Guidelines for health care providers on prescribing naloxone, treating opioid use disorder, and safe opioid prescribing
In this section:
Any health care provider with prescriptive authority in Washington State may prescribe take-home naloxone to anyone at risk for having or witnessing an opioid overdose. In WA State, the Agency Medical Directors Group recommends co-prescribing naloxone for patients in its 2015 Interagency Guideline on Prescribing Opioids for Pain.
The San Francisco Department of Public Health’s clinicians’ guide Naloxone for Opioid Safety includes tips for patient conversations and patient inclusion criteria.
The American Medical Association, the American Public Health Association, and the American Pharmacists Association have all endorsed policies to expand availability of take-home naloxone:
- Combating Prescription Drug Abuse and Diversion, American Medical Association
- Preventing Overdose Through Education and Naloxone Distribution, American Public Health Association
- Combating Opioid Drug Abuse with Naloxone, American Pharmacists Association
Prescribe To Prevent is a comprehensive resource on integrating naloxone prescribing into your health care practice. Includes patient education videos, fact sheets, prescribing information, and other materials.
Public Health-Seattle & King County in partnership with Stopoverdose.org has created a Naloxone Prescribing Practice Guideline with recommendations about which patients should be prescribed naloxone.
Naloxone in emergency departments
Several emergency departments in WA State are also implementing take-home naloxone programs for patients being seen for opioid overdose.
These resources are useful for emergency department clinicians and administrators interested in naloxone models:
Naloxone Distribution: Key Considerations/Implementation Strategies (ACEP)
Sample naloxone protocol from Harborview Medical Center Emergency Department
In 2019, SB 5380, legislated changes to make it easier for hospitals to distribute naloxone to people at risk of overdose. These changes include:
- Allowing distribution of prepackaged opioid overdose reversal medication to patients at risk of overdose when barriers may exist to them obtaining the medication after release.
- Modifying the requirements for labeling of medications in the case of opioid overdose reversal medications “The labeling requirements of RCW 69.41.050 and 18.64.246 do not apply to opioid overdose reversal medications dispensed, distributed, or delivered pursuant to prescription, collaborative drug therapy agreement, standing order, or protocol issued in accordance with this section.”
Opioid use disorder among patients
Health care professionals across multiple areas of clinical practice encounter patients with problematic misuse of opioids. In response, more practitioners are actively screening patients for opioid use disorder, referring them for appropriate care, and in some cases, becoming licensed to provide medication-assisted treatment within their scope of practice.
The WA State Medical Association Opioid Clinical Guidance includes a comprehensive list of resources for clinicians on screening, referring and treating patients for opioid use disorder, including:
- webinars and CME on opioid addiction treatment
- treatment guidelines and quality practice standards
- becoming a licensed buprenorphine provider
Screening and diagnosis
Screening patients for problematic opioid use is the first step in diagnosing and treating opioid use disorder. Opioid use disorder is defined by the DSM-5 as “A problematic pattern of opioid use leading to clinically significant impairment or distress” evaluated against 11 diagnostic criteria.
SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. SBIRT is a tool to universally screen and identify patients with mild to severe substance use disorders, including opioid use disorder. The WA SBIRT Primary Care Integration website has more information on SBIRT including clinical tools, forms, training and reimbursement for SBIRT activities.
Medications for opioid use disorder (MOUD) are the current standard of care for patients with opioid use disorder. These medications include buprenorphine, methadone, and naltrexone.
To learn more about MOUD check out our new webpage, Learn About Treatment. This site includes information about the three FDA approved medications, as well as patient engagement tools, and sample protocols.
- The Substance Abuse and Mental Health Services Administration Medication-Assisted Treatment website features clinical tools, provider training, and information on medications and counseling.
- SAMHSA’s Pocket Guide to Medication Assisted Treatment of Opioid Use Disorder includes a checklist for assessing treatment need, an Opioid Withdrawal Scale tool, and side-by-side comparison of methadone, buprenorphine and naltrexone.
- SAMHSA’s Treatment Improvement Protocol 63: Medications for Opioid Use Disorder has information for healthcare providers about screening for opioid use disorder and treatment planning, detailed information about the medications to treat opioid use disorder, and how to partner with addiction treatment counselors.
For physicians who wish to prescribe and dispense buprenorphine to treat opioid use disorder, SAMHSA’s buprenorphine website has information on DEA-waiver qualifications, training, federal practice regulations and a national buprenorphine provider locator tool.
Opioid prescribing/pain management guidelines
The Agency Medical Directors’ Group develops guidelines for medical providers caring for patients of state agency programs in WA State. The AMDG 2015 Interagency Guideline on Prescribing Opioids for Pain recommends best practices for opioid-based and non-opioid pain management to improve care of patients with chronic pain and to reduce their risk of addiction and overdose.
Along with the AMDG Guideline, five prescribing profession boards and commissions have adopted rules on the management of chronic, non-cancer pain:
- Medical Quality Assurance Commission
- Board of Osteopathic Medicine and Surgery
- Nursing Care Quality Assurance Commission
- Dental Quality Assurance Commission
- Podiatric Medical Board
The relevant WACs for each profession can be found here.
Other pain management resources
- The University of Washington Department of Anesthesiology and Pain Medicine’s Pain Medicine Provider Toolkit has a comprehensive list of clinical tools and patient education materials.
- The University of Washington School of Medicine COPE program offers a suite of free CME courses for primary care doctors, nurses, physician assistants, and other health care specialists who treat patients with chronic pain and want to learn how to safely address opioid prescribing.
- The WA State Department of Health Pain Management Resources website includes pain rules, dosage calculator, clinical tools, and CME training opportunities.
- The American Medical Association also offers CME courses and webinars on safe opioid prescribing.
Prescription Monitoring Program (PMP)
The WA State Department of Health Prescription Drug Monitoring Program runs a centralized database that holds controlled substance prescription dispensing information for all patients across the state. Prescribers are able to review their patients’ prescription dispensing history information before they prescribe or dispense drugs. This allows them to look for duplicate prescribing, dispensing history, drug interactions, and other potential concerns.
More information and factsheets on program rules, registration, use, and reports are available on the Prescription Monitoring Program website.