76th Annual  Meeting
The U.S. Conference of Mayors
76th Annual Meeting
June 20-24, 2008
Miami

2008 ADOPTED RESOLUTIONS

SAVING LIVES, SAVING LIVES, SAVING MONEY: CITY-COORDINATED DRUG OVERDOSE PREVENTION

WHEREAS, drug overdose is the second leading cause of injury death in the United States, behind only motor vehicle accidents and ahead of firearms; and

WHEREAS, overdose mortality rates have increased significantly since the 1990s; and

WHEREAS, according to the Centers for Disease Control and Prevention (CDC), illegal and prescription drug overdoses killed more than 33,000 people in 2005, the last year for which firm data are available; and

WHEREAS, overdose deaths are more commonly attributable to heroin and narcotic analgesics (opiates derived from opium, and opioids, their synthetic derivatives) than any other drug category; and

WHEREAS, death from opioid overdose is preventable through use of naloxone, an opiate antagonist medication that reverses the respiratory depression that causes death from overdose; and

WHEREAS, many overdose fatalities occur because peers delay or forego calling 911 for fear of arrest or police involvement, which researchers continually identify as the most significant barrier to the ideal first response of calling emergency services; and

WHEREAS, the United States Conference of Mayors adopted a resolution at its 75th Annual Meeting calling for "A New Bottom Line in Reducing the Harms of Drug Abuse," which specifically states that the prevention of overdose fatalities should be a primary goal of national and state drug policy and encourages cities to adopt local overdose prevention strategies; and

WHEREAS, a recent and ongoing outbreak in fatal and nonfatal overdoses due to heroin contaminated with clandestinely manufactured fentanyl has killed over 1,000 people in at least eight states, including nearly 200 in Chicago, 150 in Detroit, nearly 100 in Philadelphia, and nearly 75 in Camden, New Jersey, since April of 2006; and

WHEREAS, the United Nations Office on Drugs and Crime warned world health authorities to prepare for a sharp rise in rates of heroin overdose mortality due to a dramatic increase in the global supply and purity of heroin; and

WHEREAS, naloxone is effective, affordable and safe, does not have serious side effects other than those associated with opioid withdrawal, works within minutes, is not addictive, cannot be abused, and has no psycho-pharmacological effects; and

WHEREAS, naloxone is currently administered by paramedics and emergency room personnel to treat opioid overdose but could prevent far more deaths through widespread distribution to police and first responders; and

WHEREAS, distributing naloxone directly to community members, as opposed to restricting it to medical personnel, saves lives, as people frequently use in pairs or groups and there is often someone nearby to detect the signs of an overdose in time and administer emergency treatment; and

WHEREAS, trained participants of naloxone distribution programs are able to recognize and respond to opioid overdoses as effectively as medical experts; and

WHEREAS, naloxone can be safely administered by lay people intravenously, intramuscularly, and intranasally; and

WHEREAS, numerous programs that provide overdose prevention education, rescue breathing training and take-home naloxone directly to lay people have been developed in New Mexico, Connecticut, Northern California, and the cities of Baltimore, New York City, Chicago, Philadelphia and most recently Los Angeles; and

WHEREAS, naloxone distribution programs save cities money by averting significant health care costs. Nationally, poisonings resulted in $2.24 billion worth of direct medical costs in the year 2000, corresponding to $23.7 billion in lost productivity. Los Angeles County, which approved a pilot naloxone distribution program in September 2006, admitted 232 patients for opioid overdose treatment in the county-run hospitals from 1997 to 2002, at a cost of $3.7 million; and

WHEREAS, naloxone distribution programs are inexpensive: Material costs are minimal (naloxone-filled syringes cost less than two dollars apiece) and naloxone distribution programs have been added to existing services, such as syringe exchanges, without the need for increased staff or space; and

WHEREAS, naloxone distribution programs have resulted in reversals of respiratory depression leading to saved lives: Data on 16 organizations in the United States that distribute take-home naloxone show that 20,950 people have been trained to administer naloxone, and 2,642 overdoses were successfully reversed; and

WHEREAS, in New Mexico, approximately 200 people have said that they have saved a life with naloxone, and New Mexico officials report up to a 20 percent drop in overdoses since they started distributing the drug. In San Francisco, more than 150 people who were trained to administer naloxone stated that they saved someone with the drug; and

WHEREAS, the Baltimore City Health Department has documented over 114 overdose reversals with naloxone as of June 2006, and the City's overdose death rate is now at a 10-year low. In Chicago, at least 465 people have reported peer overdose reversals, halting and reversing a consistent trend of increasing overdose deaths the very same year the city instituted its naloxone distribution program (during which time expanded access to treatment for opioid dependence was also provided); and

WHEREAS, participants in programs report that education about and availability of naloxone has helped connect users to safety and personal health information and resources, and that the frequency of heroin use decreased among opioid users in a pilot study of naloxone distribution; and

WHEREAS, establishing emergency "Good Samaritan" limited immunity policies that protect from prosecution people who call 911 would increase timely medical attention to overdose victims; and

WHEREAS, nearly one hundred colleges and universities have adopted Good Samaritan policies that have proven effective in encouraging students to seek help in the event of an alcohol or other drug overdose; in 2006, researchers found that Cornell University's Good Samaritan policy led twice as many students to call 911 in a drug or alcohol emergency, while substance use remained constant; and

WHEREAS, New Mexico recently enacted the first such law in the country-the 911 Good Samaritan Act of 2007-which is expected to save countless lives in cities across the state; and

WHEREAS, similar life-saving legislation is pending in several states across the country, including California, Illinois, Maryland, New York, New Jersey, Rhode Island and Washington; and

NOW, THEREFORE, BE IT RESOLVED, that the United States Conference of Mayors encourages cities to implement life-saving, cost-effective overdose prevention programs that provide overdose prevention education, rescue breathing training and take-home naloxone directly to lay people; and

BE IT FURTHER RESOLVED, that the United States Conference of Mayors supports establishing emergency "Good Samaritan" policies that provide immunity from prosecution:

  • For individuals at the scene of a health emergency related to the acute toxic effects of controlled substance use, intoxication, withdrawal or addiction,who have contacted 911 in good faith to receive emergency medical treatment for a victim of drug toxicity or overdose; and
  • For individuals who have experienced an accidental or intentional drug overdose and who have been rendered aid by public safety personnel responding to a 911 call placed in good faith requesting emergency medical treatment; and

BE IT FURTHER RESOLVED, the United States Conference of Mayors calls upon:

  • The National Institute of Drug Abuse and the Centers for Disease Control and Prevention to urgently fund research to evaluate scientifically the effectiveness of overdose prevention interventions and develop model programs; and
  • The Food and Drug Administration to take all necessary and reasonable steps to facilitate the testing and approval of nasal and/or over-the- counter formulations of naloxone and to consider recommending prescription naloxone concurrent with prescribing strong opioid analgesics.

Project Cost: Unknown