On May 24, 2021, the New York State Assembly passed Assemblyman Edward C. Braunstein’s (D-Bayside) bill A.336-A, which would require medical professionals to co-prescribe an antagonist, such as “Narcan,” with a new opioid prescription once annually when certain patient risk factors are present. The bill received overwhelming bipartisan support, with a vote of 144-3.

As COVID-19 cases surged in the United States in 2020, so did substance abuse, which increased during the months of uncertainty and isolation. According to the CDC, 81,000 drug overdoses occurred in the U.S. from May 2019 to May 2020, the highest ever recorded in a 12-month period. Drug overdose deaths in New York increased by an estimated 37% in the first eight months of 2020, year-over-year. Between January and March of 2020, 440 New York City residents died due to an accidental drug overdose, nearly 100 more deaths during the same time in 2019. Opioid-related overdoses mainly drove these increases.

Naloxone hydrochloride, an opioid antagonist more commonly known as “naloxone” or “Narcan,” acts to block the effects of opioids and reverse overdose. However, it is mainly used in an emergency capacity. Co-prescribing this antidote to patients with a history of overdose, or who are prescribed a high dose or cumulative prescriptions that result in 90 morphine milligram equivalents or more per day, or who concurrently use benzodiazepines would help educate New Yorkers, reverse the addiction crisis and save lives. 

“In 2020, as we fought to contain one public health epidemic, another was quietly on the rise: opioid abuse,” said Assemblyman Edward Braunstein. “Increasing access to the antidote naloxone would not only save lives in New York and reduce emergency room admissions, but also open a critical dialogue between doctor and patient about the dangers associated with opioids and long-term use.”

"Ensuring access to naloxone is critical in stopping the sharp rise in opioid overdoses and this bill guarantees that naloxone will be available for those at the highest risk of overdose. Naloxone is an essential tool that can and should be used," said Allegra Schorr, President of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State (COMPA). “Thank you to the NYS Assembly and Assemblyman Braunstein for their leadership on this important issue.”

Co-prescription has strong national and local support from groups including the Substance Abuse and Mental Health Administration, American Pharmacist Association, New York State Association of County Health Officials and the Alcoholism and Substance Abuse Providers of New York State. In recent guidelines issued to clinicians, the NYC Department of Health and Hygiene said, "Prescribing naloxone for overdose prevention to at-risk patients can have a two-fold benefit: the naloxone could be used to reverse an overdose experienced by the patient, or the patient could use it to reverse an overdose that he/she witnesses." 

If signed into law, the bill would add New York to a group of at least eleven states that have now enacted similar laws in recent years. These states include, among others, New Jersey, Vermont, California and New Mexico. After mandating co-prescription, the New Mexico Department of Health reported a subsequent decline in prescription opioid overdose deaths. Studies in New Jersey have also indicated co-prescribing naloxone with prescription opioids may help reduce emergency room visits by 63% in one year.

Insurance covers naloxone for over 99% of New Yorkers today and the New York Naloxone Co-payment Assistance Program (N-CAP) covers up to $40 of an insurance co-pay for naloxone, allowing most New Yorkers to access the medication at no cost.

The companion bill in the New York State Senate is sponsored by Senator Pete Harckham.