Who can prescribe naloxone (Narcan®)?
Physicians, nurse practitioners and physician assistants in Washington State who have prescriptive authority may prescribe take-home-naloxone to anyone at risk for having or witnessing an opioid overdose (prescription opioids or heroin) according to WA law RCW 69.50.315.
Alternatively, pharmacists can prescribe naloxone directly to the public if a pharmacist has a signed Collaborative Drug Therapy Agreement (CDTA, also known as a collaborative practice agreement) in place with a legal prescriber and on file with the Pharmacy Quality Assurance Commission.
How can my pharmacy start dispensing naloxone?
Whether you are filling prescriptions from other providers or writing your own prescriptions directly under a collaborative practice agreement, each pharmacy needs to consider the following steps to dispense naloxone and provide appropriate opioid overdose education.
See also this presentation, "Starting a Take-Home Naloxone (THN) Program."
1. Decide which form of naloxone to carry (e.g., intranasal, intramuscular, or both).
Order intranasal naloxone HCL, both parts:
2. Verify which insurance companies in your area will cover naloxone. For example Medicaid in Washington State pays for naloxone for a person at risk of an overdose but not a potential bystander who is not at risk (e.g., a family member who does not use opioids).
3. Decide if your pharmacy wishes to fill orders from other prescribers or would like to prescribe directly to the public with a collaborative drug therapy agreement.
4. Design patient education materials that:
Overdose education information is available on this website. Sample patient education materials are also available at: http://www.prescribetoprevent.org.
5. Prepare an overdose rescue kit with the naloxone, nasal applicator or intra-muscular syringe, overdose education materials, perhaps a rescue breathing mask, and a list of local social and health services providers. Set a price.
6. Prepare a demonstration/practice kit so patients can demonstrate that they understand the instruction (e.g., drawing up the medication, selecting an injection site, or assembling the nasal applicator). Hands-on practice is important.
7. Let your local prescribers know that you are carrying naloxone. [If you would like to be included in the naloxone locator on this website, email: firstname.lastname@example.org]
8. Train the pharmacy team so all members know that take-home-naloxone is available, which pharmacists are authorized on the CTDA, the education to provide, and where to find answers to frequently asked questions.
How can I enter into a collaborative drug therapy agreement (CDTA) to directly prescribe naloxone?
First you will need to create a Collaborative Drug Therapy Agreement (CDTA) and identify a provider to sign off on the agreement. A sample CDTA may be downloaded here.
Then submit it for review by a pharmacist consultant at the Pharmacy Quality Assurance Commission. More information is available here: http://www.doh.wa.gov/LicensesPermitsandCertificates/
For sample prescriptions, see http://www.prescribetoprevent.org/
Who supports prescribing take-home naloxone?
Take-home naloxone is a widely-endorsed policy. In March 2012 the Washington Pharmacy Quality Assurance Commission released a letter of support for take-home naloxone CDTAs.
The American Medical Association, the American Public Health Association and the American Pharmacists Association have all endorsed policies to expand availability of take-home naloxone:
Professional research articles also suggest prescribing take-home naloxone to those at risk for having an opioid overdose. For example: Diagnosing and treating opioid dependence (Hill KP, Rice LS, Connery HS, Weiss RD. Journal of Family Practice 2012;61(10):588-597).
This information made available by the UW Alcohol &
Drug Abuse Instititute
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