Mandated Rehabilitation for Individuals who

are Administered Naloxone

By: Danielle Crissey

The opioid epidemic is affecting many Americans every day. Victims of this epidemic
line the streets of major cities with no place to call home. The consequences of the
epidemic go beyond just the victims, it touches families, communities, and business
owners. There needs to be accountability for those who have fallen into this lifestyle and
there needs to be government action to end this epidemic and the consequences that
burden communities. Mandatory rehabilitation should be a requirement for those who
are administered naloxone.
More than 932,000 people have died since 1999 from a drug overdose.1
In 2020, roughly 92,000 deaths were a result of opioid abuse.2
The number of prescriptions for naloxone doubled from 2017 to 2018.3
9.7 million people misused prescription pain relievers in 2019.4
Nearly 8.7 million children below the age of 17 have at least one parent with addiction issues.5

1
Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health
Statistics; 2021. Available at http://wonder.cdc.gov.
2
Drug Overdose Deaths Remain High. Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at
https://www.cdc.gov/drugoverdose/deaths/index.html.
3
Life-Saving Naloxone from Pharmacies. Atlanta, GA: CDC, National Center for Health Statistics; 2019. Available at
https://www.cdc.gov/vitalsigns/naloxone/index.html?deliveryName=DM8022.
4
Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on
Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration: 2020. Available
at
https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1
PDFW090120.pdf.
5
Aron, Laudan Y, Benatar, Sarah, & Peters, Rebecca. Supporting Children and Families Affected by the Opioid
Epidemic. Washington, D.C.: Urban Institute; 2020. Available at
https://www.urban.org/sites/default/files/publication/103249/supporting-children-and-families-affected-by-the-
opioid-epidemic_0.pdf.
 Graph courtesy of National Institute on Drug Abuse
https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

These facts should be alarming to the average person. I would venture a guess and state
that nearly every person reading this knows somebody who is or has been addicted to
some type of opioid. I would take that statement one step further, most people reading
this personally know someone who has died as a direct result of opioid abuse. The opioid
epidemic has spread like wildfire through the United States and its effects go beyond just
the individual with the addiction. Many of these individuals have taken to living in the
streets either because they have no income to pay for housing, their income is being used
to support their addiction, or because family members can no longer provide a safe place
for these individuals to live. Countless videos can be found on YouTube detailing out the
streets of cities like Philadelphia, specifically Kensington Ave. In one video by SBC News
you can see people lining the sidewalks and brazenly injecting themselves with drugs
right in front of the cameras.6 Drug possession is illegal in Pennsylvania yet it appears
that law enforcement and local government agencies have given up on enforcing these
laws.7 Individuals are using these drugs in public places and are not being held

6
SBC News. “Streets of Philadelphia, Kensington Ave Documentary, June 12-13, 2022.” June 19, 2022. Available at
https://www.youtube.com/watch?v=1FGDcC6X7_U
7
Pennsylvania Drug Possession Laws. Eagan, MN: Thomas Reuters, Find Law; 2022. Available at
https://www.findlaw.com/state/pennsylvania-law/pennsylvania-drug-possession-
laws.html#:~:text=In%20Pennsylvania%2C%20it%20is%20a,%2C%20methamphetamines%2C%20and%20other%20
drugs.
accountable for violating the law. More importantly, these individuals are not being
provided assistance to overcome this addiction. I wish to explore options to help these
individuals overcome their addictions and become a valued member of society.

It may seem like a daunting task to fix the opioid epidemic, and rightfully so based on
the facts listed above but if even a small percentage of individuals can be helped then any
change will certainly pay off. Most, if not all, law enforcement agencies and emergency
services are required to have naloxone available for individuals who call 911 due to a
drug overdose. After naloxone is administered, the individual is required to either be
taken to the hospital or to jail.8 This is obviously not ideal due to hospitals being over
worked and under staffed due to the Coronavirus epidemic and due to jails not being the
proper place to house an individual in need of medical attention.9 The individuals are
then released just days later and are falling right back into the same vicious cycle. There
needs to be treatment programs available to these individuals. Research shows that
treatment programs are more effective when they include:

 The understanding that addiction is a treatable disease that alters brain function
and behavior and there is a risk for relapse even after long periods of abstinence
 The ability to attend to needs in addition to treating the drug or alcohol use,
including medical, psychological, social, vocational, and legal issues
 A combination of evidence-based therapy and medication-assisted therapy
tailored to a person’s age, gender, ethnicity, and culture for an appropriate length
of time
 The understanding that no single treatment program is right for everyone.
 Support for co-occurring mental health issues
 Medically-assisted detox
 Continuous monitoring of drug use during treatment
 Testing for the presence of diseases such as HIV/AIDS, hepatitis B & C, and
tuberculosis10

This type of treatment is long-term and not readily available to everyone suffering from
addiction issues. The key is making this treatment available to those in need to help
combat the opioid epidemic.

