Naloxone Background

    The Bureau of Justice Assistance’s Law Enforcement Naloxone Toolkit is a clearinghouse of resources to support law enforcement agencies in establishing a naloxone program. The U.S. Department of Justice vows to work closely with law enforcement to help combat the opioid epidemic, including expanding access to drugs, such as naloxone, that can help reverse opioid overdose. The Law Enforcement Naloxone Toolkit provides law enforcement with the knowledge and tools needed to reduce opioid overdoses and help save lives. 

    In the toolkit you will find answers to frequent questions about naloxone and sample documents and templates, such as data collection forms, standard operating procedures, training materials, press releases, community outreach materials, and memoranda of agreement (MOA) between first responders and medical directors. These templates can be downloaded and customized for your own agency.

    On November 1, 2017, the White House announced the release of the Fentanyl Safety Recommendations for First Responders. The Recommendations provide first responders with unified, scientific, evidence-based recommendations to protect themselves when the presence of fentanyl is suspected. The recommendations are the result of a Federal Interagency Working Group coordinated by the White House National Security Council. The U.S. Department of Justice served on the Federal Interagency Working Group and is pleased to support the release of these recommendations as a critical first step in keeping first responders safe in the field. Stakeholder associations and organizations representing the medical, public health, law enforcement, fire, emergency medical services (EMS), and occupational safety and health disciplines provided invaluable input to inform the Interagency Working Group’s efforts, and their feedback helped ensure the recommendations are operationally relevant, appropriately tailored to first responders, and conveyed in a user-friendly one-page format. In addition to the recommendations, U.S Customs and Border Protection has produced a companion training video, Fentanyl: The Real Deal, to help first responders protect themselves when the presence of fentanyl is suspected or encountered on the job.

    Download the Fentanyl Safety Recommendations for First Responders, watch the first responders' companion training video Fentanyl: The Real Deal for more information. 

    What is naloxone and why was the toolkit developed?

    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. When administered, naloxone (marketed in the past under the tradename Narcan) restores respiration within two to five minutes, and may prevent brain injury and death.  Naloxone works on overdoses caused by opioids, which includes prescription painkillers and street drugs like heroin. Naloxone has no potential for abuse.

    On October 21, 2015, public and private sector efforts were announced to address prescription drug abuse and heroin use, including the expansion of naloxone dispense programs and training on using naloxone kits. See the full list of federal, state, local, and private sector actions being taken.

    Resources:

    COPS Office Letter on Addressing the Opioid Epidemic

    Date: 
    Oct, 2014
    Contributor: 
    COPS Office
    Resource Type: 
    Resource Document

    The former Director of the Office of Community Oriented Policing Services (COPS), Ronald L. Davis, voices his support for law enforcement carrying naloxone

    Five Things You Need to Know About Naloxone

    Date: 
    Oct, 2014
    Contributor: 
    Police Foundation
    Resource Type: 
    Resource Document

    This one-page document from the Police Foundation is intended to give agency's the knowledge it needs to save lives and to improve community relationships.

    Former U.S. Attorney General Eric Holder Remarks

    Date: 
    Mar, 2014
    Contributor: 
    Department of Justice
    Resource Type: 
    Video

    In one of former U.S. Attorney General Eric Holder's weekly video addresses, he calls the rise in heroin overdoses an urgent public health crisis and vows a mix of enforcement and treatment.

    Is Narcan (naloxone) Nasal Spray approved by the U.S. Food and Drug Administration?
    image of Narcan packaging and dispenser

    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.

    How can implementing agencies benefit from an overdose reversal program using naloxone?

    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. Similarly, collaboration between law enforcement, public health, drug treatment, and other sectors on law enforcement overdose response initiatives lead to improved cross-agency communication, and helps take a public health approach to drug abuse.

    Resources:

    New York Department of Criminal Justice Services Officer Interview

    Date: 
    May, 2014
    Contributor: 
    New York State Division of Criminal Justice Service
    Resource Type: 
    Video

    New York Police Department (NYPD) Officers speaking of their experience using and administering naloxone to prevent fatal opioid overdoses. Film by Joshua Vinehout, NYS Division of Criminal Justice Services.

    Ocean County, NJ, Police Get Drug Overdose Antidote

    Date: 
    Feb, 2014
    Contributor: 
    NJTV News
    Resource Type: 
    Video

     

    Ocean County police officers learned how to administer the medication naloxone to temporarily reverse the effects of a narcotic overdose. Video courtesy of NJTV news and the Ocean County, NJ, Prosecutor's Office.

