Wisconsin Enacts Naloxone Standing Order for Pharmacists

Wisconsin Governor (and former Republican presidential candidate) Scott Walker recently joined state health officials at the Pharmacy Society of Wisconsin’s annual meeting to announced a statewide standing order that enhances pharmacists’ ability to provide naloxone to patients at high risk for opioid overdose.

Wisconsin now joins a handful of states that have implemented similar naloxone programs to help combat the opioid overdose epidemic in the United States. These standing orders allow pharmacists to dispense this lifesaving medication without a prescription.

Wisconsin’s standing order for naloxone builds upon the 2013 Wisconsin Act 200, which was originally signed into law in April 2014. Additionally, legislation allowing for the use of standing orders for naloxone dispensing was signed in December 2015, but the actual standing order was implemented in August 2016 by the state’s chief medical officer.

The state has issued guidelines for the naloxone standing order, which are now available on its website. In a YouTube video, Governor Walker states, “In Wisconsin, we’re leading the country. We’re one of the leading states when it comes to a full-scale comprehensive approach to both prescription drug abuse and heroin abuse.”

In the same video, Tom Engels, deputy secretary for the Wisconsin Department of Health Services (DHS), notes, “In 2009, opioid death exceeded those of car crashes in the state of Wisconsin. We have to find ways to solve this problem so families do not have to face the devastating effects of opioid deaths.”

The standing order can be downloaded from the state’s website by attesting that the pharmacy intends to fulfill all the requirements, which include:

• All registered pharmacists at each pharmacy site must complete at least 1 hour of training.
• The managing pharmacists must sign the standing order, attesting that all registered pharmacists have completed the training and are familiar with naloxone rescue kits and patient education materials.
• The signed statewide standing order must be kept on file at each pharmacy site.
• The pharmacist must educate the patient and distribute patient education materials at the time of naloxone dispensing.
• Each pharmacy site must maintain records of specified data and submit summary reports to DHS every quarter.

This announcement follows a similar proclamation by the Texas Pharmacy Association (TPA) in June related to the state’s naloxone standing order program. The Texas program builds on the “Saving Lives Initiative,” which includes a law that took effect August 1, 2016 to allow pharmacists to administer epinephrine to patients in emergency situations. Participation in the program requires the completion of a 1-hour continuing education course that is available at no charge through TPA.

Pharmacists can expect to see this trend expand across the United States as additional advocacy efforts come to fruition. Michigan is pursuing legislation that would give explicit authority to the state’s chief medical executive to issue a statewide standing order to allow pharmacists to dispense naloxone without a prescription order. In the legislation’s current form, a pharmacist dispensing pursuant to this protocol would have to create a file referencing the protocol, rather than generating or receiving a prescription. I anticipate this legislation will be an important part of the regulatory conversation this fall when the Michigan legislature reconvenes.