An Act concerning administration of opioid antidotes by EMTs and first responders, supplementing Title 26 of the Revised Statutes, and amending P.L.2013, c.46.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) As used in this act:

"Commissioner" means the Commissioner of Health.

"Emergency medical technician" means any person who has been trained and certified by the Department of Health to engage in basic life support services, as defined in section 1 of P.L.1985, c.351 (C.26:2K-21), intermediate life support services, as defined in section 1 of P.L.1985, c.351 (C.26:2K-21), or advanced life support services, as defined in section 1 of P.L.1984, c.146 (C.26:2K-7).

"Employer" means a public or private entity, including, but not limited to, a hospital or emergency services organization; a police or fire department; a State, county, or municipal prosecutor's office; or any other department or agency of State or local government, which employs the services of one or more emergency medical technicians or first responders.

"First responder" means a law enforcement officer, paid or volunteer firefighter, paid or volunteer member of a duly incorporated first aid, emergency, ambulance, or rescue squad association, or any other individual, other than an emergency medical technician, who, in the course of the person's employment, is dispatched to the scene of a motor vehicle accident or other emergency situation for the purpose of providing medical care or other assistance.

"Opioid antidote" means naloxone hydrochloride or any other similarly acting drug approved by the United States Food and Drug Administration for the treatment of an opioid overdose.

2. (New section) a. An emergency medical technician or a first responder may administer an opioid antidote in an emergency, without fee, if the emergency medical technician or first responder: (1) has signed a certification form verifying their successful completion of an approved training course in opioid antidote administration, as provided by subsection b. of this section; and (2) believes, in good faith, that another person is experiencing an opioid overdose.

b. Before engaging in the administration of opioid antidotes pursuant to this section, an emergency medical technician or first responder shall sign a form, provided thereto and maintained by their employer, certifying that the emergency medical technician or first responder has successfully completed a training course in opioid antidote administration, which has been approved by the commissioner pursuant to subsection c. of this section.

c. (1) The commissioner shall approve a training course in opioid antidote administration for use in the training of emergency medical technicians and first responders, pursuant to this section, if the course includes, at a minimum, training and the provision of information on: opioid overdose recognition; opioid antidote dosages and procedures for opioid antidote administration; and methods for the appropriate care of an overdose victim following administration of an opioid antidote thereto.

(2) The commissioner shall approve or deny a request for training course approval within 14 days after receipt thereof. If the commissioner fails to take action on such a request within the 14-day period specified herein, the request shall be deemed to have been approved, and the training course identified in the request may be implemented without further delay.

d. An employer shall maintain a list of all emergency medical technicians and first responders under the employ thereof who have certified their completion of an approved training course, in accordance with this section. The employer shall make a copy of this list available to members of the public, upon request.

e. In order to cover the cost of training that is required pursuant to this section, an emergency medical technician or first responder may be required to pay a fee for their enrollment and participation in an approved training course, so long as the entity providing the training is not reimbursed for training costs through the "Emergency Medical Technician Training Fund," established pursuant to section 3 of P.L.1992, c.143 (C.26:2K-56).

3. (New section) No emergency medical technician, first responder, or employer thereof shall be liable for any civil damages resulting from an act or omission committed by the emergency medical technician or first responder while in training to administer, or while engaged in the good faith and certified administration of, an opioid antidote, in accordance with the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill).

4. (New section) Nothing in P.L. , c. (C. ) (pending before the Legislature as this bill) shall be construed to:

a. authorize an emergency medical technician or a first responder to perform the duties, or fill the position, of a health care professional employed by a hospital;

b. interfere with an emergency service training program authorized and operated under the provisions of the "New Jersey Highway Traffic Safety Act of 1987," P.L.1987, c.284 (C.27:5F-18 et seq.);

c. prohibit the administration of an opioid antidote by a person who is acting pursuant to a lawful prescription or standing order issued in accordance with sections 1 through 6 of the "Overdose Prevention Act," P.L.2013, c.46 (C.24:6J-1 et seq.); or

d. prevent a licensed and qualified member of a health care profession from administering an opioid antidote if such administration is consistent with the accepted standards of practice applicable to the member's profession.

5. Section 2 of P.L.2013, c.46 (C.24:6J-2) is amended to read as follows:

2. The Legislature finds and declares that encouraging witnesses and victims of drug overdoses to seek medical assistance saves lives and is in the best interests of the citizens of this State and, in instances where evidence was obtained as a result of seeking of medical assistance, these witnesses and victims should be protected from arrest, charge, prosecution, conviction, and revocation of parole or probation for possession or use of illegal drugs. Additionally, naloxone is an inexpensive and easily administered antidote to an opioid overdose. Encouraging the wider prescription and distribution of naloxone or similarly acting drugs to those at risk for an opioid overdose, [or] to members of their families or peers, and to emergency medical technicians and first responders, would reduce the number of opioid overdose deaths and be in the best interests of the citizens of this State. It is not the intent of the Legislature to protect individuals from arrest, prosecution or conviction for other criminal offenses, including engaging in drug trafficking, nor is it the intent of the Legislature to in any way [modify or] restrict the current duty and authority of law enforcement and emergency responders at the scene of a medical emergency or a crime scene, including the authority to investigate and secure the scene.