8
Smiley-McDonald, H.M., Attaway, P.R., Richardson, N.J. et al. Perspectives from law enforcement officers who
respond to overdose calls for service and administer naloxone. Health Justice 10, 9 (2022).
https://doi.org/10.1186/s40352-022-00172-y.
9
French G, Hulse M, Nguyen D, et al. Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic —
United States, July 2020–July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1613–1616. DOI:
http://dx.doi.org/10.15585/mmwr.mm7046a5
10
National Institute on Drug Abuse. “Principles of Effective Treatment.” Drugabuse.Gov, 2018. Available at
https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-
edition/principles-effective-treatment
If treatment was mandated for all individuals who are administered naloxone by
emergency personnel it would help get some individuals off the streets and into
rehabilitation centers in order to get them back on the right track.

Rehabilitation programs tailored to the victim have proven to be successful. A study by

the CDC and National Institution on Drug Abuse in 2020 states
that 75% of people who are addicts will recover.11 This is a very
promising figure that further supports the concept of mandated
treatment for individuals suffering from addiction. The most
75%
Recover from
effective way to defeat addiction is through effective treatment addiction

tailored to fit the individuals’ needs. There are laws currently in

place if you are caught driving under the influence of alcohol, including the possibility
of losing your driver’s license, fines, and alcohol/drug classes.12 These measures are
effective for combatting drunk driving and therefore similar measures should be
implemented for opioid abuse resulting in emergency personnel administering naloxone.
Won’t mandated treatment stop individuals from calling 911 and result in additional
unnecessary deaths?

While it is expected that some individuals might be leery of contacting 911 for assistance
when experiencing a possible overdose there is a law in place that protect the individual
making the call. This law is known as the Good Samaritan Drug Overdose Immunity
Law. It protects the individual who assists someone who is experiencing and overdose.
The individual assisting is immune from being held criminally or civilly liable as long as
they meet certain criteria.13
Are rehabilitation centers equipped to assist individuals in need of immediate
enrollment?

There are many drug rehabilitation programs available in Pennsylvania with 24/7
hotlines. Partnership with law enforcement and government agencies is key in making
this type of treatment available to those in need.
Is rehabilitation a one size fits all treatment, what if the individual has specific needs?

Rehabilitation is not a one size fits all treatment option. There are many different options
such as:

11
Mann, Brian. January 15, 2022. There is life after addiction. Most people recover. NPR. Available at
https://www.npr.org/2022/01/15/1071282194/addiction-substance-recovery-treatment.
12
Driving Under the Influence. August 22, 2018. Erie, PA: Erie County Bar Association. Available at
https://www.eriebar.com/public/e-law/driving-under-the-influence?gclid=EAIaIQobChMIhbzEscCt-
gIVs8mUCR2FpAnPEAAYAyAAEgKk7fD_BwE.
13
Keane, Daniel M. Doylestown, PA: Clemons, Richter & Reiss, P.C.; 2014. Available at
https://www.clemonslaw.com/recent-news/pa-enacts-good-samaritan-drug-overdose-immunity-law/.
  Detox Programs
 Inpatient Services
 Counseling
 Group Sessions
 Therapy

The key is finding the right treatment for the individual and following through with that
treatment.
How will the mandated treatment be monitored?

Mandated treatment for opioid abuse can be monitored by the courts, much like
mandated treatment related to DUIs are monitored.
How will this treatment program be funded?

The government offers grants for programs that can be applied for through various
methods such as a $1 billion grant for opioid addiction services through the Substance
Abuse and Mental Health Services Administration.14
Won’t this program require more of law enforcement agencies, which are already
burdened with the task of responding to 911 calls related to overdoses?

There are many examples of individuals who had to be administered naloxone multiple
times in a short period of time.15 If these individuals were placed into mandated
treatment this would alleviate calls received and responded to by law enforcement
agencies. In theory it would lessen the calls received as the repeat offenders would be
receiving treatment and would most likely be on the road to recovery.
What if the person who is administered naloxone refuses treatment?

It is suspected that some individuals would not be ready to accept treatment for their
addiction. That’s why it is necessary to tailor the rehabilitation to the need of the
individual and it could be necessary to start with counseling and group sessions to help
the individual understand the need for recovery.

In order to clear the streets of drugs it may be necessary to take drastic steps. These drastic
steps include resources already available to individuals in need. Mandated treatment

14
SAMHSA Releases $1 Billion in Opioid Grant Applications. Washington, DC: National Council for Mental
Wellbeing; 2022. Available at https://www.thenationalcouncil.org/samhsa-releases-1-billion-in-opioid-grant-
applications/?gclid=EAIaIQobChMIhNTc78at-gIVqvbjBx3QWgf2EAAYAiAAEgJwCvD_BwE.
15
Police release statement after using Narcan to save same person three times in 72 hours. September 9, 2022.
WGAL. Available at https://www.wgal.com/article/police-use-narcan-to-save-same-person-three-times-in-three-
days/41083479.
may be the only viable answer to curb the opioid epidemic facing our friends and
families.