Naloxone Toolkit Content

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 Trump administration 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, or visit https://www.whitehouse.gov/ondcp/key-issues/fentanyl for more information. 

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. Included under the Comprehensive Opioid Abuse Site-Based Program is support for overdose outreach projects, which can connect overdose survivors with treatment and recovery services, including naloxone, and educate communities on overdose prevention. BJA recently announced the 50 communities and organizations who were awarded funding for Category 1 through 6 of the fiscal year (FY) 2017 Comprehensive Opioid Abuse Site-based Program, and the four awardees that will receive funding under the COAP TTA Program. Read more about each award on BJA's website. FY 2018 solicitations will be announced here when they are released in early 2018.

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 website.

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) recently made funding awards for more than $43 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 were made available through the following three grants:

  • Medication-Assisted Treatment and Prescription Drugs Opioid Addiction: Provides $31 million to six grantees to increase access of medication-assisted treatment (MAT) for opioid use disorder. MAT combines behavioral therapy and FDA-approved medication.
  • First Responders: Provides $11.2 million to 21 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: Provides $1 million 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 were due Monday, July 31, 2017. View the resources below to learn about the funding opportunities. To view the recipients of each award, visit the SAMHSA Grant Announcements and Awards page.

Resources:

First Responders - Comprehensive Addiction and Recovery Act Cooperative Agreement

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May, 2017
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The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is accepting applications for fiscal year (FY) 2017 First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Cooperative Agreements. SAMHSA will award FR-CARA funds to states, tribes and tribal organizations, and local governmental entities. Local governmental entities include, but are not limited to, municipal corporations, counties, cities, boroughs, incorporated towns, and townships.

Improving Access to Overdose Treatment

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May, 2017
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The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is accepting applications for fiscal year (FY) 2017 Improving Access to Overdose Treatment (Short Title: OD Treatment Access). SAMHSA will award OD Treatment Access funds to a Federally Qualified Health Center (FQHC), Opioid Treatment Program, or practitioner who has a waiver to prescribe buprenorphine to expand access to Food and Drug Administration (FDA)-approved drugs or devices for emergency treatment of known or suspected opioid overdose.

Medication Assisted Treatment - Prescription Drug and Opioid Addiction

Date: 
May, 2017
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The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), is accepting applications for fiscal year (FY) 2017 Targeted Capacity Expansion: Medication Assisted Treatment - Prescription Drug and Opioid Addiction (MAT-PDOA) grants. The purpose of this program is to expand/enhance access to medication-assisted treatment (MAT) services for persons with an opioid use disorder seeking or receiving MAT.

SAMHSA Use of Funds for Naloxone

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Apr, 2014
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A letter that summarizes funding opportunities for naloxone available through the Substance Abuse and Mental Health Services Administration (SAMHSA).

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.

Several options exist for providing training to law enforcement overdose response program participants.

One model is for the training to be provided by the staff of the local hospital, another health facility, health department, or EMS service. In these situations, the same medical organization often acts as a liaison for the naloxone supply. Some law enforcement agencies have an existing emergency response training infrastructure to maintain required first aid and first responder certifications. Depending on the organization’s internal capabilities, this training may be provided by a designated training officer, who often has additional medical training, or provided by staff of the external health agencies. Opioid overdose response training can be incorporated into this existing training infrastructure.

Another option is for a community-based organization providing naloxone access to members of the public to provide such training.

A third option is for the training to be organized at the state or county level using a distance learning or train-the-trainer model. E-learning tools may be especially useful for rural and tribal agencies.

By including presentations from law enforcement professionals in opioid overdose trainings, agencies can take advantage of the benefits of peer-to-peer learning, thus improving uptake and retention.

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.

Most trainings also cover some combination of the following content:

  • Drug abuse basics, including the chronic nature of addiction
  • Mechanisms by which opioids can cause overdoses and the reversal properties of naloxone
  • Occupational safety considerations
  • Legal considerations, including naloxone authorization and applicable Good Samaritan laws or policy provisions covering overdose victims and bystanders
  • Standard operating procedures for the administration of naloxone
  • Overdose education and naloxone distribution programs available to community members
  • Substance abuse treatment resources available in the jurisdiction

Programs that meet best practices cover information and skills that equip officers to engage in prevention and treatment program referral. The particular mix of training content and delivery channels depends on local needs and circumstances. Employees who hold existing medical response certifications such as CPR or basic life support may require an abridged training.

There are a number of existing resources to help agencies design their own law enforcement overdose response training. Sample training curriculum can be found below.

Resources:

High Intensity Drug Trafficking Area (HIDTA) Training

Indianapolis (IN) Metropolitan Police Department Training Presentation

Massachusetts Department of Public Health Core Competencies

New York City Train the Trainer

Norfolk County (MA) Naloxone Training

Opioid Overdose and Intranasal Naloxone Training for Law Enforcement - Trainer's Guide

Rhode Island Law Enforcement Officer Toolkit

Suffolk County, NY, Police Department Training Presentation

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. See the 2014 Policy Inventory: State Action to Prevent and Treat Prescription Drug Abuse resource. 

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. Any triage plans developed with EMS and fire agencies can also be reflected in the department’s SOP.

A list of sample procedures from a variety of jurisdictions are available for download below.

Resources:

Lorain Police Department Policy and Procedure

New York City Pilot Policy and Procedure

Norwood Overdose Police Department Policy

Rhode Island State Police Policy and Procedure

Vermont State Police Naloxone Policy and Procedure

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