Preventing Opioid Overdose Deaths through Legislation: Amending Maryland Law to Increase Access to Naloxone


In 2013, the Maryland State Legislature created the Overdose Response Program (ORP), legalizing naloxone administration by layperson bystanders to treat opioid overdoses. Modeled on laws implemented in other states and supported by numerous studies, the law sought to curtail the growing number of deaths in Maryland from opioids. However, the number of opioid overdose deaths in Maryland subsequently rose by 22% between 2013 and 2014. During the first three months of 2015, the upward trend worsened, with a 27% increase in opioid-related overdose deaths in comparison to the same period during 2014.

While the growing number of opioid overdose deaths in Maryland cannot be attributed entirely to failure of the ORP, it is clear that the program is not working as intended. On closer inspection, the ORP has a critical flaw. Unlike other states, whose laws simply provide civil and criminal immunity for laypersons who dispense naloxone in good faith, Maryland’s version allows naloxone to be administered by laypersons only after completion of a state-approved certification course supervised by a physician.

As naloxone is safe, effective, and has no abuse potential, these barriers are unnecessary. Thus, the fix is simple: The law governing Maryland’s ORP should be amended to eliminate the certification requirement for the administration of naloxone. This should be replaced by a simple immunity clause for laypersons. Naloxone is an important tool in preventing deaths from opioids, but it can only work if it is readily accessible and can be used without fear of prosecution.

Video source: Baltimore City Health Department



3 Responses to “Preventing Opioid Overdose Deaths through Legislation: Amending Maryland Law to Increase Access to Naloxone”

  1. jmcunningham3388 Says:

    I agree that naloxone is an incredibly powerful tool in treating and reversing opioid overdoses. The evidence greatly supports the safety and efficacy of this drug, and should definitely be standard issue in any emergency responder’s bag. From a patient safety standpoint, however, I do see some risks in allowing untrained bystanders give injections of naloxone to confirmed or suspected overdose cases. For instance, I am not a medical professional, and have never administered an injection of any kind – I would not feel particularly safe administering an intramuscular injection to someone without proper training. That said, provision of the intranasal spray to individuals who could come into contact with an overdose case seems like a very safe, if slightly more expensive alternative (given the cost differential between the intranasal and injection dosage forms). Kids can be trained to use their asthma inhalers and this does not seem all that different. Perhaps a policy distinction can be made whereby administration of the intranasal naloxone does not require training or a certification, but the injection version would require some training to avoid some cited safety concerns (needle stick injuries, etc.). Regardless, I also agree that the administration of naloxone in a case of overdose should not have any criminal penalty; what sense is there in punishing someone for trying to save a life?

  2. katienlilly Says:

    Very interesting article- it is so sad to see the rise of opioid deaths in our city, in spite of targeted efforts by the Maryland ORP. I definitely agree with you that criminal and civil immunity in the administration of naloxone is a key initial step toward preventing overdoses. However, it would be interesting to learn more about how other states run their naloxone distribution programs, and what kind of, if any, training is given to those who receive naloxone. I agree with the previous responder that some sort of training should be given to those who are administering the naxolone, not only to correctly give the injection, but also to be able to recognize the signs of a potential overdose. I wonder if it is not so much the training that is a barrier, but maybe it is due to not enough people being aware of the training? So much of the success of this initiative relies on people being in the right place at the “right” time (with the right training and supplies) in order to prevent an overdose. I have faith in the initiative and think that if given more time, it could have a big impact on overdose rates. However, I also believe that the issue of opioid use is multifaceted and the Maryland government needs to pay serious attention to this issue, and approach remedies from several angles, if they want to see significant reductions.

  3. jmcunningham3388 Says:

    This week, the White House announced an initiative to increase funding to curb the rise in opioid abuse along the Eastern Seaboard of the US. It is definitely a high profile issue, and Massachusetts, which has experienced major issues with heroin and other opioid overdoses, has dedicated a number of resources to combat. Proper use of Narcan is a key tenet of both the White House funding initiative and is part of MA’s strategy.

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