Last year, the Texas Legislature passed Senate Bill 1462 by Sen. Royce West (D-Dallas), making it legal for laypeople to administer naloxone outside a medical care setting. The law cleared the way for physicians to prescribe naloxone not only to patients but also to family members or friends of those who might be at risk of an overdose. The law also allows a person or organization acting under a standing order to distribute naloxone and allows pharmacies to dispense the drug. TMA strongly supported the life-saving law.
Drug addiction and overdose are top causes of accidental injury and death among adults. Texans overdose on illegal opiates such as heroin, as well as legal prescription opioids (painkillers) such as fentanyl, hydrocodone, and oxycodone. Many deaths can be prevented if the overdose victim can take naloxone and receive emergency care, because the drug rapidly blocks the effects of the opioid, even heroin, long enough for patients to get more advanced treatment.
Since the law’s passing, Texas physicians have issued several standing orders for pharmacies to allow anyone to get the drug without a prescription from their doctor. Texas Walgreens and CVS pharmacies both have obtained standing orders for naloxone because of the new law. This summer, the Texas Pharmacy Association (TPA) announced it would implement a physician’s standing order authorizing pharmacists to dispense naloxone after they had completed a one-hour training course.
“I felt the standing order was important because we’re currently in a historic opioid epidemic in our country and our state,” said Austin addiction psychiatrist Carlos Tirado, MD, who issued the standing order for TPA.
Alicia Kowalchuk, DO, an assistant professor in Baylor College of Medicine’s Department of Family and Community Medicine, wrote the blanket order for Walgreens. But she cautions that naloxone is not a “be-all, end-all,” as the effects of the overdose kit last only 30 to 90 minutes, while the effects of opioids can last four hours to 12 hours or more.
“They still need treatment immediately after this kit is used for them,” Dr. Kowalchuk said. “That’s where you really need the education of the person who’s going to be using the overdose kit for their loved one or their associate, … that they do need to stay with the person, encourage them to not use [the opiate] on top of it, and get them appropriate medical care emergently.”
While the law theoretically makes naloxone more available, the rising cost of the drug in recent years has physicians concerned that lower-income Texans are being priced out of the life-saving medication.
“The price has certainly gone up quite a bit, and health plans, regulators, and consumers should certainly demand that the price of this medication does not become inflated. There is too much at stake for people not to have access to this medication,” said Dr. Tirado.
TMA has adopted comprehensive policy on opioid overdose prevention and prescription drug monitoring. TMA supports “Good Samaritan” legislation that would in certain situations legally protect drug users who request emergency assistance for a fellow user who overdoses. TMA wants to continue working with lawmakers to develop a Good Samaritan law for Texas.
Meanwhile, Texas physicians are working to raise awareness of prescription drug abuse and lessen the stigma associated with opioid addicts.
“The medical community by and large understands that this disorder is more than just having a weak will or being an unfit or delinquent person or a person fundamentally lacking in moral character,” Dr. Tirado said. “As more good research on the neurobiology of addiction comes out, we’re going to see even more awareness and acceptance of the fact that addiction, if we’re really going to deal with it effectively in our culture, is better addressed as a chronic relapsing condition, as a public health matter, and not necessarily as a legal and moral matter.”