Naloxone Quick Start Guide
Use this guide as a stepwise approach to identify naloxone candidates, get them started on naloxone, and get on with your day.
This quick start guide is based on our FAQ, Meds for Opioid Overdose, which you can consult for additional information.
- 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.
- 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 US, “Good Samaritan” laws are being drafted and passed to protect bystanders who administer naloxone (see footnote). Canada passed a “Good Samaritan” law in 2017.
- Contact the prescriber for a naloxone prescription, if required.
- US: Naloxone can be purchased without a prescription (see footnote).
- In the US, laws are being drafted and passed to protect prescribers who prescribe naloxone and pharmacists who dispense it (see footnote).
- Canada:Naloxone is available for purchase by anyone, but in some provinces, it must be sold at a pharmacy under the supervision of a pharmacist.
- Prescribe/Dispense naloxone.
- Our chart, Meds for Opioid Overdose, has information on getting naloxone paid for, getting paid for counseling patients about naloxone (prescribers), and how to write/dispense a prescription for a naloxone kit (i.e., naloxone vials and syringes or a nasal atomization device).
- 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 US, patient/caregiver training materials for naloxone use are available at http://www.prescribetoprevent.org.
- Naloxone teaching materials and a teaching point checklist from the College of Pharmacists of British Columbia are available at http://www.bcpharmacists.org/naloxone.
Footnote: See http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139 and https://naspa.us/resource/2022-state-fact-sheets/. [September 2023]