1. Pharmacist Role in Naloxone Prescribing
KariLynn Dowling, PharmD
PGY2 Health-System Pharmacy Administration Resident
Penobscot Community Health Care
April 1, 2016

2. Objectives
Explain why naloxone prescribing is a critical component of the response to the opioid abuse epidemic.
Describe interventions that pharmacists in community, ambulatory care, and institutional settings can make to encourage naloxone prescribing.

3. Why naloxone? 28,000 U.S. deaths from opioid overdose in 20141
Pure opioid antagonist inducing rapid withdrawal
Ease of Use (intranasal): High
Risk: Low
Cost-Effectiveness: High
$421/quality-adjusted life-year (QALY) gained2
Cost-effective at amounts less than $50,000/QALY
Colorectal Cancer Screening: $10,000-$25,000/QALY gained
Aspirin for Secondary Prevention: $11,000/QALY gained
Statins for Secondary Prevention: $21,600/QALY gained (patient with 10-yr risk of 20%)
EpiPen with Specialist: $28,500/QALY gained

4. Know the Products Naloxone solution for injection
Off-label intranasal kit
Evzio® auto-injector
Narcan® nasal spray

5. Know the Law: 22 M.R.S.A. § 2353(2)
“A health care professional may directly or by standing order prescribe naloxone hydrochloride to an individual at risk of experiencing an opioid- related drug overdose.”

6. Know the Law: 22 M.R.S.A. § 2353(2)
Or… “prescribe naloxone to a member of an individual's immediate family or a friend of the individual or to another person in a position to assist the individual if the individual is at risk of experiencing an opioid-related drug overdose.”

7. Know the Law: 22 M.R.S.A. § 2353(4)
“Under standing orders from a licensed healthcare professional authorized to prescribe naloxone, an overdose prevention program may store and dispense naloxone without being subject to the provisions of [the Maine Pharmacy Act] as long as these activities are undertaken without charge or compensation.”

8. Know the Proposed Law: LD 1547
Will allow pharmacists to dispense naloxone without a prescription
“Behind-the-counter” standing order
Record keeping and education requirements
Advanced out of HHS committee by a vote of 8-2

9. Be Prepared: CE Venue Credits Cost Prescribe to Prevent 1 Free
Narrated slide deck with videos of patient-provider-pharmacist encounters 1
Free
APhA Pharmacy Today
Article 2
Members: Free
Non-members: $25
Pharmacists’ Letter
Recorded session with slides
$36 for subscribers

10. Decrease Stigma Universal prescribing Minimize overdose language
Prescribing for risky meds, not risky patients
Minimize overdose language
“Naloxone for someone with opioids is like an EpiPen for someone with allergies.”
“Every home should have a fire extinguisher. Every home with opioids should have naloxone.”

11. Address Health Care Providers’ Concerns
No known instances of malpractice suits against prescribers of naloxone3
Naloxone does not encourage increased use of illicit substances4
No harm if naloxone is administered to someone who is not experiencing an opioid overdose5

12. Resources PrescribeToPrevent.org HarmReduction.org ProjectLazarus.org
GetNaloxoneNow.org

13. References
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. Jan 2016;64(50):
Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med 2013;158(1):1-9.
Frequently Asked Questions. Prescribe to Prevent Website. Available at: Accessed March 28, 2016.
Doe-Simkins M, Quinn E, Xuan Z, et al. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study. BMC Public Health 2014;14:297.
Robinson A, Wermeling DP. Intranasal naloxone administration for treatment of opioid overdose. Am J Health Syst Pharm 2014;71(24):

14. Post-Assessment Question
In Maine, naloxone may be distributed through all of the following methods EXCEPT:
Prescription to a relative of a patient at risk of experiencing an opioid overdose
Over-the-counter sale by a pharmacist to a patient screened for risk of opioid overdose
Under a standing order at a community-based drug overdose prevention program
Prescription to an individual whose work brings them into contact with patients who may overdose

15. Post-Assessment Question
In Maine, naloxone may be distributed through all of the following methods EXCEPT:
Prescription to a relative of a patient at risk of experiencing an opioid overdose
Over-the-counter sale by a pharmacist to a patient screened for risk of opioid overdose
Under a standing order at a community-based drug overdose prevention program
Prescription to an individual whose work brings them into contact with patients who may overdose

16. Contact: