Police officers are often first on the scene following a 9-1-1 call. With the continued increase in deaths from opioid overdoses, the U.S. Department of Justice recognized the need to provide law enforcement with the knowledge and the tools to reverse overdoses in the field. Opioids cause death by slowing, and eventually stopping, the person’s breathing.
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Yes. In November 2015, the U.S. Food and Drug Administration approved Narcan Nasal Spray for the emergency treatment of known or suspected opioid overdose. Prior to November 2015, naloxone was FDA-approved only as an injection. See the highlights of prescribing information.
First and foremost, an overdose reversal program offers a potential lifesaving opportunity. Additionally, individual officers have cited improved job satisfaction rooted in an improved ability to “do something” at the scene of an overdose. Law enforcement agencies that have implemented an overdose reversal program report improved community relations, leading to better intelligence-gathering capabilities.
As of March 2017, law enforcement agencies in at least 38 states have implemented naloxone programs. For a list of law enforcement agencies who have implemented programs, please visit the North Carolina's Harm Reduction Coalition web site.
The Law Enforcement Naloxone Toolkit is a one-stop clearinghouse designed to answer the most frequent questions about naloxone and provide resources, such as sample standard operating procedures and training materials, to support law enforcement agencies in establishing an overdose reversal program.
You can access the information in the toolkit by using the search tool, selecting one of the six topic pages on the left-hand side, or through the links below:
The authors of the resources made available for download have generously offered their materials for your review and use. If you borrow content from any of the resources, please attribute the material to the original author and their respective agency or organization.
If you are interested in downloading a PDF of all the questions addressed in this toolkit, please follow the link below. Please note the PDF document contains the questions, but not the questions associated resource documents.
We would like to thank of all of the members of the U.S. Department of Justice’s Expert Panel on Law Enforcement and Naloxone who provided guidance on the development of the Naloxone Toolkit. In particular, we would like to recognize Leo Beletsky, JD, MPH, for his development of the document, “Engaging Law Enforcement in Opioid Overdose Response: Frequently Asked Questions” that is the basis for much of the online toolkit.
Claiming nearly 120 American lives daily, drug overdose is a true national crisis. The main driver of this epidemic is opioid overdose (OOD), which cuts across class, race, and demographic characteristics. Certain groups, including veterans, residents of rural and tribal areas, recently released inmates, and people completing drug treatment/detox programs are at an especially high risk of opioid overdose. Law enforcement officers are on the front lines of the battle against drug-related harm in our communities. The current opioid overdose crisis is no different.
Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills. Opioids are a class of prescription pain medications that includes hydrocodone, oxycodone, morphine, and methadone. Heroin belongs to the same class of drugs, and four in five heroin users started out by misusing prescription opioid pain medications.
Naloxone only works on overdoses caused by opioids. This family of drugs includes prescription painkillers like OxyContin, fentanyl, methadone, and Vicodin, as well as street drugs like heroin. Naloxone will not reverse overdose resulting from non-opioid drugs, like cocaine, benzodiazepines (“benzos”), or alcohol. Given how safe naloxone is, a victim of a non-opioid overdose, or an overdose caused by a mixture of drugs will not be harmed by naloxone.
Law enforcement overdose reversal programs are designed to teach law enforcement officers to recognize and reverse an active opioid overdose using naloxone. The idea is that providing law enforcement with the knowledge and the tools to reverse overdoses in the field can reduce the time between when an opioid overdose victim is discovered and when they receive lifesaving assistance. Law enforcement overdose rescue programs are similar to the already widespread efforts to train police in first aid and cardiopulmonary resuscitation (CPR).
Below are a few example law enforcement agencies that have overdose response programs:
Quincy, MA, Police Department
There are a number of collateral benefits to the officers, implementing agencies, as well as to the public at large that are associated with implementing a law enforcement overdose response program. First and foremost, the program can lead to the reversal of possibly fatal overdoses in the community. Additionally, individual officers have cited improved job satisfaction rooted in improved ability to “do something” at the scene of an overdose. Implementing departments report improved community relations, leading to better intelligence-gathering capabilities.
Some labor unions may consider opioid overdose response and associated training as a change in work conditions or an additional duty, raising the possibility of contract renegotiation. Collective bargaining unit representatives should be consulted early in the process and given the opportunity to address personnel and occupational safety concerns. Agencies concerned about collective bargaining issues can make officer participation in overdose reversal a voluntary activity.
Yes. This is standard practice among emergency medical personnel.
Whether it is by actually reversing acute overdoses using naloxone, by supporting effective medical response, by supporting the availability of opioid addiction treatment in the community, or by undertaking prevention activities like community education and targeted outreach, law enforcement officers have a vital role to play in curbing the overdose epidemic.
