NH Ends Prohibition of Narcan, the Heroin Overdose-Reversal Drug

State Rep Amanda Bouldin, UBER Customer

State Representative Amanda Bouldin

Free State Project early mover Amanda Bouldin was elected in Manchester in 2014 as a state representative and one of the first things she did was file a bill, HB 271, that ends prohibition on possession of Narcan.  Narcan is a trade name for Naloxone which can be administered to counter the effects of an opioid overdose – saving lives.  Until now, Narcan could only be possessed legally by EMS and police.  Now anyone who acts with “good faith and reasonable care” may store or administer the life-saving drug to a person in overdose with no criminal or civil liability.  It’s a major change that will likely result in saving the lives of multiple heroin and other opiate addicts in New Hampshire.

Bouldin is also known for her Shire Sharing organization that feeds poor families on Thanksgiving each year across the state.

Not only is the ending of Narcan prohibition a major success for a freshman legislator, it’s a big win for the Free State Project, and more proof that the 1500 early movers continue to have a significant impact.  If you love liberty and aren’t here yet, start planning your move and join the FSP!

That NH governor Maggie Hassan signed this harm-reducing legislation into law is a sign that there might be a glimmer of humanity inside her.  Now hopefully she’ll do the right thing on cannabis decriminalization if it gets passed by the senate this week.

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16 Comments

  1. I suggest you re-read what the bill is actually saying. It’s for healthcare providers who are off duty that can administer Narcan and not be subject to lawsuits ect.. It doesn’t apply to the average Joe Shmo  

    (c) No health care professional who, acting in good faith and with reasonable care, prescribes, dispenses, or distributes an opioid antagonist directly or by standing order and no person who, acting in good faith and with reasonable care, stores, dispenses, or distributes an opioid antagonist or administers an opioid antagonist to another person who the person believes is suffering an opioid-related drug overdose shall be subject to any criminal or civil liability, or any professional disciplinary action, for any action authorized by this paragraph or any outcome resulting from an action authorized by this paragraph.

    Narcan doesn’t reverse anything. It blocks the opioid receptor sites so opiods cannot be taken by the synapses. Thus your brain ect.. cannot up take the drug.  
     Narcan doesn’t last that long. Depending upon how much heroin the person took, once the Narcan wears off, they can go right back into a opioid coma or die. 
     Should a patient take heroin or another benzodiqazepine, the Narcan won’t work.  

    Should a long time opioid user be given Narcan, it can cause serious withdraw symptoms resulting in very aggressive behavior, seizures, coma and or death. Should a patient be given Narcan and it wears off, the patient could also vomit and obstruct their airway.

    Narcan can only be given through an injection, IV, or endotracheal tube. 

    Narcan is not an adjunct for all over doses. Should someone give Narcan to a person, it can block the effects of other medications. Just injecting someone with Narcan could affect seizure medications, ect..

    It is a very interesting idea but, there are a significant number of logistical problems that could arise from this.

    I occasionally get a few addicts who go through treatment who use Narcan to titrate  their high. They will hold respectable jobs and before they go to work, they take an overdose of heroin and given themselves injections in the toes, fingers, ect.. places no one can see the track-marks.  Unfortunately should something go wrong and they can’t get the injection, they go into an opioid overdose. 

    Again, the administration of this drug does nothing for marijuana or the attempt of legalizing marijuana. I wouldn’t get your hopes up.

    http://www.gencourt.state.nh.us/legislation/2015/HB0271.html

  2. Jumping Jacks Might want to work on reading.  The langauge that you quoted applies to both health care professionals and also in general to any person.

    Even if you have trouble with the clear language of the bill (“…and no person…”), the link you provided includes a plain-English analysis which states the same thing.

    Naloxone isn’t magic.  It’s an emergency treatment used to ensure someone’s survival long enough to get proper medical care.  It’s for safety in an emergency situation, not long-term care, just like an epi-pen or an AED.  As with either of those devices, mis-use can be dangerous or fatal, but the benefit of having a safety device far outweighs the risks.  Similarly to epinephrine, naloxone may be administered be syringe, or by an auto-injector.  Naloxone may also be administed intranasally using an atomizer.  Unlike epinephrine, naloxone is far safer, as accidental venous injection won’t result in v-tach.

