Over the past couple of weeks I have become more aware of opinions that could be unfortunate barriers to HB 271 being passed by the Senate.  While participating in an EMS continuing education presentation, the question was put forward as to who might not be in favor of having naloxone (Narcan) more readily available for addicts, their friends, family members and others to administer emergently to anyone whose life is threatened from an opioid overdose.  Surprisingly, there was more than one hand raised.  The supporting commentaries shared a similar concern, that it will only aid and abet abusing illicit drugs.  Others, who are not EMS providers or healthcare professionals, have also recently expressed their biases to not support easier access to Narcan, regardless of its lifesaving potential.  There have been deeper dives and hard looks at the risks and benefits for bystander Narcan to be more readily available.

Historically, it has been identified that peer to peer and bystander education of how to administer Narcan, perform CPR and be prepared for the physical response to the rapidly acting opioid antagonist (reversal agent), bolstered by a reduction in punitive risks for calling 911 is essential.  This symbiosis supports HB 270 to move forward as well.  It is not necessary to ruminate and jaw bone on the emotional, rather to recognize the many years of evidence-based support. “Most drug misusers in our pilot study had witnessed an overdose, and take home naloxone or cardiopulmonary resuscitation may therefore be useful in Glasgow. We are concerned that not all the misusers called for immediate help, but other studies have suggested that this may be due to fear of the police becoming involved.” BMJ 2001; 323:934.  The focus should be on directing resources to funding public health education in tandem of full support of HB 270 and 271.  “Prescribing take-home naloxone to IDUs (IV drug users) with training in its use and in resuscitation techniques may represent a life-saving, peer-based adjunct to accessing emergency services.”  Journal of Urban Health June 2003, Volume 80, Issue 2, pp291.  These references are more than a decade old and are in parity with the aforementioned emotional opinions against HB 270 and 271.  The work has already been done over the past decade to show that similar emotional reactions are unfounded and quite possibly more dangerous than shooting and abusing drugs.  Evidence-based outcomes support education and distribution in the use of Narcan, to dramatically reduce deaths and reduce, not increase, the illicit use of opioids.  Refer to the online PowerPoint, Bystander Overdose Education and Naloxone Distribution, by Alexander Y. Walley, M.D., MSc. Medical Director, Opioid Overdose Prevention Pilot, Boston University School of Medicine, 2012.

The decision of who should make the call for getting help to anyone that has potentially overdosed on opioids should be made as simple as possible.  There is no way to guarantee 100 percent immunity as it will be case by case dependent, as noted in the recent NHPR interview with Franklin, New Hampshire, Police Chief David Goldstein.  However, as much stigma as possible needs to be eliminated from being able to save more lives and remove inhibition, in many cases to call 911, without having to face prosecution in a majority of circumstances. 

During the months and years of my medical career I have frequently treated some patients over and over again, for medical noncompliance, bad behavior with a glaring underpinning of self-destruction and gross abuse of the medical and public health systems.  This runs the gamut from chain-smoking COPD patients to dietary noncompliant brittle diabetics with raging cardiovascular disease.  Additionally many of these patients also misuse opioids and overdose on their medications. The bottom line, if health providers of any ilk find it antithetical to save lives based on emotional opinion, then they should leave healthcare altogether.  For those who are not healthcare providers, they should not exercise their powers to obstruct anyone from calling 911. 

There is a place for judge and jury wannabes, and it is for sure not when a person is dying from an overdose or for the myriad of issues that are part of the person’s underlying circumstances.  HB 270 and 271 need to move forward to offer greater common sense opportunity to save lives.


Lukas Kolm, MD, MPH

Please send your comments or questions to president@nhms.org or post a comment below.


Thanks for pointing out the facts regarding having Narcan available to the public and shaking off some of the prejudices and misinformation. My son was saved by Naloxone administered by a paramedic at Frisbie who would not have gotten there quickly enough had my son's girlfriend not called 911 and had he not been a block away from the hospital. Having Narcan available to family and firends makes sense. I have not seen any evidence that users ever expect they are going to overdose quite the contrary. Having Narcan isnt going to make them start thinking of overdosing any less than they do already or start being cavalier about how much they use. It isnt a well thought out process .... illicit opiate use. Having a second chance might allow some of the opiate users time to find help as my son did now clean for 2 years and helping others find recovery. All the people overdosing are someone's child including the over 300 that died in NH last year. Having Narcan available may save some of those children and give them a chance to find a way out.


It is often very difficult for some persons, including legislators, to consider separating their personal value systems and subsequent moral judgments from some issues, and apparently this is one of them. They may argue that their constituents elected them to do just that, but that argument is specious. They have been elected to look more deeply into complex issues as our representatives and not to be dismissive of data just because it does not agree with their preconceptions. But this is difficult work and I appreciate this attempt by the NHMS to support this legislation. As does Dr. Kolm, I too work clinically in emergency medicine do everything that I can to save a life now, and talk about it later. Rarely does one wake up one day and decide to become a heroin addict. Their path there is typically convoluted and full of bad decisions, but I have yet to meet many who ever thought that they would wind up where they are now. And there is a certain percentage of the addicted that come to treatment via ER visits and/or law enforcement encouters.