Naloxone Rescue for Opioid Overdose

Prescribers

1.      Why should I prescribe naloxone?
Accidental opioid overdose is preventable, and naloxone saves lives. Co-prescribing naloxone in primary care settings can significantly reduce emergency department visits, and may help patients become more aware of the potential hazards of opioid misuse.
 
2.      Who is able to prescribe naloxone?
Naloxone is not a controlled substance and can be prescribed by anyone with a medical license. Any pharmacist can prescribe it as well.

 
3.      Who should get naloxone?
All patients of any age with factors that increase risk for overdose, such as history of overdose, higher dosages (≥50 MME daily), concurrent benzodiazepine use, or history of substance use disorder.

Anyone otherwise at risk of experiencing or witnessing an opioid overdose (Insurance coverage will vary.)

More information:
CDC Guideline recommendation #8: Use Strategies to Mitigate Risk
Detailed clinician guidance and instructions for co-prescribing naloxone: http://prescribetoprevent.org/
Providers' Clinical Support System for Prescribing Naloxone to Patients for Overdose Reversal ​ 

1.      What do we have to do to have naloxone on-site for staff to use (but not distribute)?
If your organization has a MD, DO, NP or PA on staff, these clinicians may order naloxone for you to have onsite or to carry on outreach activities.  If you do not have a staff member with prescribing capabilities, a pharmacist may prescribe naloxone to a person or an organization. A map of pharmacies confirmed to distribute naloxone can be found here.

If you do not have an MD, DO, NP, or PA on staff and are located in Multnomah, Clackamas, or Washington County, you may have a staff member attend the Naloxone Train-the-Trainer class sponsored by Multnomah County. Organizations who have a representative attend the training are able to purchase naloxone through the Multnomah County Pharmacy. Contact Kelsi Junge (kelsi.junge@multco.us) for more information
 
Under Oregon law, organizations' staff and volunteers may have naloxone on-site or carry naloxone with them in the event of an opioid overdose.  Any staff or volunteer of a social service agency may administer naloxone, even if this naloxone was not distributed to that person, to reverse an opioid overdose (ORS 689.684).  Additionally, those staff are protected against civil liability as long as there is reasonable cause to believe the person is experiencing an opioid overdose (ORS 689.681).

2.      What training do our staff need to use naloxone?
Naloxone training is not required in Oregon; however, it is strongly recommended that you use the following online training tools to ensure the safe and effective use of naloxone.

1. Watch the online naloxone training videos.
2. Read the Oregon Health Authority's (OHA) naloxone training protocol. You may print the protocols and sign to acknowledge you've read them.
3. Contact your local syringe exchange programs, social service agencies and public health departments who distribute naloxone, to ask if about training near you.

 
3.      Do staff need to be certified in CPR to administer naloxone or to train others to administer naloxone?
While CPR training may be beneficial to your staff and organization, it is not required for staff or trainers to be CPR certified.

4.      How can our organization get naloxone?
There are a few ways to get naloxone for your organization.

1. Check Save Lives Oregon to see whether or organization is eligible to order naloxone and other harm reduction supplies at no cost.
2. Call local pharmacies and ask if you can purchase naloxone from them.
3. Call your local health department to see whether there are other naloxone sources in your area.
4. Conduct an online search for companies that sell naloxone (this would be for bulk purchases). The Oregon Health Authority cannot recommend private companies.
   
    

5.      Are there any purchasing programs specifically for public safety or law enforcement?
Law enforcement, fire departments, and EMS may qualify for reduced price naloxone.  For more information feel free to reach out to Oregon HIDTA's Public Health Analyst, Erin Porter, erin.porter@dpsst.oregon.gov. Public safety may also be able to purchase naloxone through Save Lives Oregon.  Although there are no additional training requirements for public safety, the Multnomah County Sheriff's Office created a naloxone training video for law enforcement.

6.      Is starting a naloxone distribution program right for my organization?

If your agency or organization works with clients at risk for opioid overdose, starting a distribution program might be right for you. A naloxone distribution program includes distributing take-home naloxone kits to clients.  To distribute naloxone, an organization much first legally obtain naloxone (OAR 855-019-0460), which can be done by working with a prescriber within your organization, a local pharmacy, or contacting your local public health agency to see if they offer resources.

 

Here are some questions to consider when starting a program:

1. Have you identified a legal pathway to obtaining naloxone?
2. What data will you collect from participants (i.e., demographics, substance use history, overdose experiences)?
3. Will you offer training to your clients and staff on how to recognize and reverse an opioid overdose?
4. How (and when) will you have your naloxone supplies available?
5. Do you know how to order supplies for naloxone kits?
6. Where will you store the naloxone kits? ​