Editing Naloxone (section)

===Legal status and availability to law enforcement and emergency personnel===
{{Globalize|date=September 2022|2=US|3=Canada|talk=Talk:Naloxone#North-America-centric_legal_status_section|section}}
Naloxone (Nyxoid) was approved for use in the European Union in September 2017.<ref name="Nyxoid EPAR">{{cite web | title=Nyxoid EPAR | website=[[European Medicines Agency]] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/nyxoid | access-date=12 May 2020 | archive-date=5 April 2020 | archive-url=https://web.archive.org/web/20200405084842/https://www.ema.europa.eu/en/medicines/human/EPAR/nyxoid | url-status=live }}</ref>

In the United States, some nasal naloxone are legally available without a prescription.<ref>{{cite news|url=https://www.wyomingnews.com/news/local_news/wyoming-s-albertsons-safeway-pharmacies-to-offer-narcan-over-the/article_ca4b259c-08ae-11e8-9f50-17a75174a10d.html|title=Wyoming's Albertsons, Safeway pharmacies to offer Narcan over the counter|vauthors=Suttles C|work=Wyoming Tribune Eagle|access-date=19 September 2018|archive-date=3 February 2018|archive-url=https://web.archive.org/web/20180203160745/https://www.wyomingnews.com/news/local_news/wyoming-s-albertsons-safeway-pharmacies-to-offer-narcan-over-the/article_ca4b259c-08ae-11e8-9f50-17a75174a10d.html|url-status=live}}</ref><ref>{{Cite web | vauthors = Kekatos M |date=May 15, 2024 |title=Walgreens announces it will sell generic version of over-the-counter Narcan |url=https://abcnews.go.com/Health/walgreens-announces-sell-generic-version-counter-narcan/story?id=110258916 |access-date=2024-08-10 |website=ABC News }}</ref>

As of 2019, officials in 29 states had issued standing orders to enable licensed pharmacists to provide naloxone to patients without the individual first visiting a prescriber.<ref name="Network for Public Health Law">{{cite web|title=Addressing Opioid Overdose through Statewide Standing Orders for Naloxone Distribution|url=https://www.networkforphl.org/news-insights/addressing-opioid-overdose-through-statewide-standing-orders-for-naloxone-distribution/|access-date=5 January 2022|website=Network for Public Health Law|archive-date=6 January 2022|archive-url=https://web.archive.org/web/20220106000240/https://www.networkforphl.org/news-insights/addressing-opioid-overdose-through-statewide-standing-orders-for-naloxone-distribution/|url-status=live}}</ref> Prescribers working with harm reduction or low threshold treatment programs have also issued standing orders to enable these organizations to distribute naloxone to their clients.<ref>{{cite journal | vauthors = Wheeler E, Jones TS, Gilbert MK, Davidson PJ | title = Opioid Overdose Prevention Programs Providing Naloxone to Laypersons - United States, 2014 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 64 | issue = 23 | pages = 631–635 | date = June 2015 | pmid = 26086633 | pmc = 4584734 }}</ref> A standing order, also referred to as a "non-patient specific prescription" is written by a physician, nurse or other prescriber to authorize medicine distribution outside the doctor-patient relationship.<ref>{{cite web |title=Guide: Treating Heroin and Opioid Use Disorder |url=https://www.pa.gov/guides/opioid-epidemic/ |access-date=1 October 2020 |publisher=PA.Gov |archive-date=1 October 2020 |archive-url=https://web.archive.org/web/20201001131912/https://www.pa.gov/guides/opioid-epidemic/ |url-status=live }}</ref> In the case of naloxone, these orders are meant to facilitate naloxone distribution to people using opioids, and their family members and friends.<ref name="Network for Public Health Law" /> Over 200 naloxone distribution programs utilize licensed prescribers to distribute the drug through such orders, or through the authority of pharmacists (as with California's legal provision, [[AB1535]]).<ref name="Beletsky 2009">{{cite report |title=Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States |year=2009 |url=https://medicine.wright.edu/sites/medicine.wright.edu/files/page/attachments/Naloxonewhitepaper09.pdf |publisher=[[Boonshoft School of Medicine]] |archive-url=https://web.archive.org/web/20230127043207/https://medicine.wright.edu/sites/medicine.wright.edu/files/page/attachments/Naloxonewhitepaper09.pdf |archive-date=27 January 2023 |ssrn=1437163 |vauthors=Beletsky L, Burris SC, Kral AH|doi=10.2139/ssrn.1437163 }}</ref><ref>{{cite SSRN|title=Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose|year=2009 |ssrn=1434381|vauthors=Burris SC, Beletsky L, Castagna CA, Coyle C, Crowe C, McLaughlin JM}}</ref>

Laws and policies in many US jurisdictions have been changed to allow wider distribution of naloxone.<ref>{{cite journal|vauthors=Davis C|title=Legal interventions to reduce overdose mortality: Naloxone access and overdose good samaritan laws|url=https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf|url-status=live|journal=Network for Public Health Law|archive-url=https://web.archive.org/web/20140903114828/https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf|archive-date=3 September 2014}}</ref><ref>{{cite journal | vauthors = Davis C, Webb D, Burris S | title = Changing law from barrier to facilitator of opioid overdose prevention | journal = The Journal of Law, Medicine & Ethics | volume = 41 | issue = Suppl 1 | pages = 33–36 | date = March 2013 | pmid = 23590737 | doi = 10.1111/jlme.12035 | s2cid = 22127036 }}</ref> In addition to laws or regulations permitting distribution of medicine to at-risk individuals and families, some 36 states have passed laws that provide naloxone prescribers with immunity against both civil and criminal liabilities.<ref>{{cite web | vauthors = Cutcliff A, Stringberg A, Atkins C |title=As Naloxone Accessibility Increases, Pharmacist's Role Expands|url=https://www.pharmacytimes.com/contributor/marilyn-bulloch-pharmd-bcps/2016/10/as-naloxone-accessibility-increases-pharmacists-role-expands|access-date=31 October 2019|website=Pharmacy Times|archive-date=31 October 2019|archive-url=https://web.archive.org/web/20191031180459/https://www.pharmacytimes.com/contributor/marilyn-bulloch-pharmd-bcps/2016/10/as-naloxone-accessibility-increases-pharmacists-role-expands|url-status=dead}}</ref> While paramedics in the US have carried naloxone for decades, law enforcement officers in many states throughout the country carry naloxone to reverse the effects of heroin overdoses when reaching the location before paramedics. As of 12 July 2015, law enforcement departments in 28 US states are allowed to or required to carry naloxone to quickly respond to opioid overdoses.<ref>{{cite web |url=http://www.nchrc.org/law-enforcement/us-law-enforcement-who-carry-naloxone/ |title=US Law Enforcement Who Carry Naloxone |website=North Carolina Harm Reduction Coalition |access-date=12 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150713032125/http://www.nchrc.org/law-enforcement/us-law-enforcement-who-carry-naloxone/ |archive-date=13 July 2015 }}</ref> Programs training fire personnel in opioid overdose response using naloxone have also shown promise in the US, and efforts to integrate opioid fatality prevention into emergency response have grown due to the [[Opioid epidemic in the United States|US overdose crisis]].<ref name="Beletsky_2012">{{cite journal | vauthors = Beletsky L, Rich JD, Walley AY | title = Prevention of fatal opioid overdose | journal = JAMA | volume = 308 | issue = 18 | pages = 1863–1864 | date = November 2012 | pmid = 23150005 | pmc = 3551246 | doi = 10.1001/jama.2012.14205 }}</ref><ref>{{cite journal| vauthors = Lavoie D|date=April 2012|title=Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands|url=https://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html|url-status=live|journal=Huffington Post|archive-url=https://web.archive.org/web/20120518161613/http://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html|archive-date=18 May 2012}}</ref><ref name="pmid19602236">{{cite journal | vauthors = Davis CS, Beletsky L | title = Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities | journal = Harm Reduction Journal | volume = 6 | issue = 1 | pages = 16 | date = July 2009 | pmid = 19602236 | pmc = 2716314 | doi = 10.1186/1477-7517-6-16 | doi-access = free }}</ref><ref>{{cite report |year=2013|title=2013 National drug control strategy|url=https://obamawhitehouse.archives.gov//sites/default/files/ondcp/policy-and-research/ndcs_2013.pdf|url-status=live|archive-url=https://web.archive.org/web/20170121100239/https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/ndcs_2013.pdf|archive-date=21 January 2017|publisher=[[Office of National Drug Control Policy]] }}</ref>

Following the use of the nasal spray device by police officers on Staten Island in New York, an additional 20,000 police officers will begin carrying naloxone in mid-2014. The state's Office of the Attorney General will provide US$1.2 million to supply nearly 20,000 kits. Police Commissioner [[William Bratton]] said: "Naloxone gives individuals a second chance to get help".<ref>{{cite news| vauthors = Durando J |date=27 May 2014|title=NYPD officers to carry heroin antidote|newspaper=USA Today|url=https://www.usatoday.com/story/news/nation-now/2014/05/27/new-york-police-department-naloxone/9630299/|url-status=live|access-date=30 May 2014|archive-url=https://web.archive.org/web/20140703123154/http://www.usatoday.com/story/news/nation-now/2014/05/27/new-york-police-department-naloxone/9630299/|archive-date=3 July 2014}}</ref> [[Emergency medical services in the United Kingdom|Emergency Medical Service]] Providers (EMS) routinely administer naloxone, except where basic Emergency Medical Technicians are prohibited by policy or by state law.<ref>{{cite journal | vauthors = Faul M, Dailey MW, Sugerman DE, Sasser SM, Levy B, Paulozzi LJ | title = Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in US rural communities | journal = American Journal of Public Health | volume = 105 | issue = Suppl 3 | pages = e26–e32 | date = July 2015 | pmid = 25905856 | pmc = 4455515 | doi = 10.2105/AJPH.2014.302520 }}</ref> In efforts to encourage citizens to seek help for possible opioid overdoses, many states have adopted Good Samaritan laws that provide immunity against certain criminal liabilities for anybody who, in good faith, seeks emergency medical care for either themselves or someone around them who may be experiencing an opioid overdose.<ref>{{cite web|title=Drug Overdose Immunity and Good Samaritan Laws|url=http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx|access-date=31 October 2019|website=www.ncsl.org|archive-date=13 September 2019|archive-url=https://web.archive.org/web/20190913233059/http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx|url-status=live}}</ref>

States including Vermont and Virginia have developed programs that mandate the prescription of naloxone when a prescription has exceeded a certain level of morphine [[Equivalent (chemistry)|milliequivalents]] per day as preventative measures against overdose.<ref>{{cite journal | vauthors = Jones CM, Compton W, Vythilingam M, Giroir B | title = Naloxone Co-prescribing to Patients Receiving Prescription Opioids in the Medicare Part D Program, United States, 2016-2017 | journal = JAMA | volume = 322 | issue = 5 | pages = 462–464 | date = August 2019 | pmid = 31386124 | pmc = 6686765 | doi = 10.1001/jama.2019.7988 }}</ref> Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in [[North Carolina]], and have been replicated in the US military.<ref name="Beletsky 2009" /><ref name="pmid21668761">{{cite journal | vauthors = Albert S, Brason FW, Sanford CK, Dasgupta N, Graham J, Lovette B | title = Project Lazarus: community-based overdose prevention in rural North Carolina | journal = Pain Medicine | volume = 12 | issue = Suppl 2 | pages = S77–S85 | date = June 2011 | pmid = 21668761 | doi = 10.1111/j.1526-4637.2011.01128.x | doi-access = free | title-link = doi }}</ref>

In Canada, naloxone single-use syringe kits are distributed and available at various clinics and emergency rooms. [[Alberta Health Services]] is increasing the distribution points for naloxone kits at all emergency rooms, and various pharmacies and clinics province-wide. All [[Edmonton Police Service]] and [[Calgary Police Service]] patrol cars carry an emergency single-use naloxone syringe kit. Some [[Royal Canadian Mounted Police]] patrol vehicles also carry the drug, occasionally in excess to help distribute naloxone among users and concerned family/friends. Nurses, paramedics, medical technicians, and emergency medical responders can also prescribe and distribute the drug. As of February 2016, pharmacies across [[Alberta]] and some other Canadian jurisdictions are allowed to distribute single-use take-home naloxone kits or prescribe the drug to people using opioids.<ref name="cbc.ca" />

Following Alberta Health Services, [[Health Canada]] reviewed the prescription-only status of naloxone, resulting in plans to remove it in 2016, making naloxone more accessible.<ref>{{cite news |url=https://www.cbc.ca/news/health/naloxone-s-prescription-only-status-to-get-health-canada-review-1.3166867 |title=Naloxone's prescription-only status to get Health Canada review |website=CBC News |access-date=5 February 2016 |url-status=live |archive-url=https://web.archive.org/web/20160205205030/https://www.cbc.ca/news/health/naloxone-s-prescription-only-status-to-get-health-canada-review-1.3166867 |archive-date=5 February 2016 }}</ref><ref>{{cite web |url=http://www.health.alberta.ca/health-info/AMH-Naloxone-Take-home.html |title=Fentanyl and the take-home naloxone program Alberta Health |access-date=5 February 2016 |url-status=dead |archive-url=https://web.archive.org/web/20160205142858/http://www.health.alberta.ca/health-info/AMH-Naloxone-Take-home.html |archive-date=5 February 2016 }}</ref> Due to the rising number of drug deaths across the country, Health Canada proposed a change to make naloxone more widely available to Canadians in support of efforts to address the growing number of opioid overdoses.<ref>{{cite press release | title=Health Canada Statement on Change in Federal Prescription Status of Naloxone | publisher=[[Health Canada]] | date=14 January 2016 | url=https://www.canada.ca/en/health-canada/news/2016/01/health-canada-statement-on-change-in-federal-prescription-status-of-naloxone.html | access-date=6 October 2024}}</ref> In March 2016, Health Canada did change the prescription status of naloxone, as "pharmacies are now able to proactively give out naloxone to those who might experience or witness an opioid overdose."<ref>{{cite web |url=http://www.hc-sc.gc.ca/dhp-mps/prodpharma/pdl-ord/pdl-ldo-qa-naloxone-qr-eng.php |title=Questions and Answers - Naloxone |website=[[Health Canada]] |date=22 March 2017 |access-date=12 June 2017 |url-status=live |archive-url=https://web.archive.org/web/20170908140357/http://www.hc-sc.gc.ca/dhp-mps/prodpharma/pdl-ord/pdl-ldo-qa-naloxone-qr-eng.php |archive-date=8 September 2017 }}</ref>