type of immunity (criminal, civil, or administrative) and potential pushback from various stakeholders (legal/judicial, medical). "The liability protections or immunity would need to specify what exactly the immunities relate to"
Low N/A N/A

Affordability

The extent to which the resources (costs) required to implement the policy are affordable from a societal perspective.

Implementation Rating Summary of Expert Opinion Representative Quotations
High
(selected)
 Little-to-no ongoing costs once passed. "There should be minimal to no cost to providing these protections to pharmacists"
Moderate Potential for pushback and legal battles during implementation. "No substantial cost to create the policy; perhaps a legal battle to implement, though"
Low N/A N/A

Equitability

The extent to which the policy is equitable in its impact on health outcomes across populations of people who use opioids.

Implementation Rating Summary of Expert Opinion Representative Quotations
High
(selected)
 Facilitates greater access to naloxone, especially among stigmatized populations. "Leaving pharmacists unprotected would negatively impact equity by playing into pharmacists' bias about who is worth the career risk to themselves"
Moderate Does not have any impact on structural oppression or interpersonal biases in the health care system. "In terms of intersectional inequity among people who use drugs, naloxone access is in large part patterned by the same social forces affecting access to the health [care] sector in general. I see no real reason why encouraging pharmacists to engage in naloxone distribution through simply removing penalties would occur more (or less) in providers serving marginalized communities"
Low Replicates existing disparities in the health care system. "Considering the widespread bias in the health care system against those with mental illnesses, who experience homelessness, or who live in poverty, I doubt that reducing dispenser liability will improve equitable access to naloxone"
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Liability Protections for Dispensers of Naloxone, RAND Corporation, RB-A3054-2, 2023. As of September 12, 2024: https://www.rand.org/pubs/research_briefs/RBA3054-2.html
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Liability Protections for Dispensers of Naloxone. Santa Monica, CA: RAND Corporation, 2023. https://www.rand.org/pubs/research_briefs/RBA3054-2.html.
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