Don't wait until an employee or customer overdoses on opioids at your business to consider implementing a workplace naloxone program. Naloxone is a life-saving opioid overdose treatment that is administered as a nasal spray and is commonly known by its brand name, Narcan.

In 2018, the U.S. Surgeon General called for workplaces and businesses to stock Narcan and train their employees on administering the nasal spray, just as many employers already do for CPR, defibrillators, and EpiPens. Since then, some employers have voluntarily incorporated naloxone training into their workplace safety programs. This article discusses several considerations employers should assess before deciding to implement naloxone training. The article does not discuss policies and procedures governing workplace administration of naloxone, though Venable can and does assist with developing them into workplace safety programs.

Assessing the Need for a Naloxone Program

Employers should consider the likelihood of an opioid overdose occurring in the workplace or on workplace grounds before implementing a naloxone program. Factors to consider include:

  • Open to the Public. Businesses and places that are open to the public-such as restaurants, bars, hotels, malls, theaters, stadiums, stores, libraries, and parks-may encounter clients or customers on their premises who are experiencing an overdose. Offering naloxone training to service industry employees may save the lives of patrons and, in turn, lessen business disruptions and enhance the company's reputation in the community.
  • Industry. The Centers for Disease Control and Prevention (CDC) has publicized that industries with high rates of workplace injuries, such as construction, transportation, and warehousing, have workers who are at higher risk of opioid addiction and higher opioid overdose death rates. Employees in those industries are sometimes initially prescribed opioids to manage pain arising from slips, trips, falls, and heavy workloads, which leads to misuse, dependence, and ultimately heroin use. The CDC has also publicized that rates are higher in occupations with lower availability of paid sick leave and lower job security.
  • Geographic Location. The opioid crisis is severe in most parts of the country. Employers who decide that it isn't that bad in the areas where they operate should reevaluate their decision periodically, because rates are constantly changing. Employers can obtain solid opioid use, abuse, overdose, and overdose death data from the CDC's website. For example, the CDC even has a color-coded map of prescription opioid dispensing rates by county across the United States, so that employers can contemplate potential future trends.
  • Past Evidence of Drug Use On-Site. If there has been evidence of opioid drug use on your workplace grounds in the past (such as finding drugs, needles, or other paraphernalia), that is a factor that weighs in favor of implementing a naloxone training program.

Naloxone Access Laws

Employers should also consider the liability and legal implications of integrating naloxone training into their workplace safety programs. All 50 states and the District of Columbia have some form of naloxone access law. Naloxone access laws vary significantly by state and cover a broad range of topics, from immunity for individuals prescribing, dispensing, and/or administering naloxone, to naloxone in schools and laws applying to health insurers. Aspects of naloxone access laws that employers should evaluate include the level of immunity provided to laypersons who administer naloxone, any training/education requirements before a person can administer naloxone, and whether an individual can obtain naloxone without a prescription.

Good Samaritan Laws

A majority of states and the District of Columbia have enacted Good Samaritan laws that specifically protect laypersons who administer naloxone in good faith, in an emergency, from both civil and criminal liability. Other states provide only civil immunity, and a few provide only criminal immunity. For states like Delaware and South Dakota, that do not have a naloxone-specific Good Samaritan law, the state's general Good Samaritan law would still apply to aiding someone suffering an overdose.

Narcan-related litigation tends to be brought against healthcare providers for failure to administer Narcan, and indeed, Venable's review of the caselaw did not turn up a single case against a Good Samaritan. Moreover, the theoretical risk of such liability is minimal, considering that side effects from naloxone are very rare and allergic reactions to naloxone are very uncommon. Indeed, the CDC has said that "even if the cause of unconsciousness is uncertain, giving naloxone is not likely to cause further harm to a person" and "only in rare cases would naloxone cause acute opioid withdrawal symptoms." Overall, the life-saving benefits of using naloxone during an overdose far outweigh the risk of litigation.

Training

Several states, including Maryland, require individuals to receive training before administering naloxone. Local health departments and community-based organizations usually provide the training free of charge upon request. Training typically covers overdose recognition, safe naloxone administration procedures, and potential side effects.

Possession

One of the more practical concerns for employers that want to implement naloxone training is how to obtain the Narcan nasal spray in the first place. In most states, a person can purchase naloxone at a pharmacy over the counter without a prescription. In those states where a prescription is still required, doctors or pharmacists may initiate "third-party prescriptions" for family members, friends, or other individuals who may have contact with at-risk users. Employers in certain industries or that have businesses open to the public may satisfy this latter category. Furthermore, if you choose to have employees participate in a health-department-sponsored training program, Narcan kits are usually distributed to participants.

Conclusion

Employers should consider implementing a naloxone program for the safety of their employees and the public.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.