A nasal administration kit typically includes a zippered bag, two doses of naloxone, two nasal misters, directions on appropriate use, and, in some instances, latex gloves. EVZIO® is dispensed in a package containing two auto-injectors containing naloxone and one trainer device (without naloxone or needle).
Naloxone is a prescription medication, but it is not a controlled substance. This means authorization is needed to allow possession and administration of the drug by first responders. In most cases, a protocol called a “standing order” can be issued for the entire department by any provider holding a license to write prescriptions. To obtain naloxone, many law enforcement agencies implementing law enforcement overdose response programs have collaborated with physicians from the state or local departments of health, local EMS agencies, hospitals, or community organizations. Typically the agency signs a memorandum of agreement (MOA), or another agreement, to formalize the collaboration with the authorizing healthcare or public health agencies. A list of sample MOAs is available as part of this Toolkit.
In the case of large departments, the agency’s medical director or other licensed staff prescribers may provide medical oversight to the naloxone program.
Some states have made it easier for law enforcement officers to access naloxone. For example, at least one state’s Board of Pharmacy (New York) streamlined the process through which law enforcement agencies can order the medication, allowing them to purchase naloxone directly from a wholesaler instead of receiving it from a retail pharmacy via a prescription from a health care provider. Other states have supported agreements between law enforcement overdose response programs and EMS agencies to handle purchasing and training. Other states have supported agreements between law enforcement overdose response programs and EMS agencies to handle purchasing and training.
With proper authorization, law enforcement overdose response programs can access any naloxone product currently available on the market. For the discussion on the differences in these products, see Administration of Naloxone.
Ideally, each opioid overdose victim can receive timely attention from emergency medical responders, just like the entire range of other accidents during which law enforcement officers routinely step up to provide first aid, including instances of motor vehicle accidents and heart attacks. In most situations, during overdose events law enforcement officers work in coordination with other first responders. Depending on the design of emergency services in the jurisdiction and the geographical setting, law enforcement officers may be in the position to save lives by providing the initial emergency assistance. Any follow-up assistance, including medical transport (or refusals of medical attention) are typically handled by emergency medical responders.
Even when emergency medical responders are already present on the scene, those responders may request assistance from law enforcement officers. This may include providing direct first aid, securing the scene, or other types of support. When setting up and executing a law enforcement overdose rescue program, it is important for all three branches of the emergency response system (police, fire, and EMS) to collaborate at the scene of an overdose. Therefore, it is worthwhile to obtain buy-in from the EMS and fire service to plan for how care of the victim will flow during an overdose response.
The way law enforcement conducts themselves during overdose response events is critical to community perceptions of—and partnership with—law enforcement. Officers who are professional and create a culture of trust between first responders and members of the public maximize the chances bystanders will call 9-1-1 during overdose events. Basic outreach at the scene can help educate families, friends, and other bystanders to be vigilant for signs and symptoms of overdose, since many victims experience more than one such event over their lifetime. Additional outreach, including referral to treatment and community overdose prevention programs may be appropriate.
The easiest way for a law enforcement agency to order naloxone is to partner with a local or state public health agency, or a local healthcare agency that already has a drug procurement structure. So long as naloxone remains a prescription drug, the ability of law enforcement agencies to order the medication from a distributor will be limited by applicable state laws and regulations. For more information on these provisions, see Should every law enforcement agency get involved in an overdose prevention program?
Funds can come from a variety of sources. Some law enforcement overdose response initiatives have been funded directly out of their operational budget. Others have partnered with sister health agencies such as state or county Departments of Public Health to cover naloxone kit supplies and provide training. Naloxone supplies can also be made available through partnerships with local emergency medical services, businesses, or healthcare institutions. Forfeiture funds can be used to fund naloxone rescue kits along with training and limited overtime costs.
