Background on Opioids, Opioid Overdose, Naloxone, and Michigan Legislation
Introduction to Opioids and the Opioid Epidemic
Opioids are a class of natural and synthetic substances that act on the opioid receptors in the brain and body to reduce feelings of pain.1,2 This drug class encompasses everything from illegal opioids such as heroin, legal pain medications such as oxycodone and morphine, and legal and illicit synthetic opioids and its analogs such as fentanyl and carfentanil.1,2 While opioids are most known for treating pain, they can also cause other side effects such as slowed breathing, altered mood, constipation, and euphoric effects.2 These euphoric effects are often referred to as a “high” and can be addictive, which heightens opioids’ potential for misuse and abuse.3
Over the past three decades, communities across the nation have experienced the negative impacts of the opioid epidemic. According to the CDC, about 450,000 people have died from an opioid-related overdose between 1999-2018.4During that time, the dynamics of the epidemic have shifted multiple times, initially due to rises in prescription opioid deaths, leading to a rise in heroin-related deaths, and now other synthetic opioids in recent years.5 The dynamics also shift at smaller temporal and spatial scales, motivating the creation of rapid-response strategies to address spikes when, and where, they happen.
Signs of an Opioid Overdose and How to Respond
Opioid overdoses can quickly become fatal without immediate medical attention and the administration of naloxone, an opioid overdose reversal medication.
About Naloxone
Naloxone, otherwise known as Narcan or Evzio, is a life-saving medication that works to reverse opioid-related suspected overdoses.2,7-9 Once administered, naloxone blocks opioid receptor sites in the brain, which reverses respiratory depression and other negative effects of an opioid overdose.2,7 While naloxone is effective in suspected overdoses that stem from opioids in combination with other substances, it has no impact on overdoses caused by non-opioid substances alone.2,7,8 Naloxone has been shown to be safe and non-addictive,2 which is why its administration is encouraged for anyone found unresponsive.
Michigan Legislature
Naloxone Standing Order
As of 2019, all fifty states and the District of Columbia implemented a version of a Naloxone Standing Order, which increases community access to the life-saving medication naloxone.10 Michigan’s Naloxone Standing Order Law was passed in 2016 to allow individuals to obtain naloxone from a pharmacist through a standing doctor’s order from the state.8,9 Individuals at-risk of an overdose, or other community members, can purchase naloxone without having a prior prescription or identifying a specific patient.9,10 In addition, the law ensures civil immunity for healthcare professionals and community members that dispense or administer naloxone.10 When purchasing naloxone, pharmacists are required to provide information on signs of an opioid overdose, proper steps to take when someone is overdosing, and how to administer naloxone.8
Good Samaritan Law
Individuals who witness an overdose may not call emergency responders due to fear of being arrested for drug-related charges or other legal consequences.10,11 In an effort to reduce this risk, many states have implemented Good Samaritan laws that provide criminal immunity for bystanders that call emergency services for individuals experiencing a drug overdose.11 Michigan’s 2016 law specifically provides limited criminal immunity for controlled substance possession arrest, charge, and prosecution.10,11 However, unlike other states, it does not provide protections on charges related to drug paraphernalia or other related crimes.10