Pharmacists

Pharmacists play an essential role in preventing the misuse of opioids and opioid overdose in their communities. Specifically, pharmacists can:

• Screen and identify patients at risk for opioid misuse and overdose by reviewing patient prescription histories in the state Prescription Drug Monitoring Program.
• Counsel patients on how to use opioid medications safely and prevent adverse effects such as oversedation, overdose and addiction.
• Participate in safe medication “take back” programs by offering temporary or permanent medication disposal receptacles.
• Keep naloxone in current inventory and dispense to patients who have a prescription.
• Dispense naloxone directly to patients under the Washington Statewide Standing Order to Dispense Naloxone. To use the standing order, please notify the WA Department of Healthy by sending an email to naloxoneprogram@doh.wa.gov.

Under the WA Statewide Standing Order for Naloxone any pharmacy can provide naloxone directly to patients.

Whether you are filling prescriptions from other providers or under the Statewide Standing Order, this information will get you ready to dispense naloxone and provide appropriate opioid overdose education.

• Starting a Take-Home Naloxone Program (PDF of webinar slides from WA State Pharmacy Association/Center for Opioid Safety Education)
• Naloxone Implementation Checklist for Pharmacies (from Kelley-Ross )

1. Talk with other pharmacists who already provide naloxone. Your colleagues will have helpful tips and advice.
2. Select which form(s) of naloxone to carry (e.g., intranasal, intramuscular, or both).
   Order intramuscular naloxone HCL, either:

• • 2 X 1 ml single dose vial (NDC# 00409-1215-01)
  • 1 X 10 ml as one fliptop vial (NDC# 00409-1219-01)
  • 2-pack, 2mg/0.4ml prefilled auto-inject devices (Evzio™) (NDC# 60842-051-01) (not covered by the Statewide Standing Order)

Order intranasal naloxone HCL, either:

• • 2 X 2 ml as pre-filled Needleless Luer Jet Prefilled Syringe (NDC# 76329-3369-01) plus 2 X intranasal mucosal atomizing device (MAD 300)
  • 2-pack, 4mg/0.1ml autospray devices (Narcan™) (NDC# 69547-353-02)

This is a helpful naloxone product comparison chart for pharmacists.

3. Prepare an overdose rescue kit and set a price. A kit should include:

• • 2 doses of naloxone,
  • delivery devices if needed (e.g., nasal applicator or intramuscular syringe),
  • overdose education materials

Some pharmacies also choose to include:

• • List of local social and health services providers
  • Rescue breathing mask
  • CPR Life Mask Face Shield, Healthcare Logistics, Item #7296‐01
  • Naloxone Overdose Rescue Kit Bag
  • Sunny side utility pouch from www.anypromo.com, item #680291, customizable
    • Any other pouch/bag vendor

4. Prepare a demonstration/practice kit so patients can demonstrate that they understand how to administer the medication properly. Hands-on practice is important. Pharmacies can reach out to ADAPT Pharma to obtain demonstration devices.
5. Develop in-store signage to let patients know you have naloxone. Samples can be found here.
6. Determine how you will provide patient education. Some details to consider:

• • Which staff will do the training?
  • What materials will you use: handouts, videos, etc? Patient education should include:

• • • Signs of an opioid overdose
    • Importance of calling 911 and protections under WA State’s Good Samaritan overdose law
    • Steps to give rescue breathing
    • How to administer the naloxone (based on the form you are dispensing)Resources:

• • • Sample patient education materials
    • Sample naloxone promo posters
    • Patient training videos

8. Notify the WA Department of Health of your intent to distribute naloxone under the Statewide Standing Order by sending an email to naloxoneprogram@wa.doh.gov.
9. Put your pharmacy on the naloxone locator list (email: stopovd@uw.edu).
10. Train the pharmacy team so all staff know that take-home naloxone is available, the specifics of the Statewide Standing Order, the education to provide, and where to find answers to frequently asked questions.

• WA Medicaid will reimburse for intramuscular and intranasal kits without pre-authorization for a person at risk of an overdose and for a potential bystander to overdose.
• Medicaid will reimburse a patient for two naloxone kits a month.
• WA Medicaid does not reimburse for the mucosal atomimizing device.
• The EVZIO Auto Injector, which is significantly more expensive, requires pre-authorization. It is also not covered by the Statewide Standing Order. This type may be appropriate for people with limited motor skills or other disabilities.
• Coverage for naloxone varies widely among commercial plans. It’s a good idea to call the most common carriers in your area to confirm coverage.

More resources for pharmacists

These websites feature useful tools, sample prescriptions, patient education materials and information on naloxone ordering and billing:

Prescribe To Prevent: Pharmacy Basics