Naloxone in Community Pharmacies

By: Hailey Tweden and Maisaa Abudagga, University of Iowa College of Pharmacy Class of 2023

Have you ever wondered how a patient can gain access to naloxone nasal spray (also known as Narcan) through a community pharmacy? Keeping up with all of the rules and regulations can be confusing, yet naloxone is often times a key element to patient safety. Whether dispensed to a patient who frequently needs opioid pain medications, or to a concerned family member, it is important for patients to know how they can obtain naloxone. Keep reading to find out how a patient can obtain naloxone for reversal of opioid-related overdose from a community pharmacy.

Standing Order for naloxone

A standing order is a written protocol that allows members of the healthcare team (in this case, pharmacists) to complete a particular task (in this case, dispensing naloxone to a patient/family member at risk) without having to obtain a prescription from a doctor first.

Which states have a statewide standing order for naloxone in place?

Illinois, Iowa, Minnesota, North Dakota, and Texas just to name a few. There are actually only a few states that do not have a statewide standing order for naloxone in place.

What steps does a pharmacist take to dispense naloxone per the Standing Order?

There are a few steps that a pharmacist must follow to dispense naloxone per the Statewide Standing Order. Each form that must be filled out provides relatively simple and easy-to-follow directions for the pharmacist. All forms are linked below or can be found online on the Board of Pharmacy website for each respective state.

Eligibility Assessment: each patient must be assessed to determine whether they are eligible to receive naloxone for reversal of opioid-related overdose. There are only a few criteria that the patient must meet.

Patient is at risk for an opioid-related overdose
Patient has a prescription for an opioid for pain relief, or currently is receiving treatment for Opioid Use Disorder
Patient has no known hypersensitivity to naloxone or the other ingredients in naloxone

Training and Education: each patient/family member who wishes to obtain naloxone must receive training and education from a pharmacist regarding opioid-related overdose, appropriate response, naloxone storage conditions, and naloxone administration. See the ‘helpful resources’ links below for a brochure on Opioid Overdose Recognition and Response.

Note: Pharmacists involved in dispensing naloxone per the Statewide Standing Order are required to complete specific training (called Continuing Education) related to opioid overdose and treatment. This training allows pharmacists to be helpful and knowledgeable in providing training and answering any questions that patients/family members may have regarding opioid overdose and treatment with naloxone.

What does it cost to get naloxone through my community pharmacy?

Typically patients are not required to pay anything to receive naloxone. Most Statewide Standing Orders reimburse pharmacies for the entire cost of naloxone, and nearly all insurance companies cover the entire cost of naloxone too.

Where can I find more information on my state’s standing order for naloxone?

All necessary forms, as well as full rules and regulations, can be found linked below or online on each respective state’s Board of Pharmacy website.

What other options does a patient have to obtain naloxone?

A patient who wishes to obtain naloxone can have their provider send a prescription to their pharmacy.
Many local and state harm reduction programs for substance misuse can provide naloxone to patients and family members at risk of opioid-related overdose. Reach out to your local harm reduction programs for more details.
Tele-naloxone is an online program that allows patients to have naloxone delivered to their home for free after a simple tele-health visit with a pharmacist.
Many states have online resources that list all participating locations (pharmacies and harm reduction programs) in the area that can provide patients with naloxone.

Helpful Resources: