CHARLESD.BAKER

Governor

KARYNE.POLITO

LieutenantGovernor

TheCommonwealthofMassachusettsExecutiveOfficeofHealthandHumanServicesDepartmentofPublicHealth

250WashingtonStreet,Boston,MA02108-4619

MARYLOUSUDDERS

Secretary

MONICABHAREL,MD,MPH

Commissioner

Tel:617-624-6000

September16,2015

OPTIONALNaloxoneProgramforPharmacies:AHow-to

OnThursdayMarch27,2014,GovernorPatrickdeclaredaPublicHealthEmergency,providingemergencypowerstoDPHCommissionerCherylBartlett,RNtoaddresstheopiateabuseandoverdosecrisis.AttheGovernor’sdirection,CommissionerBartlett,withtheapprovalofthePublicHealthCouncil,issuedanOrderthatauthorizedpharmaciststodispensenaloxonerescuekitstoapersonatriskofexperiencinganopiate-relatedoverdoseorafamilymember,friendorotherpersoninapositiontoassistapersonatriskofexperiencinganopiate-relatedoverdose.

Whatisrequiredtodispensenaloxonerescuekitswithoutaprescription?

•StandingordersignedbyaphysicianlicensedinMassachusetts

•StandingOrdermustbekeptonpharmacypremises

•StandingOrdermustbesubmittedtoBoardofRegistrationinPharmacyviaemail

•Completeunderstandingofallcontentinthe“NaloxonePamphlet”

•“NaloxonePamphlet”mustbedistributedwithnaloxonerescuekits

•Naloxonerescuekitsmustbelabeledandincludeexpirationdate

Stepstosettingupthedispensingofnaloxonerescuekitswithoutaprescription

A.StandingOrder

Allpharmacieswishingtodispensenaloxonerescuekitswithoutaprescription,mustfirstobtainastandingordersignedbyaphysicianlicensedinMassachusetts,andfilethatdocumentwiththeMassachusettsBoardofRegistrationinPharmacy,at: Thestandingordermustalsobekeptonpremisesatanysitewherenaloxonerescuekitswillbedispensed.

PharmacychainsmayhaveMedicalDirectorswhowillbeabletoprovideastandingorder,butsmallerchainsandindependentswillneedtofindalocalphysiciantosignone.Tothatend,

attachedpleasefindanExampleStandingOrderforNaloxoneRescueKitsand“NaloxonePamphlet”fordispensingnaloxonerescuekitswithoutaprescription.

Ifapharmacyisunabletoidentifyalocalphysicianwhowillsignastandingorder,theymaycontactBrittniReilly(DPH)at617-624-5362()andeveryeffortwillbemadetoassistinfindingone.

B.BystanderCounseling

i.Counselingeachperson(personatriskand/orbystander)atthepointofsaleisimportanttothesuccessfuluseofnaloxone.Properadministrationisparamount,butthataloneisnotenough.

ii.Atthetimenaloxoneisadministered,911shouldbecalled,andtheambulanceshouldbeontheway. Sometimes,onedoseisnotenough,andaseconddoseshouldbeadministered.Insomeinstances,theeffectsofnaloxonewearoffpotentiallycausingtherecipienttoregressbackintoanoverdosestate.Thosewhohaveoverdosedandreceivednaloxonemayalsobeconfrontationaluponarousal.Everypersonwhohasbeenadministerednaloxoneshouldreceivefollow-upmedicalattentionassoonaspossible.

iii.Pharmacistshouldcounselwhendispensingnaloxonerescuekits.Inanefforttoassistpharmacistsinthecounselingofindividualsatriskforhavingorwitnessinganopioidoverdose,a“NaloxonePamphlet”hasbeencreated.Thepamphletexplainsassimplyaspossible,howtoadministernaloxone,aswellasprovidingotherimportanttipsforitsultimateuse. Anypersonwhobelievestheyhaveevenaslightchanceofneedingtoadministernaloxone,shouldfamiliarizethemselveswiththeseproceduresBEFOREanemergencysituationoccurstomaximizethechancesforasuccessfuloutcome.

Thankyouforyourattentiontothisveryimportantmatter,DavidSencabaugh,RPh

ExecutiveDirector

MassachusettsBoardofRegistrationinPharmacy

ReferencesandHelpfulWebsites

1.NaloxoneHydrochloride[packageinsert].LakeForest,IL:Hospira,Inc.;2008.

2.Prescribetoprevent.org

3.BostonPublicHealthCommission’sYouTubepageforavideodescriptionofhowtoassembleandadministerNaloxone.Availableat

4.NaloxonePamphletAvailableat:DPHandBoardofPharmacyWebsite

5.HarmReductionCoalition.“GuidetoDevelopingManagingOverdosePreventionTake-HomeNaloxoneProjects.”HarmReductionCoalition,2012.Web.05April2014

6.CommunityCareNC.“ProjectLazarusPatientEducationVideo.”Web.05April2014