Standing Order for Naloxone in Pharmacies in New York State: A Step Closer in Pharmacy Advocacy

By: Helen Li, PharmD Candidate c/o 2023

              On August 15, 2022, the New York State Commissioner of Health, Dr. Mary T. Bassett, implemented a statewide pharmacy standing order for naloxone.¹ With this authorization, all pharmacists can assist in reducing mortality from opioid abuse, while optimizing the pharmacists’ continuous role in public health.

              In 2017, the Department of Health and Human Services (HHS) officially declared opioid overuse as a public health emergency in the United States. On average, approximately 10 million people misuse opioids per year, with approximately 50,000 of those cases resulting in death from opioid overdose.² During the COVID-19 pandemic, the number of opioid-related deaths accelerated. The Centers for Disease Control and Prevention (CDC) found that 81,000 opioid-related overdose deaths occurred in the 12 months ending in May 2020.³ Increased public access to naloxone can help decrease mortality associated with opioid abuse.

Naloxone is available by the Food and Drug Administration (FDA) in two approved forms: as an injectable and as a nasal spray. Naloxone, an opioid antagonist, is an easily administered medication that can rapidly reverse life-threatening adverse effects of opioid overdose when used in a timely manner.¹ Naloxone displaces receptor-bound opioids and inhibits opioid receptors, which not only reverses opioid-induced adverse effects but also blocks any additional opioid action. Naloxone quickly restores an individual’s normal breathing in those with respiratory depression, preventing any corresponding cardiac arrest, brain damage, and death.¹ Naloxone can be used in individuals suspected of opioid overdoses. Signs and symptoms of opioid overdose include loss of consciousness, unresponsiveness to stimuli, slurred speech, shallow or slow breathing, skin color changes, and choking sounds.⁴ Naloxone has no effect on individuals who have not consumed opioids. Naloxone should not be used as a treatment option for opioid-use disorder.⁵

A standing order is a written protocol that authorizes designated health care professionals to complete a clinical task without having to first obtain a physician order.⁶ The New York State Department of Health issued a non-patient specific prescription standing order for naloxone. Pharmacists and supervised pharmacy interns can now dispense naloxone to anyone who requests it, without a patient-specific prescription.⁷ Naloxone and any necessary supplies for its administration can be prescribed and dispensed to individuals under this standing order. Naloxone can also be administered to individuals experiencing an opioid overdose and who encounter or witness an opioid overdose. Patients can obtain naloxone at their local pharmacies without a written prescription by requesting the medication at the pharmacy counter with their insurance information.¹   

Currently, pharmacists play a crucial role in improving public health with their ability to administer vaccines without a written prescription. With the implementation of the standing order for naloxone in New York State, the role of pharmacists continues to evolve. Pharmacy advocacy has not only expanded the role of pharmacists, but also promotes the involvement of student pharmacy interns. Most importantly, it allows pharmacists to become key accessible solutions to driving down mortality rates from opioid abuse.

References

1. Department of Health. State Health Commissioner Issues Statewide Pharmacy Standing Order for Naloxone to Reduce Opioid Overdoses and Save Lives. https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/naloxone_standing_order_pharmacies. Accessed August 19, 2022.
2. Opioid crisis statistics [2022]: Prescription opioid abuse. NCDAS. https://drugabusestatistics.org/opioid-epidemic/. Published April 6, 2022. Accessed August 20, 2022.
3. Overdose deaths accelerating during COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html. Published December 18, 2020. Accessed August 21, 2022.
4. Recognizing Opioid Overdose. National Harm Reduction Coalition. https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose/. Published September 1, 2020. Accessed August 21, 2022.
5. Naloxone Drug Facts. National Institutes of Health. https://nida.nih.gov/publications/drugfacts/naloxone. Published August 4, 2022. Accessed August 21, 2022.
6. What Standing Orders Can Do For Your Practice? https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/potential_standing_orders.html. Published April 24, 2019. Accessed August 21, 2022.
7. Naloxone Dispensing Information for Pharmacies. Naloxone Dispensing Information for Pharmacies – NYC Health. https://www1.nyc.gov/site/doh/providers/health-topics/naloxone-and-overdose-prevention-in-pharmacies.page. Accessed August 21, 2022.