Narcan & Michigan Public Libraries Clare D. Membiela Narcan & Michigan Public Libraries What do Public Libraries need to know ? Mid-Michigan Library League Webinar October 26, 2017 This Photo by Unknown Author is licensed under CC BY-NC-SA

Intramuscularly – via injection Intranasally – via nasal spray What is Narcan? Opioid Inhibitor Narcan is the brand name of the drug Naloxone. According to the National Institute on Drug Abuse  It is an opioid antagonist—”it binds to opioid receptors and can reverse and block the effects of opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.” Narcan works very quickly and is safe for adults and children. How is it administered? Naloxone is generally administered in one of two ways: Intramuscularly – via injection Intranasally – via nasal spray Michigan pharmacies most often dispense the nasal option as part of the statewide Opioid Inhibitor laws. This Photo by Unknown Author is licensed under CC BY Narcan Webinar - MMLL

What is the Issue? Why are Libraries talking about this? Opioids (including prescription opioids, heroin, and fentanyl) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid. (cdc - https://www.cdc.gov/drugoverdose/index.html) Everyone is affected “The Center for Disease Control and Prevention stated that, “some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes.” Heroin is becoming less of a “street drug.” It has made its way from the rural areas to the suburbs, and heroin can kill people from any race or stature.” Drug rehab.org Opioid Overdoses are happening everywhere – from urban streets to rural parks to suburban malls. Public libraries have and will experience overdose events. https://americanlibrariesmagazine.org/2017/06/21/saving-lives-in-the-stacks/ This Photo by Unknown Author is licensed under CC BY-SA Narcan MMLL 2017

What about Michigan? Michigan’s Story & Response Opioid Inhibitor Laws According to Mlive, “A total of 1,365 died from opioid overdoses in 2016, compared to 884 in 2015 and 426 in 2012. Opioids accounted for 72 percent of all Michigan's drug overdose deaths in 2016, compared to 64 percent in 2015 ” http://www.mlive.com/news/index.ssf/2017/07/michigan_opioid_od_deaths_jump.html Opioid Inhibitor Laws The National Conference of State Legislatures reports that as of 2017, 39 states have introduced and/or enacted legislation involving rescue drugs or Opioid Inhibitors. Michigan is one. NCSL http://www.ncsl.org/research/health/injury-prevention-legislation-database.aspx In 2016 Michigan amended Pharmacist laws and initiated a new program that enabled Pharmacies to issue Narcan under a Standing Order issued by Michigan’s chief Medical Officer. http://www.michigan.gov/mdhhs/0,5885,7-339- 71550_2941_4871_79584_79585_79587_79591-409684--,00.html Narcan MMLL 2017

PERSON? Michigan Opioid Inhibitor Laws Publlic Health Code/ Pharmacist Regulation Sec. 17744b. (1) (3) Notwithstanding any provision of this act to the contrary, a person that is acting in good faith and with reasonable care may possess and dispense an opioid antagonist. any provision of this act to the contrary, a prescriber may issue a prescription for and a dispensing prescriber or pharmacist may dispense an opioid antagonist to any of the following (b) A family member, friend, or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose. (c) A school board for purposes of section 1179b of the revised school code, 1976 PA 451, MCL 380.1179b. (d) A person other than an individual that meets all of the following requirement (3) Notwithstanding any provision of this act to the contrary, a person that is acting in good faith and with reasonable care may possess and dispense an opioid antagonist. PERSON? 333.1106 Definitions. 4) "Person" means an individual, partnership, cooperative, association, private corporation, personal representative, receiver, trustee, assignee, or other legal entity. Person does not include a governmental entity unless specifically provided. This Photo by Unknown Author is licensed under CC BY-SA Narcan MML 2017

Liability What does this mean? 333.17744c Person administering opioid antagonist under certain conditions; immunity from criminal prosecution or sanction. Sec. 17744c. A person that administers an opioid antagonist to an individual who he or she believes is suffering an opioid-related overdose and that acts in good faith and with reasonable care is immune from criminal prosecution or sanction under any professional licensing act for that act.  691.1503  Administration of opioid antagonist; liability; definitions. Sec. 3.” (1) An individual who in good faith believes that another individual is suffering the immediate effects of an opioid-related overdose and who administers an opioid antagonist to the other individual is not liable in a civil action for damages resulting from the administration.”   Narcan MMLL 2017

What can a Library do? Weigh your risk CONSULT YOUR ATTORNEY Formal Policies Formal Training Library reimbursement of kits Each of these could make the Library liable as an institution in the event of a lawsuit Consult your insurer Does your liability policy cover this situation and any potential lawsuit? Weigh your risk Risk Benefit Analysis Look at the issue in your community, talk to your attorney about likely risk of lawsuit over death or injury from attempted Narcan rescue. Is potential benefit greater than risk? Narcan MMLL 2017

What can Libraries do? Individual Staff are protected Individuals can purchase Narcan under Michigan Law. LARA has a website that points to eligible pharmacies: http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79678---,00.html Use of kit prescribed to one person by another possible but unclear – check with attorney Contracted staff, Schools & First Responders are protected Security Services Police Fire EMT & Ambulance School/Public Libraries This Photo by Unknown Author is licensed under CC BY-NC-ND Narcan MMLL 2017

Libraries can also: Educate Staff An Opioid overdose can mimic other conditions, and the Narcan rescue process can come with a few surprises. Offer (don’t mandate) information on local trainings, links to information online so that staff can recognize signs of overdoses. http://www.michigan.gov/documents/mdhhs/Michigan_- _Naloxone_and_How_to_Respond_handout_for_Web_576321_7.pdf Talk to Staff about how an issue should be handled under current law Encourage individual kits (don’t require) Encourage training (don’t require) Provide lists of which staff have kits. Possible option of sharing of kits (unofficial) Narcan MMLL 2017

Contact your Legislator Library of Michigan is working to amend the law Working with MDE legislative Liaison & MLA to: Add Libraries to the list of government entities mentioned in the Narcan law. Have libraries treated similarly to schools This would mean Kits would be issued in name of Library Could be ordered and purchased by Library Release/Waiver of Liability for Library as entity This Photo by Unknown Author is licensed under CC BY-NC-ND Narcan MMLL 2017

In Sum Talk to Your Board & Attorney Know Resources To determine the best course for your Library & Community Know What the current law says What your municipality’s procedure/policy is (pa 164 libraries especially) Who else in your community carries Narcan What Opioid Overdoses look like How Narcan Rescues Work Resources Michigan DHHS Page on the Opioid program http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79584---,00.html Narcan Instructions https://nmhealth.org/publication/view/help/1712/ US Dept. VA https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Naloxone_Nasal_Spray_Instructions_Pocket_Card.pdf US Substance Abuse and Mental Health Services Admin prevention kit: https://www.samhsa.gov/capt/tools-learning-resources/opioid-overdose-prevention-toolkit Narcan MMLL 2017

Contact Information Clare Membiela Library Law Consultant, Library of Michigan Phone – 517-335-8132 membielac@michigan.gov This outline is intended as general information only and may not be relied upon as legal advice. Libraries should always consult with their legal counsel regarding legal matters including, but not limited to, Staff & Patron Policies. Narcan MMLL 2017