‘Opioid bill will effectively create necessary policy’

Attorney General Edward Manibusan has determined that a bill governing opioid overdose reversal medication will create the necessary policy to ensure that emergency medical services and others have the legal authority, access, and training in the administration of naloxone, which is used to reverse or reduce the effects of opioids.

Manibusan said House Bill 23-23 thoroughly describes who is permitted to administer naloxone, who is to be trained in its administration, who is required to carry naloxone, who is to be exempt, and other relief from liability when acting in good faith and in the absence of gross negligence or willful misconduct.

“By creating [this] new policy, as well as amending current policy, H.B. 23-23 appears to be comprehensive and well planned for a preliminary implementation,” said Manibusan in his written comments on the legislation.

Last week, the House of Representatives adopted a report by the House Committee on Health and Welfare that recommends the passage of H. B. 23-23. All 17 House members present at the session then voted “yes” to pass the legislation.

Authored by Rep. Malcolm J. Omar (Ind-Saipan), H. B. 23-23 seeks to establish a CNMI Drug Overdose Policy; to authorize and mandate first responders to possess opioid overdose reversal medication; to authorize standing orders for opioid overdose reversal medication; and to provide limited immunity for dispensing opioid overdose medication. The bill is now before the Senate for action.

Manibusan said in his comments the only policy decision for the committee would be to determine whether more regulatory framework is needed at this time.

Manibusan said medical professionals on island have published information on the number of opioid deaths and overdoses in the CNMI, which stands at around one death and two overdoses in the last year.

Manibusan said it would be crucial to monitor the usage of federal funds intended for naloxone, particularly since the actual need for naloxone is almost non-existent compared to other states.

The framework of H.B. 23-23 seems to be solid, though, Manibusan said, and any such funds would likely be used appropriately (providing naloxone, education training, etc.).

He said the bill follows the trend of many states that have granted naloxone administration authority to emergency medical services providers. Manibusan said EMS authority to administer naloxone is governed largely by state scope of practice laws and protocols. He said these policies specify appropriate indications and permissible dosages and routes of administration.

The AG noted that the authority that gives the CNMI the ability to create related policy rests with Section 319 of the Public Health Service Act. Under the PHS Act, the secretary of the Department of Health and Human Services may determine that a disease or disorder presents a public health emergency; or that a public health emergency , including significant outbreaks of infectious disease or bioterrorist attacks, exists.

While this federal public health emergency concerning the opioid crisis does not in itself permit unprescribed use of naloxone, nor create legal protections for its nonprescriptive use, it does in effect open the door for states to create their own legislation regarding the issue, Manibusan said. Due to this public health emergency, states may now draft and enact standing orders similar to H.B. 23-23.

Manibusan said the intent of the declaration is to allow individual states to control the parameters in which medications such as naloxone is to be used, by whom, and associated legal protections, as well as to receive federal funding and remove red tape in order to achieve the desired results of combatting the opioid crisis.

Dr. Lily Muldoon, who is the medical director of Public Health at the Commonwealth Healthcare Corp., has expressed support for H.B. 23-23, telling the committee that the CNMI is expected to see an increase in opiate overdoses, similar to what has been happening in the U.S. mainland and in Guam.

Edward Manibusan