Open Forum

We're having initial discussions about whether/how to offer nasal naloxone to pts, whether for their own use, or to carry for potential use on others.  This could be via Standing Order for use by nurses.  I'm betting that many ambulatory healthcare organizations have already been doing this for some time. 

Does anyone have a policy or procedure to share, outlining your process for getting naloxone to your patients/community?  Any pearls of wisdom, or things to be aware of?

Thanks in advance

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Maura Carriel MS RN
Director, Clinical Education & Quality
Core Physicians, LLC
Exeter, NH
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Hi Maura,

Your local harm reduction organization would be able to guide you on policies and procedures needed to distribute naloxone in your state. In New Hampshire you can contact the New Hampshire Harm Reduction Coalition: https://www.nhhrc.org/. Fortunately, many regressive state laws limiting naloxone access have loosened in the last several years and it is easier than ever to distribute this drug to the public (it was, in fact, just approved for OTC use this morning by the FDA, but it'll likely be a few months before we see that change at the local level). Providers can prescribe naloxone to be filled at any pharmacy, and many states have a statewide standing order so that patients don't even need a prescription to get it from the pharmacy. If you partner with a syringe service program or health department to provide no-cost naloxone to your patients, you would need to follow their policies in terms of data collection and reporting. Nurses directly dispensing naloxone in clinic would depend on your agency's existing policies around direct dispensing medications for home/community use. If you need to write a standing order, you might model it off this statewide standing order that was written for pharmacies: https://www.oplc.nh.gov/sites/g/files/ehbemt441/files/inline-documents/sonh/nh-dhhs-naloxone-standing-order-template.pdf.

My best advice, though, is to contact your friendly neighborhood harm reductionists through the NH Harm Reduction Coalition. They will be happy to provide all the state-specific guidance you need and connect you with other health care providers in your area who are doing this work. For additional training and technical assistance around naloxone distribution and other SUD treatment topics, the Grayken Center for Addiction at Boston Medical Center is a fabulous resource: https://addictiontraining.org/.

Hope this helps. Thanks for your advocacy on behalf of our patients and community members who use opioids!

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Charlotte Badler, MSN, RN
Nursing Professional Development Specialist
Lynn Community Health Center
Pronouns: she/her
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The fact that the 4mg nasal spray was just approved for OTC status should help! 

https://www.hhs.gov/about/news/2023/03/29/biden-harris-administration-takes-critical-action-make-naloxone-more-accessible-prevent-fatal-overdoses-opioids-fentanyl.html

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Leslie McDowell ANP-BC, DNP, RN
QI Specialist / Curriculum Developer
Northwest AHEC / Wake Forest University School of Medicine
Winston Salem NC
(336)972-7852
ANP-BC, DNP, RN
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Original Message:
Sent: 03-29-2023 19:14
From: Charlotte Badler
Subject: Distributing naloxone

Hi Maura,

Your local harm reduction organization would be able to guide you on policies and procedures needed to distribute naloxone in your state. In New Hampshire you can contact the New Hampshire Harm Reduction Coalition: https://www.nhhrc.org/. Fortunately, many regressive state laws limiting naloxone access have loosened in the last several years and it is easier than ever to distribute this drug to the public (it was, in fact, just approved for OTC use this morning by the FDA, but it'll likely be a few months before we see that change at the local level). Providers can prescribe naloxone to be filled at any pharmacy, and many states have a statewide standing order so that patients don't even need a prescription to get it from the pharmacy. If you partner with a syringe service program or health department to provide no-cost naloxone to your patients, you would need to follow their policies in terms of data collection and reporting. Nurses directly dispensing naloxone in clinic would depend on your agency's existing policies around direct dispensing medications for home/community use. If you need to write a standing order, you might model it off this statewide standing order that was written for pharmacies: https://www.oplc.nh.gov/sites/g/files/ehbemt441/files/inline-documents/sonh/nh-dhhs-naloxone-standing-order-template.pdf.

My best advice, though, is to contact your friendly neighborhood harm reductionists through the NH Harm Reduction Coalition. They will be happy to provide all the state-specific guidance you need and connect you with other health care providers in your area who are doing this work. For additional training and technical assistance around naloxone distribution and other SUD treatment topics, the Grayken Center for Addiction at Boston Medical Center is a fabulous resource: https://addictiontraining.org/.

Hope this helps. Thanks for your advocacy on behalf of our patients and community members who use opioids!

------------------------------
Charlotte Badler, MSN, RN
Nursing Professional Development Specialist
Lynn Community Health Center
Pronouns: she/her
------------------------------

Thanks for the responses!  Yes, FDA approval for OTC makes it less complicated.  We would potentially have access to a supply through the State of NH, and the FQHC near us has shared a copy of their Standing Order for RNs to distribute med sample.  

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Maura Carriel MS RN
Director, Clinical Education & Quality
Core Physicians, LLC
Exeter, NH
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