1110 Main Street Williamtic, CT 06226
Windhamharmreductioncoalition@gmail.com
(860) 617-8265
USING CIVIL DISOBEDIENCE TO ESTABLISH A PUBLIC
HEALTH NORM; AN OVERVIEW OF A
TRANSITIONING MODEL FOR NALOXONE
DISTRIBUTION IN CT
Chris Heneghan, Thomas McNally, Mike McNally, Windham Harm
Reduction Coalition Inc., (2012).
PA 12-159 AN ACT CONCERNING TREATMENT FOR A DRUG OVERDOSE
•
Section 1. Section 17a-714a of the general statutes is repealed and the following is
substituted in lieu thereof (Effective October 1, 2012):
A licensed health care professional who is permitted by law to prescribe an opioid
antagonist may, if acting with reasonable care, prescribe, dispense or administer
an opioid antagonist [to a drug user in need of such intervention] to treat or
prevent a drug overdose without being liable for damages [to such person] in a
civil action or subject to criminal prosecution for prescribing, dispensing or
administering such opioid antagonist or for any subsequent use of such opioid
antagonist. For purposes of this section, “opioid antagonist” means naloxone
hydrochloride or any other similarly acting and equally safe drug approved by the
federal Food and Drug Administration for the treatment of drug overdose.
•
Section 2. (Effective October 1, 2012) Not later than January 15, 2013, the
Commissioner of Mental Health and Addiction Services shall report, in accordance
with the provisions of section 11-4a of the general statutes, to the joint standing
committee of the General Assembly having cognizance of matters relating to
public health concerning the number of opioid antagonist prescriptions issued
under programs administered by the Department of Mental Health and Addiction
Services to persons other than drug users for self-administration of the opioid
antagonist, in accordance with section 17a-714a of the general statutes, as
amended by this act.
PUBLIC ACT 12-159 WHAT WILL IT DO?
• Effective in Connecticut as of October 1, 2012,
prescribers can prescribe, dispense or
administer Naloxone (Narcan) to persons
other than drug users to treat or prevent a
drug overdose.
PUBLIC ACT 12-159 WHAT IT DOES NOT DO?
• No Protection from Civil Liability for Lay administration
• No Protection from Criminal Liability for Lay Administration
• No Protection from Unauthorized Practice of Medicine for Lay Administration.
• No Protection from Criminal Liability for the Possession of Naloxone w/o a Prescription
• No State Program Created to Prevent OD Deaths through Naloxone Prescription
Access.
• No funding allocation for DMAHS Behavioral Health Programs or SEPs
• No 3rd Party Prescription Coverage
(Davis, The Network for Public Health Law 2012.)
WHAT IS CIVIL DISOBEDIENCE?
•
The concept of civil disobedience has deep roots in American political,
social and cultural history. (Loesch,1991) Acts of civil disobedience
highlight injustices in society. Civil disobedience is one means of taking
action to bring about change. Civil Disobedience is conscious and public
statement about the injustice of the status quo. The degree of attention
society give to such acts may vary but one purpose of civil disobedience is
to demonstrate to society and the governing bodies that oversee it that the
existing laws are unjust. In order for physicians and other health care
providers to legally pursue civil disobedience, they must be willing to
accept the consequences associated with their actions. (Lazarini 2000)
What is the injustice?
• Current legislation maintains existing barriers to Naloxone Access
for SEP members who do not have a PCP, or do not have a clinical
relationship CT DMHAS funded behavioral health programs…
• No legal protection for lay distribution or administration under
current Connecticut Law…
THE PROBLEM OF DRUG OVERDOSES IN CT
300
Not opioid
involved
250
Polyopioid
Count
200
Methadone only
150
Single prescription
opioids other than
methadone
100
50
1997
Heroin only
1998
1999
2000
2001
2002
2003
2004
2005
2006
• Leading cause of
adult injury death,
more than deaths
due to MVA, fire,
firearms combined
• For every fatal
overdose that occurs
in a community there
are seven non- fatal
overdoses.
2007
TC Green, LE Grau, HW Carver, M Kinzly, R Heimer. Epidemiologic and geographic trends in fatal opioid
intoxications in Connecticut, USA: 1997-2007. Drug and Alcohol Dependence (2011).
A Transitional Model Our Philosophy
• WHRC’s transitional model aims to strike a balance between what we as Harm
Reductionist believe the ideal norm for public health practice should be, and the
existing norm for public health practice in CT.
• We seek to strengthen existing community partnerships and are working to build
a state wide prescribing network in collaboration with DMHAS at community
based health centers.
• We contribute to and acknowledge the importance of legislative work on this
issue, but also believe that to effectively fight this epidemic we can not wait for
the legislative balance to tip into the arena of ethical public health practice. It may
never happen.
• Thought the state may condone prohibitive policy responsible for the erroneous
deprivation of life of individuals involved with drugs we as Harm Reductionists will
not!
20
18
Overdose Response in WHRC Peer Networks
69.2% of respondents
who reported access to
naloxone since March
2012, reported
receiving Naloxone from
WHRC.
30.8% of respondents
who reported access to
Naloxone since March
2012, reported receiving
Naloxone from a peer
who obtained Naloxone
from WHRC.
16
Witnessed OD
14
Did Not Witness OD
Naloxone
12
No Naloxone
No Response
10
8
6
4
2
0
Witnessed OD Did Not Witness OD
Naloxone
No Naloxone
No Response
WHO ADMINISTERED NALOXONE
12
10
8
6
4
Family_Friend
2
Police
EMS
No Response
0
Family_Friend
Police
EMS
No Response
77.2% of respondents
reported being
aware that any
person can request a
prescription for
Naloxone from a
prescriber in
Connecticut to
prevent overdose.
Number of ODs in Relation to Doses of Naloxone Given
Six
Five
Four
Num of Doses Given
Three
Num of OD Witnesses
Two
One
Zero
0
2
4
6
8
10
Naloxone was
administered in
only 34% of all
reported opioid
overdoses
witnessed by
respondents
between March
2012, and October
2012.
NUMBER OF ODs WITNESSED BY RESPONDENTS BY TOWN
March 2012 – April 2012
Town
Reported ODs
Willimantic 41
Coventry
5
Lebanon
5
Plainfield
3
Hampton
1
• Participants reported 19
successful reversals using
Naloxone received from
WHRC.
• It is estimated that 5 of these
55 reported overdoses were
fatal.
5
1
3
41
5