Nasal Narcan

Policy & Procedures                 No. 1.40
                                  Subject:
                Nasal Narcan
                                  Issuing Authority:                                       Effective Date:   Review Date:
                                                         10-6-      11-13-
                     Chief of Police                 2014      2023
                                                                                 References:

 Revision
 &          11-13-2016
 Reissued   10-12-2018
 Dates:     05-10-2020
            09-14-2022

BACKGROUND:

Opiate overdose is the leading cause of accidental death in Massachusetts. Fatal and nonfatal
overdose can result from the abuse of opiates such as morphine, heroin, fentanyl, oxycodone as
found in OxyContin®, Percocet® and Percodan®, and hydrocodone as found in Vicodin®.

Naloxone, commonly known by the brand-name Narcan®, is an opioid antagonist which means
it displaces the opioid from receptors in the brain and can therefore reverse an opiate overdose. It
is a scheduled drug, but it has no euphoric properties and minimal side effects. If it is
administered to a person who is not suffering an opiate overdose, it will do no harm. Naloxone
has been available as an injectable since the 1960s, but was recently developed as a nasal spray.

To reduce the number of fatalities which can result from opiate overdoses, the Canton Police
Department will train its officers in the proper pre-hospital administration of nasal naloxone. In
order to implement a safe and responsible nasal naloxone plan, the Department will establish and
maintain a professional affiliation with a Medical Control Physician (MCP) who will provide
medical oversight over its use and administration. The Medical Control Physician shall be
licensed to practice medicine within the Commonwealth of Massachusetts. At his or her
discretion, he or she may make recommendations regarding the policy, oversight, and
administration of the nasal naloxone program developed and implemented by the Department.

In order to implement this policy the Canton Police Department relies upon the following
statutes:

M.G.L. c. 94C, § 34A which states that “a person acting in good faith may receive a naloxone
prescription and administer naloxone to an individual appearing to experience an opiate related
overdose.” The statute imposes no limitation on who may possess and administer nasal naloxone,
and only requires that it is (1) obtained with a prescription and (2) administered in good faith.

M.G.L. c. 94C, § 19 which states that “Naloxone or other opioid antagonist may lawfully be
prescribed and dispensed to a person at risk of experiencing an opiate-related overdose or a
family member, friend or other person in a position to assist a person at risk of experiencing an

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opiate-related overdose. For purposes of this chapter and chapter 112, any such prescription shall
be regarded as being issued for a legitimate medical purpose in the usual course of professional
practice.”

M.G.L. c. 94C, § 7 which states that “any public official or law enforcement officer acting in the
regular performance of his official duties” shall not require registration and may lawfully possess
and distribute controlled substances.

M.G.L. 258C, § 13 which states that “No person who, in good faith, provides or obtains, or
attempts to provide or obtain, assistance for a victim of a crime as defined in section one, shall be
liable in a civil suit for damages as a result of any acts or omissions in providing or obtaining, or
attempting to provide or obtain, such assistance unless such acts or omissions constitute willful,
wanton or reckless conduct.”

Chapter 161 of the Acts of 2016 ‘An Act Relative to Protective Custody’ which is the expansion
of the protective custody law now allowing for transport to a medical facility for those who are
incapacitated due to any substance excluding alcohol. Any person administered Naloxone by
law enforcement personnel or EMS shall be transported, preferably by EMS, either voluntarily or
under protective custody to a medical facility.

DEFINITIONS:

Opiate: An opiate is a medication or drug that is derived from the opium poppy or that mimics
the effect of an opiate (a synthetic opiate). Opiate drugs are narcotic sedatives that depress
activity of the central nervous system, reduce pain, and induce sleep. Police officers often
encounter opiates in the form of morphine, methadone, codeine,
heroin, fentanyl, oxycodone (OxyContin®, Percocet® and Percodan®) and hydrocodone
(Vicodin®).

Naloxone: Naloxone is an opioid antagonist that can be used to counter the effects of opiate
overdose. Specifically, it can displace opioids from the receptors in the brain that control the
central nervous system and respiratory system.  It is marketed under various trademarks
including Narcan®.

Medical Control Physician: The Medical Control Physician, herein after referred to as MCP,
shall be a designated Medical Doctor who is licensed to practice medicine in Massachusetts. The
Canton Police department shall maintain an affiliation with the MCP.

POLICY:

Naloxone will be deployed in all marked Department vehicles for the treatment of drug overdose
victims. A patrol unit shall be dispatched to any call that relates to a drug overdose. The goal of
the responding officers shall be to provide immediate assistance via the use of naloxone where
appropriate, to provide any treatment commensurate with their training as first responders, to
assist other EMS personal on scene, and to handle any criminal investigations that may arise.

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PROCEDURE:

When an officer of the Canton Police Department has arrived at the scene of a medical
emergency prior to the arrival of EMS, and has made a determination that the patient is suffering
from an opiate overdose, the responding officer should administer naloxone (four milligrams) to
the patient by way of the nasal passages.

The following steps should be taken:

1. Officers shall use universal precautions.

2. Officers should conduct a medical assessment of the patient as prescribed by Department
Policies and Procedures, to include take into account statements from witnesses and/or family
members regarding drug use.

3.  If the officer makes a determination that there has been an opiate overdose, the naloxone kit
should be utilized.

4. The officer shall use the department issued naloxone to administer a four milligram intra-
nasal dose of naloxone. Officers should be aware that a rapid reversal of an opiate overdose may
cause projectile vomiting by the patient and/or violent behavior.

5. The patient should continue to be observed and treated as the situation dictates including
giving an addition dose(s) as needed.

6. The treating officer shall inform incoming EMS about the treatment and condition of the
patient, and shall not relinquish care of the patient until relieved by a person with a higher level
of training.

7. The patient shall be transported by EMS to a medical facility. The subject can either go
voluntarily or be placed into protective custody and mandated to go. (See Protective Custody
Policy 1.24)

Reporting:

As with any overdose a complete offense report of the event shall be completed by the treating
officer, or the primary responding officer, prior to the end of his shift.

Equipment and maintenance:

Naloxone kits will be stored in pouch attached to the AED case. The Department Infectious
Control Officer (DICO) will periodically inspect the pouches to make sure that that the Naloxone
is up to date and functional.

Damaged equipment shall be immediately reported (verbally) to a shift supervisor and the
equipment removed from service.

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The Department’s Medical Services Officer will maintain a written inventory documenting the
quantities and expirations of naloxone replacement supplies, and a log documenting the issuance
of replacement units.

Replacement

Shift supervisors shall immediately replace naloxone kits that have been used during the course
of a shift.  If no replacement kits are available, a request can be made to the Canton Fire
Department for a replacement one.

Training:
Officers shall receive a standard two hour training course administered by the MPC and the
Department prior to being allowed to carry and use naloxone. The Department shall provide
refresher training every two years.

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