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For Pharmacists and Prescribers

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.

Pharmacists can dispense naloxone directly to the public if the pharmacist has a protocol in place signed by a legal prescriber. This protocol is part of a collaborative drug therapy agreement (CDTA) also known as a collaborative practice agreement.

How do I prescribe naloxone?

For sample prescriptions, see http://www.prescribetoprevent.org/

If naloxone is not available in your area, your pharmacy may first need to order the medication.

How can my pharmacy start to dispense naloxone directly to persons at risk of an overdose?

Decide which naloxone to carry intranasal, intramuscular, or both.

Order intramuscular naloxone HCL, either:

    • 1 X 10 ml as one fliptop vial (NDC0409-1219-01
    • 2 X 1 ml single dose vial (NDC 0409-1215-01

Order intranasal naloxone HCL, both parts:

    • 2 X 2 mL as pre-filled Needleless Luer Jet Prefilled Syringe (NDC# 0548-3369-01)
    • 2 X intranasal mucosal Atomizing Device (MAD 300)

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).

Decide if your pharmacy wishes to fill orders from other prescribers or would like to dispense directly to the public with a collaborative drug therapy agreement.

Design patient education materials for each route of administration. Sample patient education materials are available from many sources.  One source for printed educational materials is: http://www.prescribetoprevent.org.

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.

Prepare a teaching kit so patients can demonstrate that they understand the instruction by practicing drawing up the medication and selecting an injection site, or practicing squirting with the nasal applicator. Hands-on practice is important.

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: info@stopoverdose.org]

Overdose education, such as that available on this website, is very important in addition to instruction on how to use naloxone. Most people are unaware that opioid overdoses are due to respiratory depression (breathing slows down) and therefore that rescue breathing (and calling 911) is very important to maintain oxygen supply to prevent brain damage or death.  Many may also be unaware of WA State’s Good Samaritan overdose law that provides immunity from drug possession prosecutions during overdose situations.

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) so that I, as a pharmacist, can dispense naloxone without the patient having to see a medical provider for a prescription?

If your pharmacy wants pharmacists to to prescribe naloxone you will need to create a Collaborative Drug Therapy Agreement (CDTA), identify a provider to sign off on the agreement, and then submit it for review by a pharmacist consultant at the WA Board of Pharmacy. A sample CDTA may be downloaded here.

Contact information for the WA State Board of pharmacy is available here: http://www.doh.wa.gov/LicensesPermitsandCertificates/
ProfessionsNewRenewor Update /Pharmacy/BoardInformation.aspx

Is prescribing take-home naloxone controversial?

No, take-home naloxone is a widely-endorsed policy.  In March 2012 the WA State Board of Pharmacy released a letter of support for take-home naloxone CDTAs.

The American Medical Association and the American Public Health Association both have policies supporting availability of take-home naloxone:

The United Nations Office on Drugs and Crime and the World Health Organization issued a report supporting that naloxone be available to first responders (e.g., police and firemen) and to people dependent on opioids, their peers and family members who are likely to be present when an overdose occurs:

Professional research articles 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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