    So, life-saving drug that can be administed by a layman, and safer than other similar emergency medicines.

  3. Jumping Jacks Oh, and since the overdose effect is the result of the interaction between the drug and the CNS, and since naloxone blocks that interaction, it does, indeed, reverse the overdose.  It does not eliminate the drug from the patient’s system, but the overdose is reversed.

  4. FlintNH Jumping Jacks I would suggest you look into pharmacology a little deeper.

  5. FlintNH Jumping Jacks You said, “The langauge that you quoted applies to both health care professionals and also in general to any person”.  No, it doesn’t apply to the general population. A citizen cannot just walk up to a person and give them Narcan. Again, re-read the bill. You can’t get Narcan without a prescription.

    You said, “Even if you have trouble with the clear language of the bill (“…and no person…”), the link you provided includes a plain-English analysis which states the same thing”.  It applies to health care professionals who are off duty. The state isn’t going to just hand out a medication like Narcan.

    You said, ” Unlike epinephrine, naloxone is far safer, as accidental venous injection won’t result in v-tach”. Narcan and epinephrine are two separate classified meds. Here is why the average person won’t be giving narcan. You are walking through an alley and you see an unconscious person. Can you tell if that person had a stroke, hypoglycemic, post seizure, or overdose. To the average citizen, you cannot tell. You don’t just start pumping medications into someone without knowing what happened.

    You said, “So, life-saving drug that can be administed by a layman, and safer than other similar emergency medicines”. All medications have side effects. If you give a medication to someone that doesn’t’ need it, bad things will happen and that includes Narcan.

    You posted your information from  a web search.  It’s not your general knowledge. That is the other reason why the civilian population will not be giving Narcan.

    Everything I posted in my first post is what I know about Narcan. I am a Nurse Practitioner certified in addiction treatment, and I own 4 drug and alcohol treatment facilities. Again, I suggest you read the bill again. You can’t get Narcan without a prescription.

  6. Jumping Jacks FlintNH You clearly cannot read.  The bill’s language is clear.  And the analysis produced by Legislative Services says the same thing: the protection applies to anyone.

    Also, “the state” does not “hand out” medications.  Medications are obtained from pharmacies.  One would imagine that a real NP would know that.

    Naloxone and epinephrine are both emergency medications.  Two compeltely separate ones (obviously – was there any purpose in pointing that out?), but both are used in life-threatening emergencies.  Giving either to someone who doesn’t need it is potentially dangerous, and epinephrine is more dangerous than naloxone, but epi-pens are available.

    Generally speaking, no one’s going to be walking around with a naloxone injector in their pocket.  Those who keep it around, will be those who actually have a potential need for it.  And, as such, will know when it is needed.  If you see someone shoot up heroin, and then go into an overdose reaction, odds are pretty good that they are overdosing on an opiate, and an opiate antagonist is appropriate.

    No medications are safe.  Hence the term “safer.”  Again, you need to work on reading.  Naloxone is much safer than epinephrine, and laypersons have been administering epinephrine for many years.  There’s always risk, but if someone is stung by a bee and then starts going into anaphylactic shock, it does not take a rocket surgeon to figure out that it’s overwhelmingly likely that it’s an allergic reaction and that epinephrine would be appropriate.

    And no, none of this is from a web search.  I, unfortunately, have had reason to know quite a bit about opiates.  When you’re a trained scientist with a spouse who’s dying of cancer and you have to manage her complex blend of meds, you tend to do the research and actually learn about these things.  And knowing how to administer naloxone when you’re handling that quantity of opiates (enough per day to kill a couple opiate-naive adults) just makes sense.

    But at least you gave me a laugh.  You claim to own “4 drug and alcohol treatment facilities,” and then follow that up with a claim that drugs cannot be obtained without a prescription.  Must not have any addicts around, then, eh?

  7. Jumping Jacks FlintNH I’m quite familiar with the pharmacology.  Naloxone blocks the receptors, reversing the overdose.  As long as the level is maintained properly, the body will have time to clear the opiate on its own (if you actually have half the training you claim, then you obviously know that opiates have a short half-life, and the level would drop below the danger threshold quickly).

  8. @Jumping Jacks @FlintNH  
    As the author of the bill and the prime sponsor, I’d like to reply to your comments. I know FlintNH has already covered most of this, but I figured I’d jump in too. I hope that with better understanding of the bill and Narcan, you can be even more effective at your job. Thanks for working with addiction. It’s a tough job, and somebody’s gotta do it.

    “I suggest you re-read what the bill is actually saying. It’s for healthcare providers who are off duty that can administer Narcan and not be subject to lawsuits ect.. It doesn’t apply to the average Joe Shmo.  
    (c) No health care professional who, acting in good faith and with reasonable care, prescribes, dispenses, or distributes an opioid antagonist directly or by standing order and no person who, acting in good faith and with reasonable care, stores, dispenses, or distributes an opioid antagonist or administers an opioid antagonist to another person who the person believes is suffering an opioid-related drug overdose shall be subject to any criminal or civil liability, or any professional disciplinary action, for any action authorized by this paragraph or any outcome resulting from an action authorized by this paragraph.”

    My reply:
    In the bill, this section means that any person – literally any person – or organization can possess and distribute Narcan. That’s anybody. The way that this is written, homeless shelters will be able to hand it out (as long as they don’t charge for it), treatment centers will be able to distribute it, etc. In MA, every person that leaves a detox or treatment facility is now sent away with a dose of Narcan. “(b) A person or organization may, if acting pursuant to the provisions of subparagraph (a), store and possess an opioid antagonist, dispense or distribute an opioid antagonist, and administer an opioid antagonist to another person who the person believes is suffering an opioid-related overdose.”

    “Narcan doesn’t reverse anything. It blocks the opioid receptor sites so opiods cannot be taken by the synapses. Thus your brain ect.. cannot up take the drug.”

    My reply:
    It seems like you’re just playing word games, but Flint NH addressed this.
    “Narcan doesn’t last that long. Depending upon how much heroin the person took, once the Narcan wears off, they can go right back into a opioid coma or die.”

    My reply:
    Right. Exactly. What’s your point? The entire purpose of take-home Narcan, the very *reason* it was invented, is to bridge the gap until emergency personnel arrive. You likely are aware that 5 minutes without breathing can cause permanent brain damage and likely death. That’s about how long it takes for the ambulance to arrive. Every person that dies of an overdose dies because they didn’t get medical help in time, period. It’s a preventable death. I met a woman in Dover whose son overdosed. They called 911 immediately. It took 18 minutes for the ambulance to arrive. They pumped him full of Narcan. He died at the hospital about 3 minutes before his mother got there. Would he still be alive today if his family had had a take-home dose of Narcan? Absolutely.

    “Should a patient take heroin or another benzodiqazepine, the Narcan won’t work.”  

    My reply:
    What’s your point? If someone overdoses on cocaine, Narcan won’t work. So what?

    “Should a long time opioid user be given Narcan, it can cause serious withdraw symptoms resulting in very aggressive behavior, seizures, coma and or death. Should a patient be given Narcan and it wears off, the patient could also vomit and obstruct their airway.”

    My reply:
    Again, what’s your point? These are true – to a point. First of all, obviously someone will be calling 911. Anyone who has Narcan will know that it’s only effective for maybe 20 minutes. Anyone who is administering Narcan is clearly interested in saving the drug user’s life. Why wouldn’t they follow through with a 911 call? It sounds like you’re saying, “If you give someone Narcan and then don’t call 911, they might die, so it’s better if you don’t have Narcan even though this will heighten the risk of death”. But secondly, I’ll point out that not everyone becomes violent when they wake up. First responders give much higher doses than you would give with a take-home Narcan kit. Oftentimes people just have restored breathing after receiving a low dose of Narcan, and they don’t wake up, and that’s A-OKAY because the goal here is to keep them breathing until the EMT arrives.

    “Narcan can only be given through an injection, IV, or endotracheal tube.”

