Naloxone Quick Start Guide

1. Identify naloxone candidates. These are generally people:

• with a history of opioid intoxication or overdose, or who may have a history of substance abuse or nonmedical opioid use.
• taking methadone, buprenorphine, or naltrexone for opioid use disorder.
• taking 50 mg or more of oral morphine or its equivalent daily, or a long-acting opioid.
• being switched from one opioid to another (due to risk of incomplete cross-tolerance).
• taking an opioid and who also smoke; have a respiratory illness (e.g., COPD, sleep apnea, asthma, etc); have renal, hepatic, or heart disease; have HIV; use alcohol or take a benzodiazepine, sedative, or antidepressant; who live in a remote location.
• who request it.

Note: Most states now allow prescribing of naloxone to a caregiver or family member (see footnote), but insurance might not cover it.

2. Talk to the patient/caregiver about naloxone. Explain that:

• Naloxone can save lives if the patient or someone else who gets access to the patient's opioid (e.g., a child) overdoses. Overdoses can happen accidentally in patients not abusing opioids. Naloxone is like a seatbelt: most people don't need it, but it's there if they ever do need it.
• Having naloxone available does not encourage opioid misuse and may even reduce it.
• Naloxone is easy to use, has a low risk of adverse effects, and is not harmful if the person didn't really need it.
• In the U.S., "Good Samaritan" laws are being drafted and passed to protect bystanders who administer naloxone (see footnote). Canada passed a "Good Samaritan" law in 2017.

3. Contact the prescriber for a naloxone prescription, if required.

• U.S.: Naloxone can be purchased without a prescription (see footnote).
• Canada: Health Canada made naloxone nonprescription in March 2016. Naloxone is available for purchase by anyone, but it must be dispensed or sold at a pharmacy under the supervision of a pharmacist in most provinces.
• In the U.S., laws are being drafted and passed to protect prescribers who prescribe naloxone and pharmacists who dispense it (see footnote).

4. Prescribe/Dispense naloxone.

• Our chart, Naloxone for Opioid Overdose (FAQs), has information on getting naloxone paid for, getting paid for counseling patients about naloxone (prescribers), and exactly how to write/dispense a prescription for a naloxone kit (i.e., naloxone vials and syringes or a nasal atomization device).

5. Teach the patient/caregiver how to use naloxone.

• Patient instructions are included with the brand naloxone products (e.g., Narcan nasal spray, S.O.S. Naloxone [Canada]).
• In the U.S., patient/caregiver training materials for naloxone use are available at http://www.prescribetoprevent.org.
• Naloxone patient handouts and a teaching point checklist from the College of Pharmacists of British Columbia are available at http://www.bcpharmacists.org/naloxone.