(cf: P.L.2013, c.46, s.2)

6. Section 3 of P.L.2013, c.46 (C.24:6J-3) is amended to read as follows:

3. As used in this act:

"Commissioner" means the Commissioner of Human Services.

"Drug overdose" means an acute condition including, but not limited to, physical illness, coma, mania, hysteria, or death resulting from the consumption or use of a controlled dangerous substance or another substance with which a controlled dangerous substance was combined and that a layperson would reasonably believe to require medical assistance.

"Health care professional" means a physician, physician assistant, advanced practice nurse, or other individual who is licensed or whose professional practice is otherwise regulated pursuant to Title 45 of the Revised Statutes, other than a pharmacist, and who, based upon the accepted scope of professional authority, prescribes or dispenses an opioid antidote.

"Medical assistance" means professional medical services that are provided to a person experiencing a drug overdose by a health care professional, acting within the scope of his or her lawful practice, including professional medical services that are mobilized through telephone contact with the 911 telephone emergency service.

"Opioid antidote" means naloxone hydrochloride or any other similarly acting drug approved by the United States Food and Drug Administration for the treatment of an opioid overdose.

["Health care professional" means a physician, physician assistant, advanced practice nurse, or other individual who is licensed or whose professional practice is otherwise regulated pursuant to Title 45 of the Revised Statutes, other than a pharmacist, and who, based upon the accepted scope of professional authority, prescribes or dispenses an opioid antidote.]

"Patient" includes a person who is not at risk of an opioid overdose but who, [in the judgment of a physician, may be in a position to assist another individual during an overdose and who has received patient overdose information as required by section 5 of this act on the indications for and administration of an opioid antidote] acting in their individual capacity, seeks to obtain an opioid antidote from a health care professional or pharmacist for administration to a third party who is at risk of an opioid overdose. "Patient" shall include an emergency medical technician or a first responder who is acting in their capacity as an individual citizen, but shall not include an emergency medical technician or a first responder who is acting in a professional capacity .

(cf: P.L.2013, c.46, s.3)

7. Section 4 of P.L.2013, c.46 (C.24:6J-4) is amended to read as follows:

4. a. A health care professional or pharmacist who, acting in good faith, directly or through a standing order, prescribes or dispenses an opioid antidote to [a] an emergency medical technician or first responder who is authorized to administer opioid antidotes pursuant to section 2 of P.L. , c. (C. ) (pending before the Legislature as this bill), or to any patient who is capable, in the judgment of the health care professional, of administering the opioid antidote in an emergency, shall not, as a result of [the professional's] their acts or omissions, be subject to any criminal or civil liability, or any professional disciplinary action under Title 45 of the Revised Statutes for [prescribing or dispensing] their prescription or dispensation of an opioid antidote in accordance with [this act] P.L.2013, c.46 (C.24:6J-1 et seq.) .

b. An emergency medical technician or a first responder who administers an opioid antidote, in good faith, in their professional capacity, and pursuant to the provisions of section 2 of P.L. , c. (C. ) (pending before the Legislature as this bill), shall not, as a result of their acts or omissions, be subject to any criminal or civil liability or any professional disciplinary action for their administration of an opioid antidote in accordance with P.L.2013, c.46 (C.24:6J-1 et seq.) and the provisions of sections 1 through 4 of P.L. , c. (C. ) (pending before the Legislature as this bill).

c. A [person, other than a health care professional,] patient may [in an emergency] administer [, without fee,] an opioid antidote in an emergency, without fee, if the [person] patient has received [patient] overdose prevention information pursuant to section 5 of [this act] P.L.2013, c.46 (C.24:6J-5) and believes in good faith that another person is experiencing an opioid overdose. The [person] patient shall not, as a result of [the person's] their acts or omissions, be subject to any criminal or civil liability for [administering] their administration of an opioid antidote in accordance with [this act] P.L.2013, c.46 (C.24:6J-1 et seq.). In addition, the immunity provided [for in] by section 7 [or] and section 8 of P.L.2013, c.46 (C.2C:35-30 or C.2C:35-31) [also] shall also apply to a [person] patient acting pursuant to this [section] subsection, provided that the requirements of [section 7 or section 8 also] those sections have been met.

(cf: P.L.2013, c.46, s.4)

8. Section 5 of P.L.2013, c.46 (C.24:6J-5) is amended to read as follows:

5. a. A health care professional prescribing or dispensing an opioid antidote to a patient who is deemed thereby to be capable of administering the opioid antidote in an emergency shall ensure that the patient receives [patient] overdose prevention information. [This] The requisite overdose prevention information shall include, but [is] need not be limited to: information on opioid overdose prevention and recognition; instructions on how to perform rescue breathing and resuscitation; information on opioid antidote dosage and instructions on opioid antidote administration; information describing the importance of calling 911 emergency telephone service for assistance with an opioid overdose; and instructions for appropriate care [for] of an overdose victim after administration of the opioid antidote.

b. (1) In order to fulfill the information distribution [of patient overdose information required by] requirements provided by subsection a. of this section, [the] overdose prevention information may be provided by the prescribing or dispensing health care professional or pharmacist, or by a community-based organization, substance abuse organization, or other organization [which] that addresses medical or social issues related to drug addiction [that] , and with which the health care professional or pharmacist, as appropriate, maintains a written agreement [with, and that includes]. Any such written agreement shall incorporate, at a minimum: procedures for [providing patient] the timely dissemination of overdose prevention information; information as to how employees or volunteers providing the information will be trained; and standards [for documenting the provision of patient overdose information to patients] for recordkeeping under paragraph (2) of this subsection.

[c.] (2) The provision of [patient] overdose prevention information shall be documented in the patient's medical record [by a health care professional] , if available; or in another appropriate record or log, if the patient's medical record is unavailable or inaccessible; or [through] in any other similar [means as determined by any] recordkeeping location, as specified in a written agreement [between a health care professional and an organization as set forth in] that has been executed pursuant to paragraph (1) of this subsection [b. of this section].

[d. The] c. In order to facilitate the provision of overdose prevention information pursuant to this section, the Commissioner of Human Services, in consultation with the Commissioner of Health and Statewide organizations representing physicians, advanced practice nurses, or physician assistants, [or] and organizations operating community-based programs, substance abuse programs, syringe access programs, or other programs which address medical or social issues related to drug addiction, [may] shall develop [and disseminate] training materials in video, electronic, or other appropriate formats , and disseminate these materials to health care professionals [or] , pharmacists, and organizations operating community-based programs, substance abuse programs, syringe access programs, or other programs which address medical or social issues related to drug addiction [, to facilitate the provision of patient overdose information] .

(cf: P.L.2013, c.46, s.5)

9. Sections 1 through 4 of this act shall take effect on the first day of the fourth month next following the date of enactment, but the Commissioner of Health may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act. Sections 5 through 8 of this act shall take effect immediately.

STATEMENT

This bill would expand the scopes of practice of emergency medical technicians (EMTs) and first responders (including police, firefighters, and other persons who, in their professional capacity, are dispatched to the scene of an emergency) to include the administration of opioid antidotes under certain circumstances. It would additionally extend immunity under the "Overdose Prevention Act," P.L.2013, c.46, to EMTs and first responders who administer opioid antidotes, in good faith, in the course of their professional practice, in accordance with the bill's provisions.

On March 20, 2014, the Department of Health (DOH) issued a waiver authorizing EMTs and certain first responders who are certified as EMTs to administer opioid antidotes in the course of their professional practice with immunity under the Overdose Prevention Act. However, the DOH waiver is only applicable for a limited time - until March 1, 2015 or the adoption of new regulations. The statutory changes made by this bill would effectively make the DOH waiver permanent, and would expand the waiver to include all types of first responders (i.e., not only those who are certified as EMTs).

The bill would authorize an EMT or first responder to administer an opioid antidote in an emergency, without fee, if the EMT or first responder believes, in good faith, that another person is experiencing an opioid overdose, and the EMT or first responder has signed a certification form, maintained by their employer, which verifies their successful completion of a training course in opioid antidote administration that has been approved by the Commissioner of Health. An entity employing EMTs or first responders would be required to maintain a running list of persons employed thereby who have certified their successful completion of an approved training course, and would additionally be required to make this list available to the public, upon request.

The bill would require the Commissioner of Health to approve a training course in opioid antidote administration if the course includes training and the provision of information on: opioid overdose recognition; opioid antidote dosages and procedures for antidote administration; and the methods for the appropriate care of an overdose victim following administration of an opioid antidote thereto. In order to expedite and facilitate the establishment of training courses, in this regard, the bill would require the commissioner to make a determination on a request for course approval within 14 days after receipt thereof. If no action is taken by the commissioner during that 14-day period, such request will be deemed to have been approved, and the training course may be established immediately, without further action by the Department of Health.

The bill would provide immunity from civil damages for acts or omissions that may be committed by an EMT or first responder while in training, or while engaged in the good faith, authorized administration of an opioid antidote. It would also extend immunity from civil, criminal, and professional liability, under the Overdose Prevention Act, to EMTs and first responders who administer opioid antidotes, in good faith, in the course of their professional practice, in accordance with the bill's provisions. The bill would further clarify that a health care professional or pharmacist will be immune from civil, criminal, and professional liability under the Overdose Prevention Act if they prescribe or dispense an opioid antidote to an EMT or first responder who is authorized to administer the same.

Nothing in the bill's provisions would be understood to:

- authorize an EMT or first responder to perform the duties, or fill the position, of a health care professional employed by a hospital;

- interfere with an emergency service training program authorized and operated under the provisions of the "New Jersey Highway Traffic Safety Act of 1987;"

- prohibit the administration of an opioid antidote by a person (including an EMT or first responder) who is acting in their individual, non-professional capacity, as a "patient," pursuant to a lawful prescription or standing order issued pursuant to the Overdose Prevention Act; or

- prevent a licensed and qualified member of a health care profession from administering an opioid antidote if such administration is consistent with the accepted standards of practice applicable to the member's profession.