Prescribing Naloxone

Heroin-related overdose deaths in Maryland have increased by 88 percent between 2011 and 2013 and fentanyl-related deaths have jumped from an average of 2 deaths per month during the years 2007-2012 to 15 deaths per month in late 2013 and 2014.

The Maryland Overdose Response Program (ORP) was established by law in 2013 to increase access to overdose education and naloxone, to reduce opioid overdose deaths throughout the state. The ORP allows non-medical persons to be trained and certified in overdose recognition and response. The Department of Health and Mental Hygiene (DHMH) authorizes organizations to conduct ORP trainings and issue certificates to trainees. Certificate holders may lawfully be prescribed and dispensed naloxone and administer it to someone believed to be experiencing opioid overdose.

Health Care Providers – Prescribing Naloxone

*Not a Health Care Provider?  Click here to learn about the St. Mary’s County Overdose Response Program.

Clinicians in Maryland have already been able to prescribe take-home naloxone and the equipment associated with administration (i.e. syringes, atomizer) for patients at risk for opioid overdose, including patients on long-term opioids for pain and those abusing prescription opioids or heroin.

The establishment of the ORP and its authorizing regulation now allow clinicians to prescribe take-home naloxone and the equipment associated with administration to qualified individuals who would then administer the medicine to others who might be overdosing on opioids.

Qualified individuals have successfully completed the Maryland Overdose Response Program and must present a valid certificate from an authorized training entity. Each certificate references Health-General Article, Title 13, Subtitle 31, Annotated Code of Maryland and also includes the full name of the certificate holder and an individualized serial number designated by the authorized training entity.

As an authorized training entity, the St. Mary’s County Health Department offers the Overdose Response Program for free to all community members. Health care providers are strongly encouraged to refer family members and friends of high risk patients to the St. Mary’s County Overdose Response Program. Click here for more information, to view the class schedule, or to register.

Guidance on standing orders for naloxone is available on the Maryland DHMH website.

The St. Mary’s County Health Department is encouraging the prescription of the intranasal and auto-injector forms of naloxone; however, health care providers may write a prescription for multiple routes (intranasal, auto-injector, or intramuscular) of administration to optimize availability to patients.

Intranasal:  Naloxone (2 mg/ 2 ml) single dose luer-lock prefilled syringe. (NDC 76329-3369-01). Dispense with intranasal mucosal atomizer device (MAD 300).

Qty = 2 syringes, 2 MAD 300s

Refill = PRN

Directions: Spray one-half of syringe (1 ml) into each nostril upon signs of opioid overdose. May repeat x1, if no response after 3 minutes.

Auto-injector:  Evzio auto-injectors (Naloxone 0.4 mg) (NDC 6084203001)

Qty = 1 two-pack kit

Refill = PRN

Directions: Use as instructed by device. May repeat x1, if no response after 3 minutes.

Pharmacists – Dispensing Naloxone

Maryland Law SB 516: Public Health – Overdose Response Program expands access to the lifesaving drug naloxone, a medication that reverses the effect of opioid overdose. As a result of this law, the St. Mary’s County Health Officer, Dr. Meenakshi Brewster, has issued a jurisdiction-wide standing order for naloxone to be dispensed by local pharmacies to qualified individuals. This standing order will help to expand access to naloxone to those at-risk of experiencing an opioid overdose and make it easier for people to get naloxone from their local pharmacist when they need it.

Medicaid

Naloxone will be available in the Medicaid program without preauthorization for all Medicaid patients state-wide. As a result, prescriptions written for naloxone can be filled at community pharmacies. There is a $1 copay for generic naloxone; however, pharmacies may not deny service to any recipient if they are unable to pay the copay (COMAR 10.09.03.03 [M]).

Additional Resources