HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 731 Drug-related Overdose Prevention
SPONSOR(S): Professions & Public Health Subcommittee, Caruso
TIED BILLS: IDEN./SIM. BILLS: SB 544
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 15 Y, 0 N, As CS Woodruff McElroy
2) Health & Human Services Committee 20 Y, 0 N Woodruff Calamas
SUMMARY ANALYSIS
An overabundance of opioids in the body can lead to a fatal overdose. Opioid antagonists are used in opioid
overdoses to counteract life-threatening depression of the central nervous system and respiratory system,
allowing an overdose victim to breathe normally.
Current law authorizes a health care practitioner to prescribe and dispense an emergency opioid antagonist to
a patient or caregiver, and pharmacists may dispense an emergency opioid antagonist pursuant to a
prescription or pursuant to a non-patient specific standing order. A patient or caregiver can store and possess
approved emergency opioid antagonists and, in an emergency, when a physician is not immediately available,
administer the emergency opioid antagonists to a person believed in good faith to be experiencing an opioid
overdose, regardless of whether the person has a prescription. Emergency responders and crime laboratory
personnel are authorized to possess, store, and administer emergency opioid antagonists. Current law affords
civil liability immunity to anyone who possesses, administers, prescribes, dispenses, or stores an approved
emergency opioid antagonist.
Current law authorizes, but does not require, emergency medical technicians and paramedics who provide
basic and advanced life support services to report controlled substances overdoses to the Department of
Health (DOH). Current law neither authorizes nor requires hospital emergency departments and urgent care
centers that treat suspected or actual overdoses to report such information. This creates a potential gap in the
data related to any person that was not transported by a basic life support service or an advanced life support
service to a hospital or urgent care center.
The Florida Public Health Institute (Institute) is a not-for-profit corporation established by s. 381.98, F.S., with
the purpose of advancing the knowledge and practice of public health, including promoting health awareness in
Florida. The law requires the Institute, in consultation with DOH, to coordinate monthly health awareness
campaigns with national, state, and local health care organizations and government entities on numerous
topics, including substance abuse.
CS/HB 731 amends s. 381.887, F.S., to allow pharmacist to order and dispense an emergency opioid
antagonist to a patient or caregiver without a prescription or pursuant to a non-patient specific standing order.
The bill also requires the Institute, in consultation with DOH, to educate the public regarding the use of
emergency opioid antagonists.
The bill expressly authorizes personnel of a law enforcement agency or other agency, including correctional
probation officers and child protective investigators, to possess, store, and administer emergency opioid
antagonists. The bill also requires hospital emergency departments and urgent care centers to report the
treatment of suspected or actual overdose victims, under certain circumstances.
The bill has a negative, insignificant, recurring fiscal impact on DOH that can be absorbed within existing
resources. There is no fiscal impact on local government. The bill provides an effective date of July 1, 2022.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0731b.HHS
DATE: 2/1/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Opioids
Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues. 1
They are commonly used as pain relievers to treat acute and chronic pain. An individual experiences
pain because of a series of electrical and chemical exchanges among 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. 3 When an individual
experiences pain, the body releases hormones, such as endorphins, which bind with targeted opioid
receptors.4 This disrupts the transmission of pain signals through the central nervous system and
reduces the perception of pain.5 Opioids function in the same way by binding to specific opioid
receptors in the brain, spinal cord and gastrointestinal tract, thereby reducing the perception of pain. 6
Opioids include prescription medications used to treat pain, as well as illegal drugs. Opioids include7:
Buprenorphine (Subutex, Suboxone)
Codeine
Fentanyl (Duragesic, Fentora)
Heroin
Hydrocodone (Vicodin, Lortab, Norco)
Hydromorphone (Dilaudid, Exalgo)
Meperidine
Methadone
Morphine
Oxycodone (OxyContin, Percodan, Percocet)
Oxymorphone
Tramadol
U-47700
In 2019, an estimated 62 million people used opioids for non-medical reasons worldwide.8 Opioids are
commonly abused, with an estimated 36.3 million people worldwide suffering from drug use disorders.9
Opioids can create a euphoric feeling because they affect the regions of the brain involved with
pleasure and reward, which can lead to abuse.10 Continued use of these drugs can lead to the
1
World Health Organization, Opioid Overdose, https://www.who.int/news-room/fact-sheets/detail/opioid-overdose (last visited Jan. 4,
2022).
2 Medical News Today, What is pain, and how do you treat it? (Sept. 7, 2020),
https://www.medicalnewstoday.com/articles/145750#:~:text=People%20feel%20pain%20when%20specific,im mediate%20contraction%
20of%20the%20muscles (last visited Jan. 4, 2022).
3
Gjermund Henriksen, Frode Willoch, Imaging of Opioid Receptors in the Central Nervous System, Brain (2008) 131 (5): 1171-1196.
4 Id.
5 Id.
6 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).
7 Florida Department of Law Enforcement, Drugs Identified in Deceased Persons b y Florida Medical Examiners 2019 Report, (Nov.
2020).
8 United Nations Office on Drugs and Crime, World Drug Report 2021, Glob al Overview: Drug Demand and Drug Supply (Jun. 2021),
WDR21_Booklet_2.pdf (unodc.org) (last visited Jan. 4, 2022).
9 Id.
10 National Institute on Drug Abuse, How Do Opioids Affect the Brain and Body?, (June 2020)
http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/how-do-opioids-affect-brain-body (last visited Jan. 4,
2022).
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development of tolerance and psychological and physical dependence. 11 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.12
Opioid Overdose
An overabundance of opioids in the body can lead to a fatal overdose. In addition to their presence in
major pain pathways, opioid receptors are also located in the respiratory control centers of the brain.13
Opioids disrupt the transmission of signals for respiration in the identical manner that they disrupt the
transmission of pain signals. This leads to a reduction, and potentially cessation, of an individual’s
respiration. Oxygen starvation will eventually stop vital organs like the heart, then the brain, and can
lead to unconsciousness, coma, and possible death. 14 Within 3-5 minutes without oxygen, brain
damage starts to occur, soon followed by death.15 However, this does not occur instantaneously as
people will commonly stop breathing slowly, minutes to hours after the drug or drugs were used. 16
An opioid overdose can be identified by a combination of three signs and symptoms referred to as the
“opioid overdose triad”:17
Pinpoint pupils.
Unconsciousness.
Respiratory depression.
The rise in opioid overdose deaths can be outlined in three distinct waves:
1. The first wave began with increase prescribing of opioids in the 1990s, with overdose deaths
involving prescription opioids increasing since at least 1999.
2. The second wave began in 2010, with rapid increase in overdose deaths involving heroin.
3. 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
manufactured fentanyl continues to change, and it can be found in combination with heroin,
counterfeit pills, and cocaine.18
More than 70,000 Americans died from drug-involved overdose in 2019, including illicit drugs and
prescription opioids.19 Overall, drug overdose deaths increased from 2018 to 2019 with 70,630 drug
overdoses reported in 2019.20 The following graph provides information on the total number of U.S.
overdose deaths involving any opioid21 from 1999 to 2019.22 Opioid-involved overdose deaths
increased from 21,088 in 2010 to 47,600 in 2017, and remained steady in 2018 with 46,802.23 This was
following by a significant increase in 2019 to 49,860 overdose deaths. 24
Opioid Deaths in the United States
11
Supra note 6.
12 Supra note 1.
13 Pattinson, K.T.S., Opioids and the Control of Respiration, BJA, Vol. 100, Issue 6, Pages 747-758. https://doi.org/10.1093/bja/aen094.
14 Harm Reduction Coalition, Guide to Developing and Managing Overdose Prevention and Take -Home Naloxone Projects, (Aug. 31,
2020) http://harmreduction.org/our-work/overdose-prevention/ (last visited Jan. 4, 2022).
15
Id.
16 Id.
17 Supra note 1.
18 Centers for Disease Control and Prevention, Understanding the Epidemic, https://www.cdc.gov/drugoverdose/epidemic/index.html
(last visited Jan. 4, 2022).
19 National institute on Drug Abuse, Overdose Death Rates, https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-
rates (last visited Jan. 4, 2022).
20 Id.
21 Any opioid includes prescription opioids (natural and semi -synthetic opioids and methadone), heroin and synthetic opioids other than
methadone (primarily fentanyl).
22 Supra note 19.
23 Id.
24 Id.
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In 2019, Florida reported 5,268 opioid overdose deaths.25 This was an 11.9 percent increase from
2018.26 Florida also experienced 4,152 opioid and 10,464 all drug non-fatal overdoses between July
and September 2019.27
With the onset of the COVID-19 pandemic, the incidence of opioid use disorder and resulting overdose
deaths has once again risen. A report from Project Opioid details provisional data from the Florida
Department of Health (DOH) showing that deaths from drug overdoses have increased by 43 percent
between 2019 and 2020, from 56 deaths per 100,000 in 2019 to 94 deaths per 100,000 in 2020. 28
Additionally, 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 2020.29
Opioid Antagonists
An opioid antagonist, such as Narcan or Naloxone, is a drug that blocks the effects of exogenously
administered opioids. Opioid antagonists are used in opioid overdoses to counteract life-threatening
depression of the central nervous system and respiratory system, allowing an overdose victim to
breathe normally.30 This occurs because opioid antagonists create a stronger bond with opioid
receptors than opioids. This forces the opioids from the opioid receptors and allows the transmission of
signals for respiration to resume.31 This effect lasts only for a short period of time32 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 and it is why it is generally recommended that anyone
who has experienced an overdose seek medical attention.
