Narcan (naloxone) is a life-saving reversal agent for opioid overdose, which is now more accessible to patients than ever. Pharmacists can dispense Narcan to patients without a prescription through a standing order.1 Standing orders are written documents that outline rules, policies or procedure allowing patient care under stipulated clinical situations. In this case, patients presenting to a pharmacy in the may receive Narcan without a prescription in the state of Arizona. Even more, Arizona’s state health plan, AHCCCS, will provide this medication at no cost to fully enrolled members. 2
So what does this mean for emergency physicians? Talk to your patients about Narcan (naloxone) if you suspect the patient may be at risk for overdose. You may elect to prescribe Narcan as a reminder to patients to pick up the medication. Patients should tell others they use opioids with about their Narcan and in addition, know that their Narcan may be administered to someone else suffering an opioid overdose.
There are several formulations of Narcan, the most common being an intranasal dosage (given like Flonase) and an intramuscular dosage (given like an EpiPen). Reassure patients that they will receive additional training from the pharmacist regarding recognizing opioid overdose and how to safely administer Narcan.
Narcan is even easier in the Maricopa Adult ED, patients may be prescribed Narcan to be filled at the MIHS outpatient pharmacy only. When patients fill this special prescription they will receive an IM injection kit for Narcan at no charge regardless of insurance status (Sonoran Prevention Works generously supplies our Narcan kits!)
Narcan is not without its controversy, check out this article in ACEP Now from June 2016 about the ongoing discussion about dispensing Narcan.
In closing, a reminder that the American College of Emergency Physicians recommends3 “physicians may prescribe naloxone to at-risk patients such as the following:
• Discharged from the emergency department following opioid intoxication or poisoning
• Taking high doses of opioids or undergoing chronic pain management
• Receiving rotating opioid medication regimens
• Having a legitimate need for analgesia combined with a history of substance abuse
• Using extended-release/long-acting opioid preparations
• Completing mandatory opioid detoxification or abstinence programs
• Recent release from incarceration and past abuser of opioids”
You could save a life with just one Narcan prescription and some targeted advice, don’t let your opportunity slip away.
1. Christ, C., MD. MS. (2017, November 20). Naloxone Standing Order[PDF]. Phoenix: Arizona Department of Health Services.
2. AHCCCS. (2018). AHCCCS Behavioral Health Drug List(Rep.). Phoenix, AZ. doi:https://www.azahcccs.gov/Resources/Downloads/PharmacyUpdates/AHCCCSBEHAVIORALHEALTHDRUGLIST.pdf
3. American College of Emergency Physicians. (2018, March). Naloxone Prescriptions by Emergency Physicians. Retrieved August 27, 2018, from https://www.acep.org/patient-care/policy-statements/naloxone-prescriptions-by-emergency-physicians/#sm.001gjc26h1a4rei4r9x2i6wwhl8ez