Corey Davis

Unlike how they regulate the far more deadly drug products tobacco and alcohol, states overwhelmingly continue to treat individuals who use illicit drugs as criminals, and state law is oriented towards arresting, prosecuting, and incarcerating them. A few states, however, have made more significant changes, and some have made less drastic but still important changes.

Variations among jurisdictions in determining and reporting causes of death and delays in obtaining and reporting fatality data often result in an incomplete and out-of-date view of the overdose epidemic in the U.S. It is imperative that health departments, harm reduction organizations, and people who use drugs are provided with accurate, timely and actionable information on drug-related overdose. This fact sheet provides a snapshot of current laws, regulations, and sub-regulatory sources governing mandatory disease reporting and a description of the laws and regulations governing reporting of overdoses in the jurisdictions that require or explicitly permit it as of March 31, 2023.

This fact sheet details the state laws that require private insurers to cover at least one formulation of naloxone and those that reduce barriers to access naloxone where it is covered. Because these laws were written during a time when no over the counter (OTC) naloxone formulations were available, none explicitly require coverage for OTC naloxone.

In May 2021, Washington state passed a law that, among other changes, re-classified drug possession from a felony to a misdemeanor and required law enforcement officers to refer individuals to treatment at least twice before making an arrest. The law, which expires on July 1, 2023, also created the Substance Use Recovery Services Advisory Committee (SURSAC) to research best practices, create a statewide plan, and advise state lawmakers. Lawmakers are now considering whether to implement SURSAC’s 17 recommendations.

Between May 2020 and April 2021, 64% of overdose deaths in the nation involved synthetic opioids, primarily illicitly manufactured fentanyl, which is 50 to 100 times more potent than morphine. A low-cost, high-impact harm reduction strategy for reducing the risk of overdose due to fentanyl contamination comes in the form of fentanyl test strips (“FTS”).At the price of approximately one dollar per disposable strip, FTS can detect the presence of fentanyl and many fentanyl analogs in drug samples dissolved in water. This fact sheet briefly discusses the emerging evidence that supports the broad distribution of FTS as one tool to reduce fentanyl-related harm.

Equipping people who use drugs, as well as their friends and family members, with the overdose reversal medication naloxone can significantly reduce the number of opioid overdose deaths. This fact sheet discusses laws in California that protect those who respond at the scene of an overdose emergency, including by administering naloxone to a person experiencing an overdose. These laws show a clear intention by the state to encourage laypersons to respond to overdose and increase access to and use of naloxone to reduce preventable overdose death and disability.

Although it’s been shown to reduce many of the harms associated with opioid use disorder, including overdose deaths, access to the medication buprenorphine has been hampered by several legal restrictions.  The recently passed 2023 Consolidation Appropriations Act includes a provision that removes a key barrier: the X-waiver requirement, which will increase access to buprenorphine, as well as improve provider knowledge of evidence-based substance use disorder treatment, and address disparities in access to care.

On December 29, 2022, President Biden signed the 2023 Consolidation Appropriations Act (“the Act”) into law.1 Among many other provisions, the Act included substantial regulatory changes to remove barriers and promote access to evidence-based treatment of substance use disorders (“SUD”). In particular, the Act removed legal barriers to the prescription of buprenorphine for opioid use disorder (“OUD”). It also requires almost all prescribers to obtain training in the identification and treatment of SUD. Although it will add a small educational burden to most providers who prescribe controlled substances, these changes should make it easier for all prescribers to provide buprenorphine treatment to individuals with OUD and significantly expand the base of prescribers who receive at least some training in identifying and treating individuals with SUD.

Paraphernalia laws make it illegal to have, sell, or give away nearly any object used in conjunction with illegal drugs. Every state except Alaska penalizes the possession or distribution of syringes, pipes, and other objects people use to get certain drugs into their bodies. This leads to people sharing and re-using syringes, which can spread bloodborne disease like HIV and hepatitis and cause endocarditis and other deadly infections.

In 2021 drug overdose claimed the lives of nearly 108,000 people, and either by themselves or in combination with other drugs or alcohol, opioids were responsible for approximately 75 percent of these deaths. Many of these deaths could have been prevented with the administration of the opioid antagonist naloxone and, where needed, other emergency care. This fact sheet outlines modifications and other changes to laws in Tennessee to increase access to naloxone, including removal of some confusing language that previously limited the impact of state efforts to increase access to lifesaving opioid antagonist medications.

There are many reasons a person under the age of 18 may wish to obtain the life-saving overdose reversal medication naloxone or another opioid antagonist. Substance use disorders often develop in adolescence, and around 10 percent of overdoses nationally occur in youth and young adults below 26 years old.  In 2020, over 15 percent (874 out of 5,502) overdose deaths in California occurred in individuals under the age of 25.  Additionally, individuals under the age of 18 may be able to intervene in the overdose of an adult, such as a friend or family member. This fact sheet examines the legality of dispensing naloxone to minors in California.

All 50 states and the District of Columbia have modified their laws to increase access to naloxone, the standard first-line treatment for opioid overdose. While these laws have been successful in increasing access to this lifesaving medication, few explicitly address the legality of distributing and administering naloxone that is past its expiration date. This fact sheet discusses whether Tennessee laws forbid the prescription, dispensing, distribution, possession, or administration of expired naloxone and whether medical professionals and others who take such actions might be held liable.