Prescribing Naloxone for Opioid Overdose Intervention

Figures & data

Table 1. Naloxone distribution models currently in use in the USA.

Factors	Traditional prescription	Community-based organization	Pharmacy-based naloxone models
			Collaborative practice agreement	Standing medication order	Protocol order	Pharmacist prescribing
Who issues prescription?	Prescriber	Prescriber via standing order	Nonpharmacist provider	Nonpharmacist provider	Licensing board	Pharmacist
Medical professionals required	Prescriber and pharmacist	Varies by state: prescriber, state/local health department	Prescriber and pharmacist	Prescriber and pharmacist	Pharmacist	Pharmacist
Potential recipients	Patients of the prescriber	Individuals served by the community-based organization	Varies by state	Anyone meeting criteria specified by prescriber	Anyone meeting criteria specified by licensing board	Anyone for whom medication is indicated
Target overdose risk population served	People who misuse/abuse opioids (prescription opioids, heroin) who are in treatment or visit a prescriber^† Patients prescribed opioids who are at risk of overdose^†	People who use drugs (prescription opioids, heroin) who access the community-based organization^†	People who use drugs (prescription opioids, heroin) who visit a pharmacy^† Patients at risk of overdose who are filling a prescription for opioids at a pharmacy^†
Geographic reach	Limited to where the prescriber practices	Limited to where community-based organizations are located and operate	Any practicing pharmacy within the state			Limited to where the pharmacist practices

† Most states now permit prescriptions to be written for third parties (e.g., family or friends, staff of organizations providing services to individuals at risk of overdose), as well as to the person at risk of overdose.

Adapted with permission from [19] via a Creative Commons Attribution 4.0 International License.

Table 2. Guidelines and policy statements on naloxone for opioid overdose.

Organization	Guidelines/policy	Key content	Ref.
WHO	Community Management of Opioid Overdose	Contains recommendations on: • Naloxone distribution to people likely to witness an overdose • Appropriate formulations and doses of naloxone for community use	[60]
CDC	Guideline for Prescribing Opioids for Chronic Pain	Clinicians should: • Prescribe the lowest effective opioid dosage, use caution increasing to ≥50 MME per day and avoid ≥90 MME per day (unless carefully justified) • Consider offering naloxone when risk factors are present (i.e., history of overdose or substance use disorder, opioid dose ≥50 MME per day, concurrent benzodiazepine use)	[40]
SAMHSA	Opioid Overdose Prevention Toolkit	• Summarizes factors to consider before prescribing opioids, use of PDMPs and patient education/monitoring • Providers should consider prescribing naloxone along with the initial opioid prescription	[61]
AAPM	Coprescribing of Naloxone in Conjunction with Opioid Therapy	Prescribers of opioid therapy should: • Fully assess overdose risk • Discuss risk factors with patients/caregivers • Offer prescription of an FDA-approved naloxone product	[62]
ASAM	Public Policy Statement on the Use of Naloxone for the Prevention of Drug Overdose Deaths	• Supports broadened accessibility to naloxone for community use • Encourages coprescription of naloxone with long-acting opioids and significant total opioid dosage • Recommends training for naloxone recipients in overdose detection and response (including naloxone administration)	[63]
ASAM	The National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use	• Discusses naloxone in the context of other medications used in the treatment of opioid addiction • Prescriptions for naloxone should be provided to patients being treated for opioid use disorder and their family members/significant others	[64]

AAPM: American Academy of Pain Management; ASAM: American Society of Addiction Medicine; MME: Morphine milligram equivalent; PDMP: Prescription Drug Monitoring Program; SAMHSA: Substance Abuse and Mental Health Services Administration.

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