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. In multiple drug overdoses (e.g., an opioid and a benzodiazepine) it is still worth administering naloxone as it will remove the effects of the opioid and may still reverse the overdose.
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.
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). See a list of existing law enforcement overdose response programs.
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Below are a few example law enforcement agencies that have overdose response programs:
Quincy, MA, Police Department
The Quincy, MA, Police Department (QPD) launched its law enforcement overdose reversal program in 2010. Created in partnership with the Massachusetts Department of Public Health, this initiative consisted of training patrol officers how to recognize and reverse opioid overdoses, and equipping them with naloxone. As of October 2015, QPD officers have reversed over 436 opioid overdoses. This program has been widely recognized for its contribution to the fight against the overdose epidemic, and has served as a model for a growing number of law enforcement overdose reversal initiatives across the United States.
Suffolk County (NY) Police Department
Example: In May 2012, the Suffolk County (NY) Police Department began a Narcan Pilot program in conjunction with the New York State Department of Health, initially training 400 officers in several precincts. In the first five months there were 32 opioid overdose (OOD) reversals. Because of this unanticipated success, the Narcan program was quickly expanded to the entire patrol and support divisions. As of October 2015, more than 1,300 officers are certified and there have been 390 successful OOD reversals. In April 2014, the New York State Attorney General, Eric T. Schneiderman, recognized the outstanding success of the Suffolk County Police Narcan Program, which he used as a model for implementation to all law enforcement agencies in the state of New York, an effort currently funded by his office.
Lummi Nation Police Department (WA)
In response to the increase in the number of reported overdose deaths on tribal lands and 20-minute ambulance response times, the Lummi Nation Police Department (WA) requested permission to participate in the overdose prevention program sponsored by the Lummi Nation Tribe. The program trained community members to use naloxone as well as 20 officers in the department and command staff. In the first six weeks of the program, Lummi officers successfully reversed three overdoses. In addition to training the remaining Lummi officers, the Lummi Nation Police Department training is growing to encompass Lummi Housing Security and neighboring First Nations police agencies.
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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. 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.
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Are there any collective bargaining issues associated with law enforcement overdose rescue programs?
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. Additionally, some union representatives conditioned their agreement on the agency’s explicit policy not to discipline officers if their agency-supplied naloxone kit is lost or stolen.
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.
Depending on the law enforcement agency’s particular role, jurisdiction, and design of emergency medical services, some law enforcement officers may be well-positioned to reverse a substantial number of acute overdoses. Regardless, all law enforcement agencies should weigh overdose rescue as a potential tool that may be appropriate. Efforts to equip law enforcement agencies with naloxone (see What is a law enforcement overdose reversal program?) should prioritize settings where law enforcement personnel may come into contact with opioid overdose victims at least two to four minutes before emergency medical personnel. Law enforcement overdose reversal training and naloxone supply are particularly beneficial to rural, tribal, and other high-risk settings where professional emergency medical response may be significantly delayed by geographic, resource, and other factors.
Whether or not an agency starts an overdose reversal program using naloxone, comprehensive overdose prevention programs can integrate other key elements. This includes community and school education about signs and symptoms of overdose, information about safe drug storage, prescription drug take-backs, and encouraging help-seeking among high-risk groups.
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.
On rare occasions, reviving an opioid overdose victim may restart existing health problems or uncover the effect of other drugs the victim had taken. This may result in heart palpitations or seizures. In all cases of overdose, it is critical victims be transferred to the care of medical professionals.
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.
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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).