Approved by the FDA since the 1970s, naloxone is a very safe medication with the potential side effect of a theoretical risk of allergy that has never been documented. Its administration may result in acute opioid withdrawal (agitation, nausea, vomiting, diarrhea, "goose flesh", tearing, runny nose, and yawning). When victims experience these symptoms, they may become irritable and anxious. It is uncommon, however, for the revived victim to become violent or combative. Intranasal naloxone delivery is less likely to result in severe withdrawal symptoms than an injection.
Your state health department or oversight agency may have an established data collection protocol so that they can evaluate the impact of the naloxone program. A few sample data collections forms can be found below, each of which can be adapted to suit your agency’s needs.
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).
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.
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.
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.
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.
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.
Several options exist for providing training to law enforcement overdose response program participants.
There are currently no legal requirements for retraining in law enforcement overdose response programs. Just like with any other law enforcement activity, annual or other periodic re-training may be needed to ensure effective and compliant practices. In some jurisdictions, refresher trainings have become part of the annual training programs.
Law enforcement overdose response program trainings typically last from 40 to 90 minutes. At the very least, such training includes three basic elements: 1) information on how to recognize signs of an opioid overdose, 2) information on how to provide basic life support and proper administration of naloxone, and 3) an applied component providing trainees an opportunity to practice their skills. Trainings also typically include time for the completion of requisite documentation to authorize naloxone possession and administration by law enforcement officers.
In June 2014, the Association of State and Territorial Health Officials administered a survey to collect information about activities and policies to address prescription opioid abuse and overdose. Individual profiles were created for the 48 states, two U.S. territories, and one freely associated state that responded to the survey. The profiles provide an understanding of the current environment of state activities to address prescription drug abuse, ranging from prevention strategies to surveillance and monitoring (PDMPs), law enforcement, and treatment and recovery.
While not legally required, it is strongly encouraged. Each agency should establish standard operating procedures (SOPs) for law enforcement overdose response activities. These procedures should be drafted in consultation with the governing laws of the jurisdiction and any applicable collective bargaining units. If applicable, policies should integrate the provisions of relevant 9-1-1 Good Samaritan laws, as well as the department’s policy on information gathering, searches, arrests, and other activities at the scene of an overdose.
Below are several sample resource documents related to liability.
Providing first aid to an opioid overdose victim carries the same general occupational risk inherent to other first aid activities that are part of policing. Universal precautions should be taken when coming into direct contact with the overdose victim, including moving them into the recovery position, providing rescue breathing, and any other manipulation.
Generally, no. In most states, a legal concept called the Public Duty Doctrine blocks such lawsuits. This means that officers have no legal duty to assist others, even when they are in a position to do so. These protections do not apply to any administrative discipline for violating standard operating procedures.
Many communities across the country have come together to develop strategic plans to address opioid abuse, including the City of Baltimore, the State of New Jersey, the State of Pennsylvania, and the State of Wisconsin. Samples of these plans can be found on the Prescription Drug Monitoring Program Training and Technical Assistance Center web site.
See the Community Outreach Letter below for one example of you can highlight partnerships in your community.
Yes, 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.
Each state and territory offers information and support regarding substance use disorders through a state substance abuse agency. The role of a state substance abuse agency is to plan, carry out, and evaluate substance use disorder prevention, treatment, and recovery services provided to individuals and families. Specifically, they oversee treatment centers and counselors in their respective states and, in many cases, supply funding to providers, track state trends, and ensure residents receive the services to which they are entitled.
Examples of promising programs include:
Programs to encourage opioid overdose witnesses to seek help:
Many opioid overdoses are witnessed, but bystanders do not call 9-1-1 because they do not recognize the signs and symptoms of an overdose, or because they are concerned about legal repercussions.
Veterans, residents of rural and tribal areas, recently-released inmates, people completing drug treatment/detox programs, and some young adults are at an especially high risk of opioid overdose. Law enforcement and correctional officers are uniquely positioned to engage in initiatives targeting these high-risk groups, thereby helping prevent fatalities by engaging in outreach initiatives. Individuals re-entering society after a period of incarceration are especially vulnerable.
Some law enforcement agencies found it helpful to develop pocket cards or brochures that can be easily distributed. Sample pocket cards and brochures are included in the resources below.
The Substance Abuse and Mental Health Services Administration (SAMHSA) Opioid Overdose Prevention Toolkit (2016) provides communities and local governments with material to develop practices and policies to help prevent opioid-related overdoses and deaths.
Below are two Massachusetts examples of model memorandum of understandings: