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Can Administering Narcan Create a General Liability Exposure?

The last few years have seen a large increase in deaths from narcotics overdose such as from fentynal. The administration of Narcan, also called Naloxone, can reverse an overdose and save lives. According to one study, emergency medical responders reported the administration of Narcan saved up to 93.5 percent of overdose victim s.

Will My Client's General Liability Policy Cover Distribution of Narcan?

Alleging negligence of any type that involves allegations of bodily injury or property damage should trigger your GL given no on-point exclusions. There is no exclusion in the CGL that applies to this type of activity. However, if an employer administers Narcan to an employee, the employer should submit any subsequent medical treatment costs to the workers' compensation insurer. That should cover medical bills and lost wages, although state workers compensation statutes guide that decision. Liability arising from that employee's exposure if one were to allege negligence could trigger the employers' liability coverage on the work comp policy.

General Information on Narcan

Here is an overview of the basics and safety factors around administering (intranasal) Narcan. Intranasal is what locations usually stock that are not medical facilities, although first responders may carry injectables. “When law enforcement or first responders feel the use of intranasal naloxone poses too great a risk, there is another lower risk option. Intramuscular naloxone is usually injected into the thigh muscle - far away from the nose and mouth - thereby reducing the risk to the rescuer," per the Substance Abuse and Mental Health Services Administration.

The bottom line regarding a claim involving Narcan administration is this: If your insured has the Narcan on site, they'd be just as likely to get sued for failure to administer as administering.

However, here are more issues to consider.

There are risks, so training is imperative. Your insured could contact the local state department of health; they usually provide training or know who will.
It's now sometimes taking first responders more than one dose to save someone who is overdosing on Fentanyl based on its potency. One dose may not be enough.
Always have gloves and safety glasses right by the Narcan to help to avoid an exposure for the person administering and this still isn't a guarantee. Those who administer should wash up immediately post administering.
Respiratory personal protective equipment is highly recommended when administering since Fentanyl can aerosolize. Aerosolized exposure is exceedingly rare but is more potent and faster than skin contact.
Don't “require" employees to administer Narcan. Organizations should provide training only to those willing to administer, in my opinion. Forcing someone to administer could open the door to several liability issues, including employment liability issues.

The best approach is to immediately call 911 while administering Narcan if available, to obtain help from trained first responders. Once on site, they can manage the situation. However, even the Society for Human Resources (SHRM) has, since 2018, recommended that employers stock and administer Narcan.

For those who administer Narcan, the Good Samaritan law should apply in many states and many states are still addressing this topic with legislation. This article contains an overview of stage legislation regarding Narcan.

This outlines some tips first responders use; however, it's important to call 911 immediately to activate first responders. They deal with this daily, even in rural communities. The mainly rural county of Yavapai, Arizona, saw sixty-eight drug overdoses deaths in 2022, with 28% of those females. However, they are seeing more deaths in the 60-year old plus population, with a 600% increase in 2022 of 14 60-plus year old deaths.

Watch Those Professional Liability Policies

Jack Schwartz, a risk management consultant in New York, offers a few words of warning on professional liability coverage from. “Those in the nonprofit and social service industries who may administer naloxone to reverse an opioid overdose should verify that such actions are not excluded by their professional liability coverage."

According to Schwartz, policies for human and social service organizations often contain professional liability coverage as part of their general liability policy or broader package policy. The terms of such coverage vary between carriers and their different forms. Depending on the form, some carriers may exclude coverage for the administering of Narcan.

Some carriers will include a specific endorsement affirmatively granting coverage and removing any doubt, but for those carriers that don't, pay attention to the wording to ensure no exclusions apply, according to Schwartz.

I spoke with Brad Storey, Vice President of Risk Management, and Dawn Martin, Vice President of Underwriting, of the Irwin Siegel Agency in New York, a managing general agency specializing in social services insurance and risk management.

According to Martin, their programs have no exclusions for administering Narcan whether by a licensed or unlicensed employee.

As far as claims history involving administering Narcan, “When Narcan recently became available over the counter, we reviewed our claims as far back as Narcan use approval in 2015, and we've had no claims," Storey said.

“Our insureds are on the front lines of serving some of the most vulnerable populations. At a time when the opioid epidemic continues to rise, Narcan is a necessary tool and saves lives" Storey said.

Advice on Managing the Opioid Overdose Event

Many people working front-line in substance abuse such as needle exchange and treatment centers specialize in preventing overdose and administering Narcan and will almost always be very open to providing information and advice.

A SHRM article on the subject states, “Increasingly, state laws shield employers from being liable for administering it." They also recommended that employers consider the industry they are in, like construction, where given the injury frequency, employees may be more prone to substance use. While this article says it should be kept locked, I do not see this practice at any place where I've seen it. Immediate access is imperative and it's simple to administer.

Remember, too, that once treated, the person treated may have a seizure and sometimes become agitated, so there is always that consideration. Training usually warns about that risk and recommends that two work to administer. I would recommend one administering and one standing back watching to assist while staying on the phone with 911, because any fentanyl exposure can then be more limited to the person administering.

Deaths from Opioids Impact All Communities

This is a timely and urgent topic. In 2021,106,999 people died in the U.S. from drug overdose deaths. There was a slight decline in 2022, probably linked to more effective use of Narcan. The US Surgeon General Jerome Adams recommended in a talk in 2018 that Narcan access should be as prevalent as EpiPens or defibrillators.

The construction industry is one of the most opioid-challenged industries, according to new reports from The Center for Construction Research and Training (CPWR). According to the CPWR Quarterly Data Report, "Construction workers are among the segments of the U.S. population opioids have hit hardest. Recent state-level studies of opioid overdose deaths show that construction workers are six to severn times more likely to die of an overdose than workers in other professions." Therefore, it's imperative for both union and non-union construction shops look for local assets that can help, and consider keeping Narcan doses on all construction sites. To do otherwise is "Stupid," according to one consultant to the International Brotherhood of Electric Workers in my recent conversation with her.

While I found few lawsuits involving the use of Narcan, all one needs to do to present a claim is to assert some type of negligence. In one instance, a person allegedly rendered a quadriplegic after mistakenly being administered Narcan after suffering respiratory distress sued the local township, fire department and several first responders.

As with any emerging risk, more issues may arise. However, when faced with saving a life, we must act quickly and decisively, and any of these life-saving decisions, whether they involve a defibrillator or Narcan, carry inherent risk.

First Publication: April 21, 2023

Updated: March 26, 2024

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