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Policy Statement

Policy Statement 2018-04: Naloxone Dispensing via Standing Order

Date: 06/07/2018
Organization: Board of Registration in Pharmacy
Referenced Sources: M.G.L. c. 94C

In an effort to combat the opioid epidemic, M.G.L. c. 94C section 19B expanded the prescribing and dispensing of naloxone to increase access to this life-saving medication. The opioid antagonist may be purchased with or without a patient-specific prescription by any person at risk of experiencing an opiate-related overdose, as well as by family members, friends or other persons in a position to assist individuals at risk of experiencing an opiate-related overdose.

In the face of this ongoing opioid crisis, the Board, through collaboration with the Department of Public Health’s Bureau of Substance Addiction Services, has determined that, compared to the national average, all areas of Massachusetts experience high incidences of opioid-related overdoses or deaths thereby requiring all pharmacies to stock naloxone in accordance with M.G.L. c. 94C section 19C. While many pharmacies are actively dispensing naloxone under the provisions of a standing order, this determination will ensure residents in all parts of Massachusetts have the opportunity to access this life-saving medication.

All retail pharmacies located in Massachusetts and licensed by the Board of Pharmacy must obtain a standing order and maintain a continuous, sufficient supply of naloxone rescue kits, or other approved opioid antagonist medication, to meet the needs of the community.  Additionally, as required by M.G.L. c. 94C section 19B, each pharmacy must annually report the number of times naloxone was dispensed.

There is no limit to the amount of naloxone that may be dispensed to an individual. Massachusetts state law specifically allows for an individual to obtain naloxone with the intention to administer it to another person. A pharmacy may dispense naloxone either pursuant to a patient-specific prescription or via the pharmacy’s standing order.

Required Action:

  • By December 1, 2017, all pharmacies without existing naloxone standing orders must obtain one. See the following links to obtain information on the procedure:

http://masstapp.edc.org/prescription-and-pharmacy-access-naloxone-rescue-kits

  • Pharmacies with existing standing orders and those who obtain a standing order as required by this policy should dispense naloxone according to the following protocol:
  • Pharmacists dispensing naloxone rescue kits must document successful completion of 1 hour of approved training on overdose prevention and naloxone rescue kits. 

Currently approved trainings include:

    • The Pharmacist Manager of Record must sign the standing order and attest that all licensed pharmacists at the location have completed the required training and are familiar with naloxone rescue kits and the Opioid Antagonist Information Pamphlet (see attached).
    • After the pharmacy’s first standing order has been signed by a Massachusetts licensed physician and the Manager of Record, it must be filed with the Board and a copy must be maintained and readily retrievable at the location.
    • Standing orders must be renewed on a biennial basis upon pharmacy license renewal (renewals do not require submission to the Board).
    • New employees must complete the required training within 30 days of hire.
    • Naloxone rescue kits must be labeled with the expiration date of the included naloxone unit.
    • In place of the name and address, “Naloxone Rescue Kit,” may be used to create a patient profile and prescription label.
    • The pharmacy must counsel the individual and distribute the Opioid Antagonist Information Pamphlet (see attached).
    • When an individual presents to the pharmacy to obtain naloxone, the order should be processed under the protocol standing order. No additional information regarding the ultimate user of the naloxone should be requested, collected, or retained for record, unless the purchaser requests to purchase with her or his insurance.
    • The pharmacy must make a reasonable effort to determine if the purchaser’s insurance will cover the product, unless the purchaser requests otherwise.
    • By January 15, the number of naloxone doses (not prescriptions or manufacturer-supplied units) dispensed under the standing order for the previous calendar year must be reported to: naloxonestandingorders@MassMail.State.MA.US
    • The pharmacy should consider advertisements or signage to inform the public that naloxone kits are available.

Downloads for 2018-04: Naloxone Dispensing via Standing Order

Referenced Sources:

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