Idaho lawmakers vote to limit who can access fentanyl overdose treatment through grant

Courtesy Idaho Capital Sun: BY: AUDREY DUTTON

A bill heading to Idaho Gov. Brad Little is necessary to keep Idaho’s psychiatric hospitals and behavioral health centers in operation, authorizing nearly $150 million in spending for Idaho’s behavioral health division.

But one sentence written into the legislation could have far-reaching consequences.

House Bill 350 passed the House earlier this month on a 40-29 vote. It passed the Senate onTuesday by a narrow margin, on an 18-17 vote.

The legislation authorizes the state to tap federal grants to support its response to the opioid crisis. But it includes a new restriction on who can receive free naloxone kits — capable of reversing the fatal effects of an opioid overdose.

Currently, the state allows a range of entities to request free naloxone kits. In addition to first responders like police, recipients can include shelters, substance use disorder treatment providers, recovery and crisis centers, hospital emergency departments, public health departments, harm reduction programs and others.

The existing program increased statewide use of naloxone, providing 17,400 kits to more than 300 agencies across the state in a recent one-year period, according to the Idaho Department of Health and Welfare.

Those kits reversed at least 628 opioid-related overdoses, the department said.

The bill heading to the governor says that, moving forward, those kits “shall be available only to first responders in the state of Idaho.”

Advocates say bill will reduce availability of naloxone, legislators say it will remain accessible

Norma Jaeger, executive director of Recovery Idaho, is a substance-use disorder recovery advocate who believes the provision will keep life-saving medication from reaching people who need it.

Sen. Rick Just standing at his desk on the Senate floor
 “I think there’s a fear (that) naloxone … will enable drug dealers to keep their addicts alive. That’s a concern I’ve heard,” said Sen. James R. “Rick” Just, D-Boise, during a floor debate March 28, 2023. (Screenshot via Idaho In Session)

Only about 25% of the supplies of naloxone that are distributed from the state have gone to first responders, she said.

Jaeger said people in rural communities, especially, will have a harder time obtaining naloxone.

Their first responders tend to be volunteer fire or ambulance crews — whose limited time and personnel make it a challenge to order and distribute naloxone kits.

The bill will reduce the availability of naloxone, “in the midst of a fentanyl crisis,” she said.

Sen. Julie VanOrden, R-Pingree, sponsored the bill in the Senate. She argued that the language to restrict distribution of naloxone kits wouldn’t hinder anyone’s ability to obtain naloxone.

In the past year, the state provided free naloxone kits to bars, hotels, restaurants and tattoo parlors in addition to the other recipients, VanOrden said.

“These entities can still get naloxone and have it available at their places of business,” she said. “Anybody can go get naloxone.”

Sen. Todd Lakey stands at his desk in the Senate
 “We have a government grant that provides this product, this drug, that is needed” by first responders, said Sen. Todd Lakey, R-Nampa, during a floor debate March 28, 2023. “Others, private citizens, shouldn’t be looking for government funding to purchase this naloxone. That’s their opportunity. It’s available.” (Screenshot via Idaho In Session)

VanOrden said, incorrectly, that people can walk into a pharmacy and get naloxone for free.

Some pharmacies — such as major chain retail pharmacies — provide the medication at no cost. Others may charge the customer.

Democratic senators and a small number of Republican senators spoke against that restriction during Tuesday’s floor debate.

“Nurses and coaches and teachers and family members and friends and ski patrol people, they need this naloxone, they need to have it on hand so they can treat people who are in a serious opioid-related overdose situation, and I can’t in good faith support this with that language in there,” said Sen. Janie  Ward-Engelking, D-Boise. 

Sen. Chris T. Trakel, R-Caldwell, said in a brief comment during floor debate that “this could be the easiest debate in the world.”

He compared the Narcan nasal-spray version of naloxone with other life-saving devices that are readily available to non-first responders.

“We’re talking about a nasal spray. If you walk around, there’s so much more complicated (tools) for first aid in this building right now,” Trakel said. “Defibrillators. Those are more serious than this. If we trust citizens with (that), we should be able to trust people with this.”

Sen. Carl Bjerke, R-Coeur d’Alene, called the restriction on free naloxone kits a matter of fiscal responsibility.

“What we don’t talk about, these drugs have an expiration date,” and unused kits are a waste of money, he said. Naloxone kits expire after 36 months.

“… I don’t think anywhere in that intent language is it that we don’t want this to be available to people,” Bjerke said. “We want to make sure it’s expeditiously utilized. And the people who can do that most effectively are the people that have been tasked with that responsibility from the get-go. So just keep that in mind when we’re talking about this. It’s not like going and buying a bottle of aspirin at your local Walgreens. It should be controlled, and I think this is a great compromise in this respect.”