HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 89 Naloxone Awareness Day
SPONSOR(S): Healthcare Regulation Subcommittee, Plakon
TIED BILLS: IDEN./SIM. BILLS: CS/SB 66
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N, As CS Osborne McElroy
2) Health & Human Services Committee 17 Y, 0 N Osborne Calamas
SUMMARY ANALYSIS
Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues . Opioids
include prescription medications legitimately prescribed to treat pain, as well as illegal drugs with no
sanctioned medical use. An overabundance of opioids in the body can lead to a fatal overdose. Opioids are the
most lethal group of drugs; worldwide they account for two thirds of all deaths relating to drug use, most of
which are the result of overdoses. In 2023 the number of overdose deaths surpassed 112,000 in a 12-month
period for the first time.
An opioid antagonist is a drug that rapidly reverses the effects of an opioid overdose. Opioid antagonists can
quickly restore normal breathing to a person if their breathing has slowed, or even stopped due to an opioid
overdose. Opioid antagonists have no potential for abuse and will not cause harm if mistakenly administered to
a person who is not overdosing on an opioid.
On March 29, 2023, the US Food & Drug Administration approved the first opioid antagonist nasal spray
available for over-the-counter, nonprescription, use. This allows an accessible, easily administered opioid
antagonist to be sold directly to consumers without the need for a prescription.
Victoria’s Voice Foundation was established in 2019 by Jackie and David Siegal after losing their 18-year-old
daughter, Victoria, to an accidental drug overdose. Victoria’s Voice is dedicated to providing drug prevention
education and raising awareness of the availability and safe use of opioid antagonists in order to support those
affected by substance use.
CS/HB 89 creates “Victoria’s Law,” and designates June 6th of each year as “Revive Awareness Day.” The bill
allows the Governor to issue an annual proclamation designating June 6th as “Revive Awareness Day.”
The bill encourages the Department of Health (DOH) to hold events with the purpose of raising awareness of
the dangers of opioid overdose and the availability and safe use of opioid antagonists.
The bill has an insignificant, negative fiscal impact on DOH and has no fiscal impact on local governments.
The bill is effective upon becoming law.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0089b.HHS
DATE: 2/8/2024
 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Opioids
Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues.1
Opioids are highly effective pain relievers, and as such are commonly used to treat acute and chronic
pain. An individual experiences pain because of a series of electrical and chemical exchanges across
the individual’s peripheral nerves, spinal cord, and brain. 2 Opioid receptors occur naturally and are
distributed widely throughout the central nervous system and in peripheral sensory and autonomic
nerves and modulate the body’s perception of pain.3 Opioids bind to specific opioid receptors, disrupt
the transmission of pain signals through the central nervous system and reduce the perception of pain.4
Opioids include prescription medications legitimately prescribed to treat pain, as well as illegal drugs
with no sanctioned medical use.5 Opioids can create a euphoric feeling because they affect the regions
of the brain involved with pleasure and reward, which can lead people to misuse the substance.6
Opioids are commonly misused; in 2020 an estimated 61 million people worldwide used opioids for
non-medical reasons.7 Continued use of opioids can lead to the development of tolerance and
psychological and physical dependence.8 This dependence is characterized by a strong desire to take
opioids, impaired control over opioid use, persistent opioid use despite harmful consequences, a higher
priority given to opioid use than to other activities and obligations, and a physical withdrawal reaction
when opioids are discontinued.9
Opioid Overdose
Opioids are the most lethal group of drugs; worldwide they account for two thirds of all deaths relating
to drug use, most of which are the result of overdoses.10 More than 109,000 Americans died from a
drug overdose in the 12-month period ending in February, 2023.11
Opioid overdoses result from an overabundance of opioids in the body which leads to the suppression
of the respiratory system. The opioid receptors that are found in major pain pathways, thus enabling
1
World Health Organization, Opioid Overdose. Available at https://www.who.int/news -room/fact-sheets/detail/opioid-overdose (last
visited January 12, 2024).
2 Medical News Today, What is pain, and how do you treat it? (2020). Available at
https://www.medicalnewstoday.com/articles/145750#:~:text=People%20feel%20pain%20when%20specific,immediate%20contraction%
20of%20the%20muscles (last visited January 12, 2024).
3 Henriksen, G. & Willoch, F., Imaging of Opioid Receptors in the Central Nervous System (2008). Brain 131 (5): 1171-1196.
doi: 10.1093/brain/awm255
4 Id.
5 Opioids legally prescribed to treat pain include morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorpho ne,
and buprenorphine. Heroine is an example of an illicit opioid with no sanctioned medical use. See also, U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services Administration, SAMHSA Opioid Overdose Toolkit: Facts for
Community Memb ers (2018). Available at https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf (last visited January 12,
2024).
6 National Institute on Drug Abuse, How Do Opioids Affect the Brain and Body? (2020). Available at
http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/how-do-opioids-affect-brain-body (last visited
January 12, 2024).
7 United Nations Office on Drugs and Crime, World Drug Report 2022, Glob al Overview: Drug Demand and Drug Supply (2022).
Available at https://www.unodc.org/res/wdr2022/MS/WDR22_Booklet_1.pdf (last visited January 12, 2024).
8 Supra, note 6.
9 Supra, note 1.
10 Supra, note 7.
11 Ahmad, F.B., Cisewski, J.A., Rossen, L.M., & Sutton, P., Provisional Drug Overdose Death Counts (2023). Centers for Disease
Control and Prevention: National Center for Health Statistics. Available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
(last visited January 12, 2024).
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 opioids to alleviate the sensation of pain, are also found in the respiratory control centers of the brain.12
Opioids disrupt the transmission of signals for respiration in the identical manner as they disrupt the
transmission of pain signals; when there is an excess of opioids present in the body, this can lead to a
reduction, and eventual cessation, of a person’s breathing. Oxygen starvation will eventually stop vital
organs like the heart and brain and can lead to unconsciousness, coma, and possible death.13 Within 3-
5 minutes without oxygen, brain damage starts to occur, soon followed by death. 14
Once a person stops breathing damage to vital organs is rapid, however, a person’s breathing will
typically slow gradually over time and breathing may not stop until minutes to hours after the drug or
drugs were used.15 Medical intervention during the period of time between opioid overdose and the
cessation of breathing is the key to preventing an overdose death. An opioid overdose can be identified
by a combination of three signs and symptoms referred to as the “opioid overdose triad”: 16 pinpoint
pupils, unconsciousness; and respiratory depression.
Opioid overdose and death have increased significantly over the last three decades. The graph below
demonstrates the total number of U.S. overdose deaths involving any opioid17 from 1999 to 2021.18
Opioid Deaths in the Unites States, 1999-2021
Prior to the COVID-19 pandemic, the increase in opioid overdose deaths formed three distinct waves:
 The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths
involving prescription opioids increasing since at least 1999.
 The second wave began in 2010, with rapid increase in overdose deaths involving heroin.
 The third wave began in 2013, with significant increases in overdose deaths involving synthetic
opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly
12 Pattinson, K.T.S., Opioids and the Control of Respiration (2008). BJA, Vol. 100, Issue 6, Pages 747-758. Available at
https://doi.org/10.1093/bja/aen094. (last visited January 12, 2024).
13 Harm Reduction Coalition, Guide to Developing and Managing Overdose Prevention and Take -Home Naloxone Projects, (Aug. 31,
2020). Available at http://harmreduction.org/our-work/overdose-prevention/ (last visited January 12, 2024).
14 Id.
15 Id.
16 Supra, note 1.
17 Any opioid includes prescription opioids (natural and semi -synthetic opioids and methadone), heroin and synthetic opioids other than
methadone (primarily fentanyl).
18National institute on Drug Abuse, Overdose Death Rates. Available at https://www.drugabuse.gov/drug-topics/trends-
statistics/overdose-death-rates (last January 12, 2024).
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 manufactured fentanyl continues to change, and the drug can be found in combination with
heroin, counterfeit pills, and cocaine.19
In 2021, 6,442 opioid overdose deaths were reported in Florida, a 22% increase from 2019. 20
Additionally, 50,803 all-drug, non-fatal overdoses resulted in an emergency department visit in 2021. 21
Fentanyl, an extremely potent opioid drug, is the leading cause of overdose deaths in Florida, and the
incidence of fentanyl overdose deaths increased by 38 percent from 2,348 in 2019 to 3,244 in 2020. 22
Opioid Antagonists
An opioid antagonist is a drug that rapidly reverses the effects of an opioid overdose. Opioid
antagonists counteract the central nervous system depression which is the primary cause of opioid
overdose deaths by attaching to opioid receptors and blocking the effects of other opioids. Opioid
antagonists can quickly restore normal breathing to a person if their breathing has slowed, or even
stopped due to an opioid overdose.23 This effect lasts only for a short period of time, with the narcotic
effect of the opioids returning if still present in large quantities in the body. In this scenario, additional
doses of an opioid antagonist would be required, which is why it is generally recommended that anyone
who has experienced an overdose seek medical attention. 24
Opioid antagonists can be safely given to people of all ages and will not cause harm if mistakenly
administered to a person who is not overdosing on an opioid. 25
On March 29, 2023, the US Food & Drug Administration approved the first opioid antagonist nasal
spray available for over-the-counter, nonprescription, use.26 This allows an accessible, easily
administered opioid antagonist to be sold directly to consumers without the need for a prescription.
Victoria’s Voice Foundation
Victoria’s Voice Foundation was established in 2019 by Jackie and David Siegal after losing their 18-
year-old daughter, Victoria, to an accidental drug overdose. Victoria’s Voice is dedicated to providing
drug prevention education and raising awareness of the availability and safe use of opioid antagonists
in order to support those affected by substance use. 27
Effect of the Bill
19 Centers for Disease Control and Prevention, Understanding the Opioid Overdose Epidemic. Available at
https://www.cdc.gov/opioids/basics/epidemic.html (last visited January 12, 2024).
20 Florida Department of Health, FL Health Charts: Sub stance Use Dashb oard. Available at
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=SubstanceUse.Overdose (last visited January 12, 2024).
21 Id.
22
Project Opioid, A Pandemic Fueling an Epidemic in Florida in 2020. Available at https://projectopioid.org/wp-
content/uploads/2020/12/PO-2020-Data-Study-Final_New-Section.pdf (last visited January 12, 2024).
23 National Institute on Drug Abuse, What is Naloxone? (2022). Available at https://nida.nih.gov/publications/drugfacts/naloxone (last
visited January 12, 2024). See also, Harm Reduction Coalition, Understanding Naloxone, (2020). Available at
http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/ (last visited May January 12,
2024).
24 Id.
25 Centers for Disease Control and Prevention, 5 Things to Know Ab out Naloxone (2022). Available at
https://www.cdc.gov/drugoverdose/featured-
topics/naloxone.html#:~:text=Naloxone%20is%20safe.,Small%2C%20constricted%20%E2%80%9Cpinpoint%20pupils%E2%80%9D
(last visited January 12, 2024).
26 US Food & Drug Administration, FDA Approves First Over-the-Counter Naloxone Nasal Spray (2023). Available at
https://www.fda.gov/news -events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray (last visited January 12,
2024).
27 Victoria’s Voice Foundation, Victoria's Voice Foundation Launches First Ever National Naloxone Awareness Day on June 6 with
Support from a Bipartisan Congressional Resolution (2023). Available at https://www.prnewswire.com/news-releases/victorias-voice-
foundation-launches-first-ever-national-naloxone-awareness-day-on-june-6-with-support-from-a-bipartisan-congressional-resolution-
301843527.html (last visited January 12, 2024).
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 CS/HB 89 creates “Victoria’s Law,” and designates June 6th of each year as “Revive Awareness Day.”
The bill allows the Governor to issue an annual proclamation designating June 6 th as “Revive
Awareness Day.”
The bill encourages the Department of Health to hold events with the purpose of raising awareness of
the dangers of opioid overdose and the availability and safe use of opioid antagonists.
The bill is effective upon becoming law.
B. SECTION DIRECTORY:
Section 1: Provides a name for the act: “Victoria’s Law.”
Section 2: Creates s. 683.3342, F.S., relating to Revive Awareness Day.
Section 3: Provides the bill is effective upon becoming law.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill may have an insignificant, negative fiscal impact on the Department of Health which is able
to be absorbed by current agency resources.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill does not require rule-making for implementation.
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 C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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