Marlene Busko

October 02, 2015

UPDATED October 10, 2015 // DENVER — Naloxone, the potentially life-saving opioid antagonist, needs to be readily accessible to first responders and caregivers who come in contact with people who might overdose on opioids, such as heroin or oxycodone, according to physicians here at the American Academy of Family Physicians (AAFP) 2015 Congress of Delegates.

Delegates voted in favor of a resolution that supports laws that "allow first responders and nonmedical personnel to possess and administer naloxone in emergency situations."

Some states have recently passed such legislation; however, in many states, "if a first responder comes across you at home and you're not breathing and you have overdosed on opioids, they can't give you naloxone," outgoing AAFP President Robert Wergin, MD, from Milford, Nebraska, told Medscape Medical News before the vote.

"Most of us are incredibly supportive about saving lives with naloxone," said incoming AAFP President Wanda Filer, MD, from York, Pennsylvania. She explained that in most of the more than 20 states she has visited in the past few years, there are huge issues related to opiate abuse, particularly heroin.

Pennsylvania is one of several states that has enacted legislation to allow more people to give naloxone. "From my personal experience, separate from the academy, I think it is working very well," she told Medscape Medical News.

This is a no-brainer to us. Naloxone needs to be available to save a life.

Families can have naloxone at home and police officers often have it in their cruisers, so if they're first on a scene of opioid abuse, they can administer it and save a life. "This is a no-brainer to us. Naloxone needs to be available to save a life," Dr Filer explained.

The resolution also states that the AAFP supports "policies which allow licensed providers to prescribe naloxone to patients using opioids or other individuals in close contact with those patients," and "legislation which protects any individuals who administer naloxone from prosecution for practicing medicine without a license."

A student delegate from Pennsylvania reported that student delegates "wholeheartedly support this resolution," with one caveat: the naloxone type should not be limited to autoinjector pens.

The resolution shied away from specifically recommending the naloxone autoinjector as opposed to the intranasal format because, at an earlier hearing of the reference committee on advocacy, delegates testified that the cost of the naloxone hydrochloride autoinjector (Evzio, Kaléo) can be prohibitive.

According to the AAFP, 17 states and the District of Columbia have already enacted legislation that supports the planning and development of expanded naloxone administration programs to prevent deaths from life-threatening opioid overdose.

The resolution to expand the use of naloxone — resolution 501 — was brought forward at the hearing of the reference committee on advocacy by the California chapter. California delegate Jeff Luther, MD, from Long Beach, said his group feels that it is important for the AAFP to have a position on this.

Accessible on the Front Lines

Other societies are also working toward broadening accessibility to naloxone. The American Medical Association "very strongly supports the initiative of getting naloxone out to the front lines and making it more accessible to high-risk individuals," said a delegate from Washington.

Delaware has enacted laws to expand the use of naloxone, but the procedure is onerous, according to a delegate from that state. To be able to give naloxone to a family member in the case of an overdose of opioid painkillers, a prescription from the head of the state health department must be obtained, an out-of-pocket $50 fee must be paid, and a class must be completed that might not be offered very often.

"Tennessee is ahead of the curve," Lee Carter, MD, a delegate from that state was happy to announce. "We've been there and done that, with specific language that protects the physician" from any litigation.

Similarly, "Massachusetts already has this legislation, so we are able to dispense naloxone," said a delegate from that state. However, she also highlighted the issue of cost.

"The autoinjector costs $600 and nasal naloxone costs our office $25," she said. "Needless to say, we chose nasal naloxone."

The residents congress also passed a resolution asking the AAFP to push for price reductions and expanded rebate agreements for naloxone, according to Stewart Decker, MD, from Cascades East Family Medicine Residency Program in Klamath Falls, Oregon.

This story was updated to correct an error in the cost of the autoinjector, which erroneously stated that the price increased by 50% during the past 2 years.


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