25 Center for Disease Control and Prevention, Drug Overdose Deaths, https://www.cdc.gov/drugoverdose/data/statedeaths/drug-
overdose-death-2019.html (last visited Jan. 4, 2022).
26 Center for Disease Control and Prevention, 2018-2019 Drug Overdose Death Rate Increase,
https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2019.html (last visited Jan. 17, 2022).
27 Florida Department of Health, Non-Fatal Opioid and All Drug Overdose Surveillance Report, Florida Q4 -2019,
http://www.floridahealth.gov/statistics-and-data/fl-dose/_documents/non-fatal-od-2019-q4.pdf
28 Project Opioid, A Pandemic Fueling an Epidemic in Florida in 2020, https://projectopioid.org/wp-content/uploads/2020/12/PO-2020-
Data-Study-Final_New-Section.pdf (last visited Jan. 4, 2022).
29 Id.
30 Harm Reduction Coalition, Understanding Naloxone, (Sept. 8, 2020) http://harmreduction.org/issues/overdose-
prevention/overview/overdose-basics/understanding-naloxone/ (last visited Jan. 4, 2022).
31 Supra note 13.
32 The half-life for a common opioid antagonist in adults ranged from 30 to 81 minutes. Acute opiate withdrawal is a potential side -effect
of naloxone; however, this would be time limited to the half-life of naloxone.
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The following map provides information on pharmacy locations where naloxone is available.33
Florida law allows an authorized health care practitioner to prescribe and dispense an emergency
opioid antagonist to a patient34 or caregiver, and pharmacists may dispense an emergency opioid
antagonist pursuant to a prescription for a specific patient or pursuant to a non-patient specific standing
order.35 Current law defines a “caregiver” as a family member, friend, or person that has recurring
contact with a person at risk of experiencing an opioid overdose. 36 Therefore, an authorized health care
practitioner may prescribe and a pharmacist may dispense opioid antagonists to any person at risk of
experiencing an opioid overdose or to any person that has recurring contact with a person at risk of
experiencing an opioid overdose.
33 New America, National Naloxone Access Map,
https://opioidepidemic.maps.arcgis.com/home/item.html?id=153b0c32fefc432eae6a0e8439b9f56b (last visited Jan. 4, 2022). The
National Naloxone Map accumulates data from many difference sources, with participation from thousands of CVS, Walmart, and
Walgreens pharmacies, along with other independent distributors. The map is meant to be a community effort, and contributing
locations is encouraged to participate, to make it the best possible representation of resources. The map is not complete, and naloxone
prescription needs and costs vary by state.
34 S. 381.887(1)(e), F.S., defines “patient” as a person at risk of experiencing an opioid overdose.
35 S. 381.887, F.S.
36 S. 381.887(1)(c), F.S.
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Pursuant to s. 381.887, F.S., the State Surgeon General issued a statewide Standing Order for
Naloxone in September 2021.37 The Standing Order authorizes pharmacists to dispense certain
naloxone formulations to emergency responders for administration to persons exhibiting signs of opioid
overdose.38 Under the Standing Order, emergency responders, including law enforcement, firefighters,
paramedics, and emergency medical technicians, can go to a pharmacy or community-based program
for training on opioid antagonist administration and receive an opioid antagonist without a patient-
specific prescription.39
Any person prescribed an opioid antagonist, or distributed an emergency opioid antagonist pursuant to
a non-patient-specific standing order, may store and possess approved emergency opioid antagonists.
In an emergency, when a physician is not immediately available, that person may administer the
emergency opioid antagonists to an individual believed in good faith to be experiencing an opioid
overdose, regardless of whether that person has a prescription for an emergency opioid antagonist.40
Current law also allows emergency responders and crime laboratory personnel to possess, store, and
administer emergency opioid antagonists.41
A person who possesses, administers, prescribes, dispenses, or stores an approved emergency opioid
antagonist is afforded the civil liability immunity protections under s. 768.13, F.S. (Good Samaritan
Act).42
Current law does