In 2016, the Centers for Disease Control and Prevention (CDC) announced that the United States is in the midst of an opioid overdose epidemic. Opioids include both prescription drugs, such as Hydrocodone, Morphine, Percocet, and Oxycontin, and illegal drugs such as, Heroin. Both prescription opioids and heroin killed more than 33,000 people in 2015, which was more than any year on record. Although street-drugs are considered by the general public to be the root-cause of the epidemic, nearly half of all opioid overdose deaths involve a prescription opioid. Also, it has been determined that in 2012, 159 million prescriptions were written for opioids. Policy and law makers have begun to take notice of these numbers, including the epidemic at large, and as a result, many pharmacists are becoming re-acquainted with an old drug, Naloxone.
Opioids work by attaching themselves to the body’s natural opioid receptors and numbing or reducing pain. However, opioids may also create a sense of euphoria in people, and are highly addictive, with many people becoming addicted after only a few doses or even when taking opioids exactly as prescribed. Naloxone is a medication, called an “opioid antagonist,” used to counter the effects of opioid overdose of either prescription or illegal opioids. It is a non-scheduled, non-addictive, prescription medication. Naloxone is used in opioid overdoses to counteract life-threatening depression of the central nervous system and respiratory system, allowing an overdose victim to breathe normally. It has been used successfully by providers in the emergency medical community for decades.
In order to help combat the rise of the opioid epidemic with the goal of saving lives, state legislatures have aimed to make Naloxone more accessible in the community. In order to carry this aim out, many state legislatures have passed laws permitting pharmacists to dispense Naloxone at community pharmacists without the need for a patient specific prescription. The laws, however, do not make Naloxone an over-the-counter (OTC) medication, but still require some type of prescriber authorization before dispensing, usually a prescriber’s authorization through a standing order. Each state’s law(s) surrounding dispensing Naloxone are slightly different, yet the main themes of each law are that pharmacists may dispense Naloxone to a person that may be at risk of opioid overdose or a caregiver of such person, pursuant to a non-patient specific standing order, and therefore under these state laws, a patient specific prescription is not required. For instance, some states allow a pharmacist to dispense Naloxone pursuant to a state created standing order that has been authorized by the state physician general. While other states require the pharmacy to draft their own standing order and require the pharmacy to locate a physician willing to sign and authorize the Naloxone standing order in order for the pharmacy to dispense Naloxone without a patient specific prescription, similar to a scenario of pharmacist administered immunization programs. The pharmacist dispensing Naloxone, at a minimum, should be aware and counsel the patient or caregiver on how Naloxone is administered, the proper dosage, side effects, potential contraindications, steps to be taken after administration, and what steps should be taken if the patient is not breathing and has no pulse due to an opioid overdose.
Physicians prescribing opioids may also want to consider prescribing Naloxone to patients receiving opioids that may be at risk for abuse or addition. Physician may also want to incorporate into their practice and educational component for patients receiving opioid and their family members about the risks of prescribed opioids and the appropriate use of Naloxone.
If you would like to integrate Naloxone dispensing pursuant to a standing order in your pharmacy and would like assistance in drafting a standing order or have any questions and/or would like additional information regarding your state’s laws and/or regulations surrounding Naloxone dispensing, contact Frier Levitt today. Also, if you are a physician or prescriber, who is concerned about Naloxone being accessible to your patients, and would like information about entering into a standing order with a pharmacy, contact Frier Levitt today.
