Testimony in Support of Immunity for First Responder Leave Behind Programs in Massachusetts
Testimony from:
Stacey McKenna, Senior Fellow, Integrated Harm Reduction, R Street Institute
In SUPPORT of S.1600 and H.2406, providing immunity for first responder naloxone leave behind programs
September 13, 2023
Massachusetts Joint Committee on Public Safety and Homeland Security
Chairman Timilty, Chairman González and members of the committee,
My name is Stacey McKenna, and I am a senior fellow in Integrated Harm Reduction at the R Street Institute, a nonprofit public policy research organization focused on advancing limited, effective government in a range of policy areas, including opioid harm reduction. For this reason, we have a particular interest in Senate Bill 1600 and House Bill 2406, which would provide immunity to first responders participating in a naloxone leave behind program.
I have been studying and writing about substance use for 15 years. In that time, I have repeatedly seen that, while abstinence works for some people, it is not a realistic approach as a policy goal for the broader population. Rather, harm reduction – a time-tested approach that meets people where they are to provide resources, services and education – is the most effective way to combat overdose deaths. This is why I am submitting testimony in support of S.1600 and H.2406.
Last year, 2,301 people in Massachusetts died of an opioid-involved overdose.[1] When administered quickly, the opioid antagonist medication naloxone can reverse these overdoses within just a few minutes.[2] Research shows that the people who are most likely to deliver those first doses of naloxone and thus save the life of someone experiencing an overdose are very often already on scene. In fact, other drug users act as the primary rescuers in the vast majority of witnessed overdoses – 87 percent in a Massachusetts study.[3] As such, policy must prioritize getting naloxone into the hands of people who use drugs and members of their social networks.[4]
Communities in Massachusetts have already taken steps toward expanding naloxone access among people who use drugs and have achieved a remarkable level of distribution. Naloxone leave-behind programs in the Commonwealth – in which first responders may not only administer the opioid antagonist in the case of an overdose, but distribute the medication to individuals who are likely to experience or witness an overdose – has been a big part of this success. However, with overdose deaths continuing to climb, especially among the state’s Black and rural residents, there is more to do.[5] By providing immunity for first responders who participate in these leave-behind programs, S.1600 and H.2406 demonstrate explicit support for this work, and may increase localities’ willingness to implement it and individual first responders’ willingness to engage in it.
Medical first responders such as emergency medical technicians (EMTs) and firefighters already administer naloxone, and they are well-equipped to dispense naloxone medication. As healthcare providers, they are already knowledgeable about the medication and familiar with administering it in a high-stress environment, and they are often trusted members of their communities. As such, it is no surprise that first responder leave-behind programs have been highly successful in a variety of environments. In 2020, a Vermont program prevented at least 279 deaths.[6] Not only do they reduce overdose fatalities, they have also been shown to increase the likelihood that patients will seek out additional support, including recovery services.[7] In addition, research from Vermont suggests that patients are highly receptive to these programs, with 85.5 percent of people accepting the take-home kits when offered by EMS personnel.[8]
However, first responders do not typically dispense medications, and as such, may be reluctant to do so even when the state has given them permission. Providing immunity in these cases thus serves as an additional and important sign of state support and legal protection for these programs, thereby reducing any hesitancy among communities or individuals.
Massachusetts has already done the hard work of establishing first responder naloxone leave-behind programs. S.1600 and H.2406 take this effort a step further by providing immunity for first responders who engage in this life-saving work. Consequently, R Street urges your favorable report.
Thank you for your time and consideration.
Respectfully submitted,
Stacey McKenna
Senior Fellow, Integrated Harm Reduction
R Street Institute
[email protected]
[1] “Massachusetts opioid-related overdose death rate declines 1.5 percent in the first nine months of 2022,” Massachusetts Department of Public Health, Dec. 14, 2022. https://www.mass.gov/news/massachusetts-opioid-related-overdose-death-rate-declines-15-percent-in-the-first-nine-months-of-2022.
[2] Substance Abuse and Mental Health Services Administration, “Naloxone,” U.S. Department of Health and Human Services, July 8, 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naloxone.
[3] Alexander Y. Walley et al., “Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis,” British Medical Journal, 346: f174, (Jan. 31, 2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688551.
[4] Stacey McKenna, “Why Naloxone Access Policy Should Prioritize People Who Use Drugs,” R Street Institute Explainer, May 22, 2023. https://www.rstreet.org/research/why-naloxone-access-policy-should-prioritize-people-who-use-drugs.
[5] Kathleen Conti, “Massachusetts opioid-related overdose deaths rose 2.5 percent in 2022,” Massachusetts Department of Public Health, https://www.mass.gov/news/massachusetts-opioid-related-overdose-deaths-rose-25-percent-in-2022#:~:text=Massachusetts%20has%20already%20exceeded%2C%20and,a%20lack%20of%20medication%20access.
[6] Samantha J. Bissonette, “Preliminary Analysis of Vermont’s EMS Naloxone Leave-Behind Program,” Larner College of Medicine at University of Vermont, 2021. https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1017&context=m4sp.
[7] Rebecca McDonald and John Strang, “Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria,” Addiction, 111:7 (July 2016), pp. 1177-87. https://onlinelibrary.wiley.com/doi/10.1111/add.13326; Samantha J. Bissonette, “Preliminary Analysis of Vermont’s EMS Naloxone Leave-Behind Program,” Larner College of Medicine at University of Vermont, 2021. https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1017&context=m4sp.
[8] Samantha J. Bissonette, “Preliminary Analysis of Vermont’s EMS Naloxone Leave-Behind Program,” Larner College of Medicine at University of Vermont, 2021. https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1017&context=m4sp.