In a move that Idaho Gov. Brad Little called “counterproductive,” the state legislature approved, and Little signed, a measure to dismantle critical components of Idaho’s overdose prevention program and reduce public access to a life-saving overdose reversal tool. For a state that saw more than 3,000 opioid overdose deaths in 2021 alone, limiting access to naloxone will be more than counterproductive–it may be deadly.
The importance of naloxone is hard to overstate. More commonly known by the brand name Narcan, naloxone is a nasal spray that instantly blocks the effects of opioids and rapidly reverses overdose symptoms, including respiratory failure, the main cause of death from opioid overdose. It has been used as the standard care for overdose in emergency rooms for around four decades.
Even when administered by laypeople, as opposed to doctors or emergency medical providers, naloxone has a more-than-90-percent success rate. It is easy to use, cheap to manufacture, shelf-stable for years, non-addictive, and unharmful if administered to someone not overdosing on opioids. Once administered, it can restore breathing in under three minutes.
The speed of naloxone is important. When someone stops breathing, bystanders have just minutes to act before brain damage and death occur. Naloxone is more effective the sooner it is administered, but most overdoses occur at home, where bystanders, often the victim’s friends and family, may be unable to do anything other than wait and hope emergency services arrive in time to administer naloxone. When every second counts and the average wait time for emergency services is between seven and 14 minutes, having naloxone on-hand could mean the difference between life and death.
Because of its near-miraculous ability to rescue lives from the precipice of death, naloxone has become a central pillar in the global response to the opioid overdose crisis. Governments around the world have taken steps to ensure its wide availability, at little-or-no cost, among the general public, including here at home.
After receiving federal grant funding, Idaho launched its naloxone distribution and training program through its Department of Health and Welfare (IDHW) in 2017. To ensure adequate distribution across the large, sparsely populated, and rural state, IDHW in 2020 contracted out this work to the nonprofit organization Idaho Harm Reduction Project, to whom IDHW provides naloxone kits and pays around $24,000 annually for administrative costs.
After receiving the kits, the Idaho Harm Reduction Project works with local partners to get naloxone into the hands of those individuals and groups most likely to need it, including first responders, substance use treatment programs, clinics, colleges and universities, and shelters. But, when the new law takes effect on July 1, that established distribution and training network may disappear.
The change is the result of a one-sentence addition to the annual appropriations bill that funds the IDHW’s Division of Substance Abuse and Prevention specifying that “funds available for naloxone and needles shall be available only to first responders in the state of Idaho.” The funds in question are those grants provided by the federal government for states’ response to the opioid overdose crisis and which IDHW uses to purchase the naloxone kits.
Idaho’s naloxone distribution program has been effective so far. In 2022, it resulted in the distribution of over 25,000 no-cost naloxone kits that were used to reverse 1,200 overdoses that year. Of those reversals, 94 percent were performed by somebody other than first responders. But now, if the state hopes to maintain the same level of distribution, IDHW will have to form new partnerships with first-responding agencies in all of the state’s 44 counties, a move that will destabilize the current program and increase costs, according to a state analysis.
Backers of the new restriction reject claims it erects barriers to naloxone access, arguing that it only alters where no-cost naloxone can be obtained. “Instead of going straight to Health and Welfare to get it, they would go through their first responders, their police, their sheriffs or firefighters, whoever is closest to them or that they’re comfortable going to,” asserted state Sen. Julie VanOrden (R-Bingham County), who sponsored the State Senate version of the bill.
But some Idahoans may not be comfortable with directly approaching first responders at all, especially if they have a history with the criminal justice system.
Proponents of the measure claim the new restrictions will ensure public safety, guaranteeing that federally-funded naloxone kits are “actually going out to the right people, people that we can actually educate and give training,” according to Rep. Josh Tanner (R-Eagle), the freshman Republican who introduced the language.
That might sound reasonable, but the evidence shows such education and training is not necessary. Operated much the same as intranasal allergy medication, naloxone is manufactured to be easy to administer. Studies have found no appreciable increase in success rates in trained versus untrained rescuers, and the medication is considered so safe that it can now be purchased by anyone at a pharmacy without a prescription. Yet, not all pharmacies that can sell naloxone do sell it. Even if they do, not all individuals who might benefit from having naloxone on-hand can afford its average retail price of $50.
That is where government-funded naloxone distribution programs are meant to step in, and the evidence of their impact is impressive. Not only does making naloxone available to the public save lives—cutting overdose deaths by half in some communities—it is also cost-effective, saving an estimated $3,000 for every $1 spent on naloxone.
In fact, until the new change, first responders in the state received their own naloxone training and kits through the IDHW’s program and relied on IDHW’s local partnerships to maintain naloxone access. Now, in addition to responding to the ever-increasing number of overdose emergencies, first responders in Idaho will have to create and maintain their own naloxone distribution programs.
Unsurprisingly, first responders in the state aren’t particularly happy about the change. In a letter to Gov. Little, Lewiston Fire Chief Travis Myklebust explained that “first responder agencies simply do not have the personnel or logistical support to add this program into their operations as a sole provider.”
Jeff Lavey, executive director of the Idaho Sheriffs Association, echoed a similar sentiment writing to the governor that law enforcement offices are already “overworked and understaffed” with limited time to distribute naloxone.
Despite those objections and his own reservations, Gov. Little–who made increasing naloxone access a priority in his first term–signed the new measure into law on April 5. In a letter accompanying his signature, he decried the additional “red tape” and noted that the likely outcome would be “fewer naloxone doses available to administer in Idaho and, tragically, fewer lives saved.” But because the change was tied to a must-pass appropriations bill, simply vetoing the new distribution rule wasn’t an option, according to Little.
While officials around the world increasingly recognize the value of increasing access to naloxone—with Arkansas just this week enacting a law requiring naloxone kits in all publicly-funded schools—Idaho lawmakers are pushing the state in the opposite direction. Unfortunately, it will be the people of Idaho, families struggling with substance use and already overworked first responders, who pay the price.