Cover: Liability Protections for the Administration of Naloxone

Liability Protections for the Administration of Naloxone

Published Dec 18, 2023

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Research Brief

Provide liability protections to laypersons or nonmedical professionals (e.g., law enforcement officers) who administer naloxone. Protections can extend to criminal liability, civil liability, and professional sanctions.

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 naloxone administration, even if liability protections may make some people more comfortable administering naloxone.
  • Experts think the public generally supports efforts to protect laypersons 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 might feel more comfortable administering naloxone. "This would help caregivers and nonmedical professionals feel more comfortable having doses available"
Little-to-no
(selected)
Concerns about liability are not a major barrier to naloxone pharmacy distribution. "While this policy could cause a slight increase in distribution, it may not have a substantial impact on distribution given that those who obtain naloxone from pharmacies are likely to administer the drug regardless of liability concerns"
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. "Unless this policy is somehow tied to treatment, I am not seeing a direct mechanism that would link it with changes in the OUD rate"
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 Modest positive impact as some might feel more comfortable administering naloxone. "Would allow more people to have naloxone and feel comfortable administering"
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 naloxone access has much if any impact on the prevalence of nonfatal opioid overdose"
Harmful Potential for revival from overdose could have a small, indirect, and mechanistic impact on nonfatal overdoses due to increased survivorship. "If naloxone access goes up, more people will survive an [overdose]"

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 positive impact as some might feel more comfortable administering naloxone. "Could be helpful for drug users or bystanders to feel more empowered to use naloxone"
Little-to-no
(selected)
Liability protections do not impact naloxone distribution sufficiently to impact fatal overdoses. "Expect mortality reductions to be small as naloxone access change is likely to be small"
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 laypersons acting in good faith to address the opioid epidemic. "I think it is highly acceptable to the public that an individual not be punished for doing what they could to assist another in good faith. . . . The concept of protections for lay people to administer naloxone and call for medical assistance is pretty well accepted"
Moderate Stigma about people who use drugs persists. "Public still hates people who use drugs. Many want to punish them, not treat them"
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)
Good Samaritan and liability protection laws are already well-established. "Assuming legislative support, existing legislative language from some states could be used as a model"
Moderate More complex to implement than provider protections, particularly with regard to law enforcement personnel and the expansiveness of protections to adjacent illegal activities (e.g., parole violation, possession). "Each state would need to promote these changes at a state/municipality level. It might be difficult to get all levels of law enforcement on board"
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. Could even be cost-saving with the reduction in costs from legal issues. "There should be minimal cost to extending liability protections"
Moderate Depends on the costs of naloxone and educating stakeholders (e.g., law enforcement, emergency services, public). "Depends on implementation and enforcement"
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. "Allowing more people (including those who may be using or in possession of illegal substances) to use naloxone in an emergency situation would hopefully reduce morbidity and mortality"
Moderate Impacts of policy may not reach most vulnerable populations experiencing inequities. Depends on implementation. "This should not exacerbate inequities. However, I am unsure if the most vulnerable populations at risk for overdose are the same people who will interact with laypeople who carry naloxone"
Low N/A N/A

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