PORTLAND, Ore. — With fentanyl-related overdose deaths rising, Oregon lawmakers passed a bill to expand access to naloxone, an opioid overdose reversal medication often referred to by the brand name Narcan.
House Bill 2395 still needs Governor Kotek's signature to become law, but the "Opioid Harm Reduction Policy Package" received widespread support in Salem, with approval from about 90% of both the House and Senate members.
The idea is to make Narcan much more prevalent throughout Oregon, helping to save lives as the state wrestles with the fentanyl crisis. It's a concept that community organizations and activists have been championing in recent years.
Expanded access
Ellen Wirshup started Project RED Initiative, determined to get Narcan to the places that people go — restaurants, bars, clubs, coffee shops, stores, and other spots.
"The goal was mass accessibility to Narcan in spaces you wouldn't necessarily see it," Wirshup said.
She said Project RED, in partnership with the Alano Club of Portland, has distributed more than 2,500 boxes of Narcan to 160 businesses and 56 schools since August of 2022.
"What I tell people is it's so much better to have Narcan and never need to use it, than to need Narcan and not have it," Wirshup said. "It doesn't cause any harm if a person does or does not have opiates in their system, it just stops the overdose from continuing and then leading to death."
There's little doubt about the need for expanded access to medication like Narcan, which state leaders refer to as "opioid antagonists."
In Multnomah County, fentanyl overdose deaths have increased year over year, from 26 in 2019 to 209 in 2022.
By passing HB 2395, Oregon lawmakers declared the fentanyl crisis a statewide emergency. The bill includes a variety of straightforward changes, if signed into law by Gov. Kotek.
For one, fentanyl test strips would no longer be considered 'drug paraphernalia' for anyone 15 or older.
"Being able to make an informed choice about what drugs you're putting into your body will reduce the number overdose deaths we're seeing, and how could that not be a good thing," Wirshup said.
The bill allows businesses and other publicly-accessible spaces to stock naloxone and removes the risk of liability for anyone who administers Narcan when they suspect an overdose.
This includes teachers and school administrators — they no longer need parental permission to administer what could be a life-saving drug.
The message, in short, is that when in doubt, don't hesitate to try and help.
"I think this removes a lot of the fear that people will feel [when asking] is this a moment when I jump in," Wirshup said. "I think it will allow us to provide more Narcan to folks who are doing work on the ground in communities with people who need it."
Getting distributors on board
But it's the primary intent of HB 2395 — expanding access to Narcan and enticing more Oregonians to have it on hand — that carries significant questions.
The final version of the bill dropped language that would have encouraged the Oregon Prescription Drug Purchasing Program (OPDP) to buy Narcan in bulk, opening up pathways to discounted widespread distribution.
Oregon Health Authority spokesperson Afiq Hisham said OPDP would like to support opioid antagonist access efforts, including support for private businesses in acquiring products at a reduced price as part of the "comprehensive statewide approach."
However, he said the currently unfunded OPDP model would be unable to do this without organizational changes and funding.
"Supporting an opioid antagonist purchasing program for private entities would require additional staff and contracting resources," Hisham said.
Oregon has existing strategies to provide Narcan to qualified individuals or organizations.
OHA's Harm Reduction Clearinghouse Project, under Save Lives Oregon, supports a "limited amount of naloxone at no cost," according to Hisham.
The Clearinghouse Project is using millions of dollars delegated from the Opioid Settlement Prevention, Treatment and Recovery board to pay for prescriptions, including Narcan.
"The Save Lives Oregon Clearinghouse is the only fully functional program that's run, sanctioned and fully operated by the state of Oregon when it comes to distributing naloxone to the community — primarily to those using drugs and people at highest risk of overdose," Hisham said.
Wirshup said Project RED, with the help of CareOregon, can currently purchase a kit of Narcan spray for about $43. She added that if Oregon wants to get Narcan in more places, any efforts to lower the cost would go a long way.
"The ability to have more Narcan on hand at a low cost would allow us to do more and more," she said.
Still, there remains questions about how, or if, Oregon might accomplish a price reduction and widespread distribution of opioid antagonists.
Hisham said that could include working with MMCAP, a national group purchasing organization for governments that provides healthcare and pharmacy services.
"Making Narcan more accessible and affordable in the private sector would require working with contractors to manage purchases through MMCAP Infuse," he said, adding that lower administrative and shipping costs could lower purchase prices. "Please keep in mind that properly implementing such a model would be an even bigger project than running the Clearinghouse as it’s currently constructed, as it would be open to anyone and everyone, hence the need for additional personnel and resources."
Despite uncertainty about the expanded access to Narcan, Wirshup said it's encouraging to meet people who are willing to hold Narcan in preparation for any potential overdose they see.
"I get more requests every day for individuals who want to carry Narcan, and I think that's a really incredible sign of where we're at," she said.