    How many law enforcement agencies have implemented naloxone programs?

    As of March 2018, law enforcement agencies in at least 41 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 website.

    What is the Law Enforcement Naloxone Toolkit?

    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:

    • Law Enforcement and Naloxone provides basic information about naloxone and why law enforcement agencies throughout the United States have implemented a naloxone program.
    • Administration of Naloxone discusses how naloxone is administered, when naloxone should be used, and side effects associated with naloxone.
    • Acquiring Naloxone addresses procurement and storage issues, as well as the cost associated with a naloxone program.
    • Law Enforcement Training discusses training options and content, including sample training briefs.
    • Liability and Risks provides information about Good Samaritan laws and occupational risk concerns associated with a naloxone program.
    • Collaboration discusses ways law enforcement can partner with other stakeholders to address opioid misuse and addiction.

    Other options within the Naloxone Toolkit for law enforcement include:

    • Search Naloxone Toolkit allows a user to search and access resources and documents in the toolkit quickly.
    • Need Assistance or Have a Question? provides an opportunity to request technical assistance or submit questions, comments, or suggestions for additional toolkit resources.
    Can I reuse the materials in this toolkit?

    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.

    Can I download a copy of this toolkit?

    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.

    Resources:

    Engaging Law Enforcement in Opioid Overdose Response: Frequently Asked Questions

    Date: 
    Sep, 2014
    Contributor: 
    Bureau of Justice Assistance
    Resource Type: 
    Resource Document

    This frequently asked question document is a compilation of the questions and associated answers of all the content included in the Naloxone Toolkit.

    Who contributed to this toolkit?

    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.

    Resources:

    Law Enforcement and Naloxone Expert Panel Members

    Date: 
    Sep, 2014
    Contributor: 
    Bureau of Justice Assistance
    Resource Type: 
    Resource Document

    Participant list for the U.S. Department of Justice Law Enforcement and Naloxone Expert Panel to advise on law enforcement and naloxone.

    How many opioid overdoses are there in the United States?

    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.

    The vast majority of opioid overdoses are accidental and result from taking inappropriate doses of opioids or mixing opioid drugs with other substances. These poisonings typically take 45-90 minutes to turn fatal, creating a critical window of opportunity for lifesaving intervention. Across the United States, law enforcement agencies are increasingly training their officers to carry naloxone in an effort to stem the tide of overdose fatalities.

    Resources:

    A Heroin Epidemic and Changing Attitudes Towards Marijuana

    Date: 
    Aug, 2014
    Contributor: 
    Police Executive Research Forum
    Resource Type: 
    Resource Document

    The summary of the Police Executive Research Forum’s National Summit on Illegal Drugs, held on April 16, 2014, in Washington, DC, which focused on two major issues: the growing epidemic of prescription opioid and heroin abuse and the legalization of marijuana in Colorado and Washington State (as well as medical marijuana in many other jurisdictions).

    What is the connection between prescription drug abuse and heroin?

    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.

    Accordingly to the National Institute on Drug Abuse, in 2010 almost 1 in 20 adolescents and adults – 12 million people – used prescription pain medication when it was not prescribed for them or only for the feeling it caused. While many believe these drugs are not dangerous because they can be prescribed by a doctor, abuse often leads to dependence.  And eventually, for some, pain medication abuse leads to heroin.

    Resources:

    National Drug Control Strategy

    Date: 
    Dec, 2014
    Contributor: 
    Office of National Drug Control Policy
    Resource Type: 
    Policy/Procedure

    The 2014 National Drug Control Strategy, a 21st century approach to drug policy that is built on decades of research demonstrating that addiction is a disease of the brain—one that can be prevented, treated, and from which people can recover. This document lays out an evidence-based plan for real drug policy reform, spanning the spectrum of effective prevention, early intervention, treatment, recovery support, criminal justice, law enforcement, and international cooperation.

    Today’s Heroin Epidemic

    Date: 
    Jul, 2015
    Contributor: 
    Centers for Disease Control and Prevention
    Resource Type: 
    Research Report

    Each month, the Centers for Disease Control and Prevention (CDC) release and monthly report called CDC Vital Signs. The July 2015 report focuses on today’s heroin epidemic and includes the latest statistics, response and prevention guidance, and what can be done at the federal, state, and provider levels.