Naloxone Training Requirements Vary Among States

Death due to opioid overdose remains a critical public health and safety issue in the United States.

The abuse of fentanyl, heroin, methamphetamine, and prescription drugs has contributed to the steadily increasing number of opioid-related overdose deaths. Here are some nationwide statistics:

• In 2018, 46,802 opioid-related overdose deaths occurred.¹
• In 2019, 49,860 opioid-related overdose deaths occurred.¹
• In 2020, 68,630 opioid-related overdose deaths occurred.¹

Expanding access to naloxone can help combat this publichealth epidemic. Naloxone is an opioid receptor antagonist that quickly but temporarily reverses the effects of opioids.² It can be given to patients who have overdosed or are suspected to have overdosed on opioid-containing drugs. Naloxone is typically administered intranasally, though there are certain situations in which intramuscular administration might be appropriate. Because its effects occur in minutes, naloxone can be administered multiple times until the patient responds or receives medical attention.

Almost anyone can administer naloxone, and its quick effects can save lives.³ Policy makers are working to increase the availability of naloxone throughout the country.

First responders and health care workers can carry naloxone and administer it as they see fit. In recent years, pharmacists have been given more authority to prescribe and dispense naloxone to patients at high risk and their family members.

New access laws allow pharmacists to establish standing orders with specific physicians or follow blanket, statewide protocols.² Pharmacists who deem patients appropriate to receive naloxone can authorize it immediately according to the set protocol or standing order.⁴

In Kentucky, for example, any pharmacist seeking certification to initiate naloxone dispensing must complete an Application for Pharmacist Certification for Naloxone Dispensing.⁵ Once the application is approved by the board of pharmacy, the pharmacist must establish a protocol with a physician or agree to a protocol available from the state. The statewide physician protocol is authorized by a physician with the Kentucky Department for Public Health.⁶ It specifies the procedures for qualified pharmacists to initiate dispensing of naloxone. The protocol outlines the following:

• procedures in place for documentation of the dispensation⁵;
• the specific education that will be provided by pharmacists to patients⁵;
• the time frame for which the protocol will be in effect⁵;
• the type of naloxone product authorized for dispensing, including the name of the product, the dose, the route of administration, and the directions for use⁵; and
• the type of patients who are eligible to receive naloxone⁵ typically have high-dose opioid prescriptions, a history of opioid poisoning or overdose, or a suspected history of substance abuse.⁶

As of November 22, 2017, all 50 states had implemented an enhanced pharmacy naloxone access law.² But just 19 states require that pharmacists complete a training course prior to dispensing naloxone in any capacity. In Kentucky, for example, pharmacists must receive naloxone training but there is no directive on how long the training must be or how often it must be completed.²

Pharmacists with appropriate naloxone training are better suited to deliver more accurate and comprehensive patient counseling than pharmacists without training.² Comprehensive knowledge of naloxone requires understanding its formulation, dosage, administration, adverse effects, and storage.² Comprehensive knowledge as a health care professional requires understanding of risk factors for overdose, signs and symptoms of overdose, and management of addiction and overdose.²

Enhanced pharmacy naloxone access laws have allowed pharmacists to uthorize and dispense naloxone, thus preventing deaths related opioid overdose.² However, there is no consensus on the specific training required for pharmacists. Ensuring that all pharmacists are appropriately trained on managing opioid overdose with naloxone can help address the overdose epidemic in our communities.

Innumerable lives have been saved by emergency responders, law enforcement officers, and pharmacists by effectively applying naloxone in serious situations. In many areas, local authorities have arranged for naloxone kits to be provided to first responders.

Training for family members of those experiencing substance use disorder involving opioids is also a great recommendation.

Naloxone rescue kits are available in some public areas, much like fire extinguishers. The University of Kentucky College of Pharmacy building has rescue kits mounted on the walls near the elevators. This is a high-visibility area so faculty members and students know these resources exist and where to find them in an emergency.

References:

The problem. JP Opioid Interaction Awareness Alliance. Accessed February 2, 2023. https://www.jpopioidalliance.org/the-problem

2. Roberts RW, Carpenter DM, Smith A, Look KA. Reviewing state-mandated training requirements for naloxone-dis-pensing pharmacists. Res Soc Adm Pharm. 2019;15(2):222-225. doi:10.1016/j.sapharm.2018.04.002

3. Naloxone: summary of state laws. Legislative Analysis and Public Policy Association. July 22, 2022. Accessed February 2, 2023. https://legislativeanalysis.org/naloxone-summary-of-state-laws/

4. Pharmacist prescribing: statewide protocols and more. Nation-al Alliance of State Pharmacy Associations. November 9, 2018. Accessed February 2, 2023. https://naspa.us/resource/swp/

5. Memorandum. Kentucky Board of Pharmacy. June 11, 2021. Accessed February 7, 2023. https://pharmacy.ky.gov/statutesandregulations/Documents/201%20KAR%202%20360%20%20Naloxone%20Dispensing.pdf

6. Kentucky statewide protocol to initiate dispensing of naloxone. Kentucky Public Health. July 28, 2022. Accessed February 2, 2023. https://chfs.ky.gov/agencies/dph/dehp/hab/Documents/KYNaloxoneRx.pdf

About the Authors

Hannah E. Moore, is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.

Joseph L. Fink III JD, DSC(Hon), BSPharm, FAPHA, is professor emeritus of pharmacy law and policy at the University of Kentucky College of Pharmacy in Lexington.