A Comprehensive Strategy to Combat the Opioid Crisis Must Include Expanding Access to Naloxone

Across the United States, we have seen the devastating toll of COVID-19, as well as the ripple effect it has had on the ongoing opioid crisis. The opioid epidemic was impacting our society well before the pandemic, and opioid overdose fatalities continue to hurt more individuals and families than ever seen before.

In March, the Collaborative for Effective Prescription Opioid Policies brought federal regulators, health leaders, prevention and treatment advocates, industry and other stakeholders together to discuss strategies that work to equip more individuals and communities with a potentially lifesaving overdose reversal medication. Their experience tells us an accidental overdose can happen almost anywhere and reminds us that everyone – policymakers, advocates, and citizens – plays a role in efforts to provide the tools to combat the opioid crisis, including naloxone.

The latest data available from the Centers for Disease Control and Prevention indicates that more than 90,000 drug overdose deaths occurred in the United States in the 12-month period ending in November 2020, the largest number of drug overdoses for a 12-month period ever recorded. By any measure, this is a shocking statistic – and behind it are stories of family members and neighbors who could have been revived and saved. We cannot accept this condition when we know we have tools to prevent an accidental overdose from becoming fatal. There’s no one answer to tackle the crisis, but there must be an effort to save more lives and help more people on their journey to recovery by increasing access to opioid overdose reversal medications and creating stronger linkages between naloxone distribution, treatment and recovery services.

Widespread access to naloxone is critical because an accidental overdose can and does happen virtually anywhere and at any moment. While all 50 states already have a mechanism to provide naloxone to individuals without a prescription, known as a “standing order,” the reality is many at-risk people don’t know these policies exist. While standing-order prescription policy is one very important step to ensuring access to naloxone, there is more that can be done to provide naloxone to individuals who remain unaware of their risk for an accidental overdose. To date, 13 states – Arizona, Arkansas, California, Colorado, Florida, New Jersey, New Mexico, Ohio, Rhode Island, South Carolina, Virginia, Vermont, Washington – have passed “co-prescribing” legislation, which requires a health care provider to offer and/or prescribe an opioid overdose reversal medication alongside an opioid medication for at-risk patients, based on CDC “high risk” criteria.

At the federal level, regulators have recognized the need to better communicate to patients about the potential risks of opioid medications and implement solutions to protect these individuals from fatal overdose. In 2020, the U.S. Food and Drug Administration released drug safety labeling changes that acknowledge the value and impact that providers can have in educating patients about the risks associated with opioid medications. The FDA now encourages all health care professionals to discuss the availability of naloxone with patients who are prescribed opioids, and to consider prescribing it to patients who are at increased risk of an accidental overdose.

Naloxone also should be made more widely available in community settings. We must empower those at-risk individuals who don’t have touchpoints with a health care provider to have immediate access to naloxone outside of the doctor’s office, hospital emergency room or pharmacy. For example, we can encourage more community-based programs, many of which already perform the critical function of teaching individuals who use or misuse drugs about their risk of accidental overdose, to distribute naloxone to these individuals. We can train more law enforcement officers and other first responders to use naloxone. We can help increase the distribution of naloxone by correctional facilities to discharged inmates identified as being at risk of an overdose. And we can better share information about how to access naloxone in community-based settings, such as in schools and libraries.

Finally, creating a stronger connection between the distribution and use of naloxone and treatment and recovery services is critical, as a person’s journey doesn’t end after they recover from an overdose. We must ensure each of them is rapidly connected with treatment resources, has guaranteed access to community access points for naloxone and receives the right information and peer recovery support services.

Our discussions with stakeholders – and the terrible events that are playing out across the country – make clear there is not a “silver bullet” solution to the complex opioid crisis. Instead, we must take an “all of the above” approach, which requires action from individuals, communities, health providers and plans, industry, and federal and state policymakers. The incredible work happening across the country reminds us what can beat this epidemic – and why we can’t stop fighting to protect our loved ones and neighbors from the potential harms of opioids.


The Hon. Mary Bono is a former United States congresswoman who represented California’s 44th and 45th districts between 1998-2013 and currently serves as the chairman of the board of the Community Anti-Drug Coalitions of America and Mothers Against Prescription Drug Abuse.

Major Gen. Barrye L. Price, Ph.D., is the president and CEO of the Community Anti-Drug Coalitions of America and previously served within the U.S. Army for 31 years.

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