TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH
21401.
CNMI Drug Overdose Policy; First Responders to Possess & Administer Opioid Overdose Reversal Medication.
(a) First responders including emergency service employees, employees, firefighters, police officers or other law enforcement officers, emergency medical services personnel, EMT, Advanced EMT, and paramedics and other emergency responders who render emergency medical services at the scene of an emergency are authorized to possess, store, and administer opioid overdose reversal medication. (b) All CNMI government agencies that employ first responders including
emergency service employees, firefighters, police officers or other law enforcement officers, emergency medical services personnel, EMT, Advanced EMT, and paramedics and other emergency responders who render emergency medical services at the scene of an emergency must provide opioid overdose reversal medication rescue kits to their first responders, require first responders to successfully complete the training required under this Act, and require the first responders to carry the opioid overdose reversal medication rescue kits in accordance with agency procedures so as to optimize the first responders’ capacity to timely assist in the prevention of opioid overdoses. Provided, that a CNMI government agency has designated sufficient funding or supplies of opioid overdose reversal medication rescue kits. A CNMI government agency that employs a firefighter or law enforcement officer that does not respond to emergency medical calls or provide medical services shall be exempt from this subsection. (c) Every publicly or privately owned ambulance, special emergency medical services vehicle, non-transport vehicle, or ambulance assist vehicle, which responds to requests for emergency services or transports patients to the hospital in emergency situations must possess opioid overdose reversal medication. (d) CNMI government agencies that are required under sections (a) and (b) to possess opioid overdose reversal medication may coordinate with the Commonwealth Healthcare Corporation for the acquisition of opioid overdose reversal medication and for training programs on the administration of opioid overdose reversal medication. (e) “Opioid overdose reversal medication” means any drug used to reverse an opioid overdose that binds to opioid receptors and blocks or inhibits the effects of opioids acting on those receptors. It does not include intentional administration via the intravenous route. (f) In the absence of gross negligence or willful misconduct, nothing in this section shall be construed to impose civil or criminal liability on a local or state governmental agency or a first responder acting in good faith in the administration or provision of an opioid overdose reversal 669
TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH
medication in cases where an individual appears to be experiencing an opioid overdose. Source: PL 23-23, § 2 (July 18, 2024), modified. Commission Comment: PL 23-23, which took effect on July 18, 2024, included a findings and purposes, as follows: Section 1. Findings and Purposes. The Legislature intends to save lives lost to drug overdoses by authorizing and mandating first responders and emergency services employees to possess opioid overdose reversal medication and encouraging the prescription, dispensing, and administration of opioid overdose medications. Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain. Overdoses of opioids, such as heroin and prescription painkillers, cause brain injury and death by slowing and eventually stopping person's breathing. According to the Centers for Disease Control and Prevention, more than 750,000 people have died since 1999 from a drug overdose. Two out of three drug overdose deaths in 2018 involved an opioid. Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased almost six times since 1999. Overdoses involving opioids killed nearly 47,000 people in 2018, and 32% of those deaths involved prescription opioids. Many of these negative outcomes are preventable. Opioid overdose is reversible through the timely administration of an opioid overdose reversal medication including naloxone and, where needed, the provision of other emergency care. When administered to a person experiencing an opioidrelated drug overdose, an opioid overdose medication can save the person's life by restoring respiration. Increased access to opioid overdose medications reduces the time between when a victim is discovered and when he or she receives lifesaving assistance. However, access to naloxone is limited by laws and regulations that predate the overdose epidemic. In an attempt to reverse the unprecedented increase in preventable overdose deaths, all fifty states and the District of Columbia have now modified their laws to increase access to opioid overdose reversal medication including naloxone, the standard first-line treatment for opioid overdose. Largely because of these legal changes, over 150,000 laypeople had received training and naloxone kits as of 2014, and naloxone program participants reported reversing more than 26,000 overdoses in the United States. Research shows that naloxone access laws are associated with increases in the dispensing of naloxone from retail pharmacies, the dispensing of naloxone paid for by Medicaid, and the number of community programs that distribute naloxone. Perhaps more importantly, naloxone laws are associated with decreases in opioid overdose deaths by approximately 14%. 670
TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH In the CNMI, first responders are not specifically authorized or required to possess opioid overdose reversal medication. Moreover, the community does not have access to such lifesaving medication. The Legislature intends to establish a CNMI Drug Overdose policy to increase access to opioid overdose medications by authorizing and mandating first responders and emergency service employees to possess opioid overdose reversal medication and permitting health care practitioners and pharmacists to administer, prescribe, and dispense, directly or by collaborative drug therapy agreement or standing order, opioid overdose medication to any person who may be present at an overdose, law enforcement, emergency medical personnel, family members, or service providers and to permit those individuals to possess and administer opioid overdose medications prescribed by an authorized health care provider. The Legislature further intends to provide limited immunity for health care practitioners for prescribing or dispensing opioid overdose reverse medication as well as for first responders and emergency service employees for administering opioid overdose reverse medication. PL-23 also included a severability and savings clause. In codifying PL 23-23, the Commission re-numbered this section under Article 13, pursuant to 1 CMC § 3806(a).
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