    My reply:
    Nope… it’s a nasal spray too. It sounds to me like you got your education in Narcan a decade or two ago, maybe longer. That’s ok – in working for this legislation, I talked to a LOT of doctors who had an outdated education about Narcan. Decades ago, the drug was being administered in very high doses that caused vomiting and seizures in addicted people (obviously, not in accidental ODs or first-time users). Over the last few decades, the doses were slowly lowered until a sweet spot was found that saves lives without causing all the side effects. So yes, a long time ago, Narcan was something that only a professional should administer. But thank goodness, over time science advances and we all benefit from new knowledge.

    “Narcan is not an adjunct for all over doses. Should someone give Narcan to a person, it can block the effects of other medications. Just injecting someone with Narcan could affect seizure medications, ect..”

    My reply:
    Unless seizure medications employ opiates, I don’t see how Narcan would affect it. Narcan blocks the opioid receptors, that’s it. And again……. let me get this straight…. “You shouldn’t be allowed to bridge the gap until an ambulance arrives and prevent brain damage and death because the patient might have a seizure”??!! Is that really what you’re saying???

    “I occasionally get a few addicts who go through treatment who use Narcan to titrate  their high. They will hold respectable jobs and before they go to work, they take an overdose of heroin and given themselves injections in the toes, fingers, ect.. places no one can see the track-marks.  Unfortunately should something go wrong and they can’t get the injection, they go into an opioid overdose. ”

    My reply:
    It sounds to me like those people are being pretty responsible with their lives. Is the preferable alternative that they not have access to Narcan and instead die of overdose? Is that what you prefer? It is sad for me to see that someone involved in healthcare sees this as an enabling opportunity, as opposed to an opportunity for safety. Health care professionals are expected to value life above all else. Being judge, jury, and executioner is someone else’s job. Perhaps you’re getting jaded… that’s happens to people in your line of work, and that’s ok. I suggest a career change.

  9. FlintNH Jumping Jacks Again, you looked your info up on the internet and interpreted it wrong.

  10. Jumping Jacks FlintNH Nope, and nope.  I note that you apparently cannot address all the glaring issues with your own claims (the bill’s actual language, your notion that the state is the supplier of medications, etc. etc.).

    I don’t think you’ve managed to get even one thing correct, have you?

  11. FlintNH Jumping Jacks The bill says a prescription must be obtained by a physician to a person who is at risk of having overdoses. The bill is totally silly. Way too many flaws.

  12. AmandaBouldin You don’t seem very educated regarding Narcan and possible complications of it’s use.. The bill says, A prescription for Narcan must be received from a person who is at risk for overdoses. Even the patient’s friends and family could carry it. There are a lot of holes in this bill.

    Telling me to get a different job and your childish rantings doesn’t promote your way of thinking. You have no clue as to what Narcan can and cannot do. I suggest you re-read the bill. You are off the beam. How is an overdose patient supposed to give themselves Narcan if they are unconscious.

    http://www.wmur.com/politics/hassan-signs-bill-allowing-narcan-prescriptions/33353586

  13. FlintNH Jumping Jacks The opiates last longer than the Narcan dose. When you are talking about an addict who has a high tolerance to narcotics and they overdose, The Narcan isn’t going to last long enough to combate the opioids. I have had patinet’s who were on Narcan drips (IV) because of the amount of opioids they have taken.

  14. Jumping Jacks FlintNH No, it doesn’t.  I’m really doubting your claim of being an NP.  NP’s have to be able to read, last I heard.

  15. Jumping Jacks FlintNH The naloxone will reverse the overdose for a time.  Long enough for emergency responders to arrive.

    Very similar to epinephrine, which does nothing to combat allergens in the system; it just boosts the metabolic rate sufficiently to keep the patient alive long enough to get proper treatment.  If the patient does not get treament before the epinephrine wears off, the patient will go back into anaphylaxis due to the allergen load.

    Yet, epi-pens save lives all the time, precisely because they provide the necessary window for a medical response.

  16. Jumping Jacks AmandaBouldin The bill does not require that anyone get a prescription.  In fact, it states that someone who posesses the drug, even without a prescription, cannot be subject to any criminal liability for that possession, if they use it on someone in an overdose.

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