According to an interactive policy
map at
lawatlas.org, 39 states now have laws immunizing a layperson ad- ministrator of naloxone from criminal prosecution. Thirty states, including Texas, have laws shielding a prescrib- er of naloxone from criminal prosecu- tion for prescribing it to a layperson. Dr. Kowalchuk, who administered
naloxone in her residency days, notes there’s a difference between the ver- sion of naloxone physicians use in a hospital setting and the product the standing orders make available. Phy- sicians in a hospital setting typically administer the drug at higher doses than laypeople administer in the com- mercial product. The higher dose can cause acute withdrawal. “Typically, in the hospital we were
always told, ‘Push and duck,’ because the person’s going to come up very not happy with you,” Dr. Kowalchuk said. “That’s not a concern so much with these overdose kit products because it’s enough of a dose to … reverse the respiratory depression and the over- dose, but it’s usually not enough to put them in acute withdrawal. Although sometimes it takes a little bit of the high away, and so they’ll want to use again.
“That’s where you really need the education of the person who’s going to be using the overdose kit for their loved one or their associate, and that they do need to stay with the person, encourage them not to use [the opiate] on top of it, and get them appropriate medical care emergently.” Noting naloxone use isn’t a “be-all,
end-all,” she says the effects of the nal- oxone overdose kit last only between 30 minutes to 90 minutes, while the effects of opioids can last four hours to 12 hours or more. “They still need treatment imme-
diately after this kit is used for them,” she said. In addition to supporting SB 1462,
TMA has adopted comprehensive policy on opioid overdose prevention and prescription drug monitoring. TMA advocates legislation reducing
September 2016 TEXAS MEDICINE 51
OPIOID DEATHS ON THE RISE
Opioid overdose deaths increased a drastic 200 percent from 2000 to 2014, according to a U.S. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, tma.tips/OpioidMMWR, released at the beginning of this year. CDC also found:
• In 2014, 28,647 drug overdose deaths involved some type of opioid, accounting for 61 percent of all drug overdose deaths.
• Synthetic opioids other than methadone accounted for the largest increase in the rate of drug overdose deaths from 2013 to 2014, nearly doubling to 1.8 per 100,000 population.
• Heroin overdose death rates rose by 26 percent from 2013 to 2014 and more than tripled since 2010, with 3.4 heroin overdoses per 100,000 population in 2014.
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