Close-up of someone holding naloxone nasal spray. (Courtesy of NIH/NIDA)
Bystanders who witness an opioid overdose in a public space, restaurant or workplace only have one option under existing state law: call 911 and wait for help to arrive.
But waiting puts lives at risk, said Rep. Brian Mulder, R-Sioux Falls.
Under current law, medications used to treat opioid overdoses in emergency situations — such as naloxone, often delivered as Narcan nasal spray — are only able to be purchased and carried by first responders, nurses and people who know someone at risk of overdose.
That will change on July 1.
Mulder introduced and passed a bill through the South Dakota Legislature this session that will allow employers to purchase opioid antagonists and make them available for employees or members of the public to use in an emergency. The bill sailed through the House and Senate with unanimous approval, and Gov. Kristi Noem signed the bill into law on March 8.
“I saw it as a win-win for the public to access this and administer it to people in need as soon as possible,” Mulder said.
Mulder originally started working on the bill with Avera Health to expand access to Narcan to assisted living facilities, where residents could overdose because of a bad reaction to a drug but don’t have direct access to a nurse, said Avera Vice President of Public Policy Kim Malsam-Rysdon.
Narcan is poised to be sold over the counter, after a committee of advisers to the Food and Drug Administration last month voted in favor of making Narcan available without a prescription. However, Malsam-Rysdon didn’t see the point in waiting, since it could be years until that happens.
“Why wait?” Malsam-Rysdon said.
Mulder wanted to make it more accessible. He envisions making opioid antagonists widely available, like the ubiquitous nature of defibrillators for cardiac arrests in a public space.
Opioids include prescription medications, heroin and fentanyl. Opioid-related deaths continue to grow in South Dakota and have doubled from 21 to 43 in the last decade.
“The only number I can think is appropriate in that statistic is zero,” said Matt Stanley, psychiatrist and clinical vice president of behavioral health services at Avera.
Malsam-Rysdon and Stanley emphasized that Narcan does not have a negative effect on someone if it’s administered and they aren’t actually suffering from an opioid overdose. The medication also does not give people the sensation of a high — it actually kicks them right into withdrawal — and is relatively easy to administer with instructions.
“We have to do everything we can in terms of resources to control this,” Stanley said. “These are lives that shouldn’t be lost.”
Mulder envisions Narcan will be beneficial in spaces such as homeless shelters, bars or restaurants that vulnerable populations frequent, or at companies such as Mulder’s employer, Volunteers of America-Dakotas, which offers residential treatment programs and assessments for people with chemical dependency issues.
The state Department of Health is redeveloping training for the public, and the “Avoid Opioid” media campaign will be updated to include awareness about the availability of Narcan and how it works, said Director of the Division of Healthcare Access Emily Kiel.
“Our department and the Department of Social Services are collaborating to promote and improve access to naloxone across South Dakota,” Kiel wrote in an emailed statement. “True to the recent legislation, these efforts will increase for targeted populations, including employers.”
Avera does not have any intentions to spread awareness about the bill to South Dakota employers, and the Greater Sioux Falls Chamber of Commerce also does not plan to give word to its members, said Jennie Doyen, chamber vice president of member services.
Stanley said it isn’t necessary that opioid antagonists are everywhere or that every employer takes advantage of the law. He said the beauty of the bill is that it isn’t a mandate, so employers decide what their employees and customers need.
Employers need a standing order from a provider before purchasing the medication. A can of Narcan nasal spray can range from $25 to $80.
How the medicine is stored will be up to the business. It can be stored in emergency kits or in a Narcan dispenser, which is what Avera has in its addiction care center, Stanley said. Other states have installed Narcan boxes and Narcan vending machines in public spaces.
“You just have to think we’re going to be even more impactful the more available this is,” Malsam-Rysdon said.
Update: This article was updated after it originally published to include comments from the South Dakota Department of Health about increasing awareness efforts about Narcan’s availability for the public and employers.
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