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Standing Order for the Possession, Distribution, and Administration of Naloxone
Naloxone is an opioid antagonist indicated for the reversal of respiratory depression or unresponsiveness caused by an opioid overdose.
This standing order authorizes the << ENTITY NAME >> to procure and maintain supplies of naloxone for the administration to an individual experiencing a suspected opioid overdose.
This standing order authorizes << ENTITY NAME >> to possess naloxone and make naloxone available to << ENTITY NAME >> employees and individuals that respond to a suspected opioid overdose.
This standing order authorizes <
> and trained individuals that may respond to opioid overdoses to possess and administer naloxone to a person experiencing a suspected opioid overdose.
This standing order authorizes << ENTITY NAME >> to maintain supplies of, possess, and administer naloxone in the following forms:
Naloxone hydrochloride nasal spray devices available in 0.4 mg to 4 mg dosages. This includes but is not limited to the Narcan Nasal Spray device from Adapt Pharma
Rx: Administer one 4mg/0.1mL naloxone nasal spray IN every 2-3 minutes as needed for suspected opioid overdose until respiratory effort returns or emergency medical services arrive. Call 911.
Commercially available naloxone hydrochloride auto-injection devices available in 0.4mg to 2mg dosages intended for intramuscular or subcutaneous injection.
Rx: Administer one 2mg/0.4mL naloxone HCL auto injector IM/SQ every 2-3 minutes as needed for suspected opioid overdose until respiratory effort returns or emergency medical services arrive. Call 911.
Naloxone hydrochloride 0.4mg 2mg vials or prefilled syringes for intranasal administration with a nasal mucosal atomization device.
Rx: Administer 2mg 1mg/mL naloxone HCL IN for suspected overdose every 2-3 minutes as needed for suspected opioid overdose until respiratory effort returns or emergency medical services arrive. Call 911.
This standing order delegates training on the administration of naloxone to qualified personnel of Grand Forks Public Health Department, << ENTITY NAME >>, or a qualified health care professional designated by either organization.
Procedure for Administration of Naloxone
Drug Information:
Drug name: Naloxone hydrochloride
Brand Name: Narcan, Evzio
Medication Class: Opioid Antagonist
Mechanism of Action: Reverses the effects of opioid medications including respiratory depression and unresponsiveness
Indications: Respiratory depression or unresponsiveness due to suspected opioid overdose
Route: 2 - 4 mg intranasal via nasal atomization device
0.4 - 2 mg intramuscular
Contraindications: Known sensitivity to naloxone hydrochloride
Precautions:
Pre-existing cardiac disease or seizure disorder
Persons who are known or suspected to be physically dependent on opioids may experience acute abstinence syndrome or opioid withdrawal from reversal of narcotic effect.
Use in pregnancy:
Pregnancy Category C No adequate or well-controlled studies in pregnant women.
Pregnant women known or suspected to have opioid dependence often have associated fetal dependence. Naloxone crosses the placenta and may precipitate fetal withdrawal symptoms.
Nursing mothers: caution should be exercised when administering to nursing women due to transmission in human milk. Risks and benefits must be considered prior to administration.
Geriatric Use: choose lower range doses taking precautions for decreased hepatic, renal, and cardiac function, as well as concomitant disease and drug therapy.
Adverse Reactions:
Adverse reactions are related to reversing dependency and precipitating withdrawal and include fever, hypertension, tachycardia, agitation, restlessness, diarrhea, nausea/vomiting, myalgias, diaphoresis, abdominal cramping, yawning, and sneezing.
These symptoms may appear within minutes of naloxone administration and subside in approximately 2 hours.
Severity and duration of the withdrawal symptoms is related to the dose of naloxone and the degree of opioid dependence.
Adverse effects beyond opioid withdrawal are rare.
Instructions for use:
Indications and Usage
Naloxone is indicated for the complete or partial reversal of opioid overdose induced by natural or synthetic opioids and exhibited by respiratory depression or unresponsiveness.
Directions for Use
Call 911 as soon as possible for a person suspected of an opioid overdose with respiratory depression or unresponsiveness, and initiate rescue breathing.
Administer naloxone as follows:
Intramuscular Naloxone:
Uncap the naloxone vial and uncap the intramuscular needle-syringe
Insert the intramuscular needle through the rubber membrane on the naloxone vial, turn the vial upside down, draw up 1cc of naloxone liquid, and withdraw the needle
Insert the needle into the muscle of the upper arm or thigh of the victim, through clothing if needed, and push on the plunger to inject the naloxone
Repeat the injection if there is no response after three minutes
Intranasal Naloxone:
Pre-filled Syringe
Pop off two colored caps from the delivery syringe and one from the naloxone vial
Screw the naloxone vial gently into the delivery syringe
Screw the mucosal atomizer device onto the top of the syringe
Spray half (1 ml) of naloxone in one nostril and the other half (1 ml) in the other nostril
Repeat if there is no response after three minutes
Narcan Nasal Spray
Peel foil
Hold with index and middle fingers on either side, thumb on plunger
Do not prime plunger
Insert nasal atomizer until backs of fingers are against nostril
Push plunger until it stops
Give rescue breaths
If no response in 3-5 minutes, use additional atomizer in other nostril
Auto-injector Naloxone:
Pull auto-injector from outer case
Pull off red safety guard
Place the black end of the auto-injector against the outer thigh, through clothing if needed, press firmly and hold in place for 5 seconds
Repeat if there is no response after three minutes
Continue rescue breathing and monitor respiration and responsiveness of the naloxone recipient until emergency help arrives.
Authorization
I have reviewed this standing order and procedure for the possession and administration of naloxone by << ENTITY NAME >> and hereby authorize << ENTITY NAME >> to use this standing order and procedure as prescribed.
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References
Adapt Pharma. (2017, February). NARCAN NASAL SPRAY Prescribing Information. Retrieved November 2, 2017, from https://www.narcan.com/pdf/NARCAN-Prescribing-Information.pdf
Colorado Department of Public Health and Environment. (2016, October). Naloxone Standing Orders. Retrieved November 2, 2017, from Harm Reduction Agency: https://www.colorado.gov/pacific/sites/default/files/PW_Naloxone-standing-orders-template_Harm-Reduction.pdf
Kaleo, Inc. (2016, October). Evzio Prescribing Information. Retrieved November 2, 2017, from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=5fbe8d17-a72f-406d-a736-48e61620f9d8&type=display
North Dakota Board of Pharmacy. (n.d.). Naloxone Prescription Sheet. Retrieved November 7, 2017, from https://www.nodakpharmacy.com/pdfs/naloxoneRx.pdf
State of North Dakota. (n.d.). North Dakota Century Code Chapter 23-01. Retrieved November 2, 2017, from State Department of Health: http://www.legis.nd.gov/cencode/t23c01.pdf
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