In January 2017, BJA released two funding opportunities as part of the Comprehensive Addiction and Recovery Act (CARA), which is the first major federal substance abuse disorder treatment and recovery legislation in 40 years. The Comprehensive Opioid Abuse Program (COAP) Training and Technical Assistance (TTA) Program and the Comprehensive Opioid Abuse Site-Based Program support CARA’s goals to address the opioid epidemic by encouraging comprehensive, cross-system, data-driven, and evidence-based planning and collaboration among stakeholders from the criminal justice field and substance abuse treatment and recovery system. Under the Comprehensive Opioid Abuse Site-Based Program there is support for overdose outreach projects, which can connect overdose survivors with treatment and recovery services, including naloxone, and educate communities on overdose prevention. The deadline for both of these solicitations was April 25, 2017. Learn more information about these solicitations, including Frequently Asked Questions.
Other federal funding opportunities include the Byrne Justice Assistance Grants (JAG) and High Intensity Drug Trafficking Area (HIDTA) grants, which may also be used to equip officers with naloxone and train them in overdose reversal and prevention. Outside funding may be predicated on certain conditions, including reporting requirements to help track overdose problems and program impact. Personnel training costs are typically covered from departments’ operational budgets, but limited funding for overtime expenditures may be available through state and federal grants. Information about JAG funds can be found on BJA's web site.
The COPS Anti-Heroin Task Force (AHTF) Program combats heroin and the unlawful distribution and trafficking of prescription opioids. COPS AHTF is a competitive grant solicitation open to state law enforcement agencies with multijurisdictional reach and interdisciplinary team (e.g., task force) structures. Under the AHTF FY 2016 grant, $5.7 million was awarded to justice agencies. Each grant is two years (24 months) in duration and there is no local match.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for over $70 million in grants over multiple years to help communities and healthcare providers prevent opioid overdose deaths and provide treatment for opioid use disorder.
Administered through SAMHSA, these funds will be made available through the following three grants:
- Medication-Assisted Treatment and Prescription Drugs Opioid Addiction: Up to $28 million to five grantees to increase access of medication-assisted treatment (MAT) for opioid use disorder. MAT combines behavioral therapy and FDA-approved medication.
- First Responders: Up to $41.7 million over four years to approximately 30 grantees to train and provide resources for first responders and members of other key community sectors on carrying and administering an FDA-approved product for emergency treatment of known or suspected opioid overdose.
- Improving Access to Overdose Treatment: Up to $1 million over five years to one grantee to expand availability to overdose reversal medications in healthcare settings and to establish protocols to connect patients who have experienced a drug overdose with appropriate treatment.
Applications for these three grants are due Monday, July 31, 2017. For more information on each grant, view the resources below.
The cost of law enforcement overdose response programs consists of three main components: cost of the naloxone kits, costs to cover the delivery of training, and personnel costs.
Cost of naloxone: Depending on the specific form of naloxone used by the department, the cost of a single naloxone rescue kit ranges from approximately $22-$60 for intranasal kits. In some departments where street-level personnel always work in pairs, equipping each officer with one dose of naloxone has been deemed sufficient because a total of two doses are always available at the scene. The EVZIO® auto injector, new to the market, is now being deployed by law enforcement agencies in several states such as Illinois, Tennessee, and Virginia.
Cost of training: As a general rule, law enforcement training for overdose reversal programs is provided at no cost by a sister or a community agency. In some instances, costs for transportation and related training expenses may be covered by state grants.
Personnel costs: The time required for personnel to undergo training as part of law enforcement overdose reversal and prevention varies on case-by-case basis. Labor unions may consider opioid overdose reversal training as a change in work conditions. If trainings are mandatory and do not fall within regular workday hours, overtime coverage may be needed. There may also be a cost for retaining a medical supervisor/director to authorize naloxone access.
Naloxone is a fairly stable medication, with a shelf life between 18 months and two years. IN and IM naloxone should be stored between 59 and 86 degrees Fahrenheit, and should be kept away from direct sunlight. In most law enforcement settings, naloxone can be stored in the cab of the vehicle. Alternatively, the medication has been stored with automated external defibrillator (AED) units. Naloxone kits can be maintained by the individual officers, or alternatively issued at roll call and checked in at the end of the shift. Upon expiration, supplies of the medication should be replaced. EVZIO® maintains stability at temperatures of up to 104 degrees for six months.
Below are two Massachusetts examples of model memorandum of understandings: