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USING CIVIL DISOBEDIENCE TO ESTABLISH A PUBLIC HEALTH NORM; AN OVERVIEW OF A TRANSITIONING MODEL FOR NALOXONE DISTRIBUTION IN CT Chris Heneghan, Thomas McNally, Mike McNally, Windham Harm Reduction Coalition Inc., (2012).

PA AN ACT CONCERNING TREATMENT FOR A DRUG OVERDOSE Section 1. Section 17a-714a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2012): A licensed health care professional who is permitted by law to prescribe an opioid antagonist may, if acting with reasonable care, prescribe, dispense or administer an opioid antagonist [to a drug user in need of such intervention] to treat or prevent a drug overdose without being liable for damages [to such person] in a civil action or subject to criminal prosecution for prescribing, dispensing or administering such opioid antagonist or for any subsequent use of such opioid antagonist. For purposes of this section, “opioid antagonist” means naloxone hydrochloride or any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of drug overdose. Section 2. (Effective October 1, 2012) Not later than January 15, 2013, the Commissioner of Mental Health and Addiction Services shall report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health concerning the number of opioid antagonist prescriptions issued under programs administered by the Department of Mental Health and Addiction Services to persons other than drug users for self-administration of the opioid antagonist, in accordance with section 17a-714a of the general statutes, as amended by this act.

PUBLIC ACT WHAT WILL IT DO? Effective in Connecticut as of October 1, 2012, prescribers can prescribe, dispense or administer Naloxone (Narcan) to persons other than drug users to treat or prevent a drug overdose.

PUBLIC ACT WHAT IT DOES NOT DO? No Protection from Civil Liability for Lay administration No Protection from Criminal Liability for Lay Administration No Protection from Unauthorized Practice of Medicine for Lay Administration. No Protection from Criminal Liability for the Possession of Naloxone w/o a Prescription No State Program Created to Prevent OD Deaths through Naloxone Prescription Access. No funding allocation for DMAHS Behavioral Health Programs or SEPs No 3 rd Party Prescription Coverage (Davis, The Network for Public Health Law 2012.)

WHAT IS CIVIL DISOBEDIENCE? The concept of civil disobedience has deep roots in American political, social and cultural history. (Loesch,1991) Acts of civil disobedience highlight injustices in society. Civil disobedience is one means of taking action to bring about change. Civil Disobedience is conscious and public statement about the injustice of the status quo. The degree of attention society give to such acts may vary but one purpose of civil disobedience is to demonstrate to society and the governing bodies that oversee it that the existing laws are unjust. In order for physicians and other health care providers to legally pursue civil disobedience, they must be willing to accept the consequences associated with their actions. (Lazarini 2000) What is the injustice? Current legislation maintains existing barriers to Naloxone Access for SEP members who do not have a PCP, or do not have a clinical relationship CT DMHAS funded behavioral health programs… No legal protection for lay distribution or administration under current Connecticut Law…

THE PROBLEM OF DRUG OVERDOSES IN CT Leading cause of adult injury death, more than deaths due to MVA, fire, firearms combined For every fatal overdose that occurs in a community there are seven non- fatal overdoses. TC Green, LE Grau, HW Carver, M Kinzly, R Heimer. Epidemiologic and geographic trends in fatal opioid intoxications in Connecticut, USA: Drug and Alcohol Dependence (2011).

A Transitional Model Our Philosophy WHRC’s transitional model aims to strike a balance between what we as Harm Reductionist believe the ideal norm for public health practice should be, and the existing norm for public health practice in CT. We seek to strengthen existing community partnerships and are working to build a state wide prescribing network in collaboration with DMHAS at community based health centers. We contribute to and acknowledge the importance of legislative work on this issue, but also believe that to effectively fight this epidemic we can not wait for the legislative balance to tip into the arena of ethical public health practice. It may never happen. Thought the state may condone prohibitive policy responsible for the erroneous deprivation of life of individuals involved with drugs we as Harm Reductionists will not!

WHO ADMINISTERED NALOXONE

Number of ODs in Relation to Doses of Naloxone Given Naloxone was administered in only 34% of all reported opioid overdoses witnessed by respondents between March 2012, and October 2012.

TownReported ODs Willimantic 41 Coventry 5 Lebanon 5 Plainfield 3 Hampton 1 NUMBER OF ODs WITNESSED BY RESPONDENTS BY TOWN March 2012 – April 2012 It is estimated that 5 of these 55 reported overdoses were fatal. Participants reported 19 successful reversals using Naloxone received from WHRC.