Implementing a Naloxone Protocol

There are naloxone programs in law enforcement that can serve as best-practice examples of these programs in the U.S.

If you or your department has determined that it may be useful to implement a naloxone protocol, there are a number of things to consider:

  • Who will coordinate with the stakeholders involved
  • Who will create and manage the new policies, inventories, and training requirements

However, the process is not as challenging as it may seem. Other programs that have been successful have models and resources you can turn to.

Establish a state-based policy:
All Law Enforcement (LE) officers receive naloxone and training on its use

Deployment Personnel:

  • Front Desk Personnel/Booking area
  • Each patrol car and K-9 Unit (sworn officers)
  • Drug Control Unit
  • Law Enforcement Department Commander Office

Establish Training

Additional Resources – NCHRC.org/law-enforcement

  • Initial training content
  • Continuing education content
    • Enduring and online
Establish centralized naloxone coordinator
Acquire naloxone from affiliated county emergency medical services (EMS) (also consider centralized ordering with optional documented and complimentary shipping) via NARCANDirect.com
Establish physician standing order for LE departments for direct ordering or utilize state naloxone standing order.
See NARCANDirect.com
Establish maintenance/replacement and documentation protocols
Establish centralized naloxone coordinator
Acquire naloxone from affiliated county emergency medical services (EMS) (also consider centralized ordering with optional documented and complimentary shipping) via NARCANDirect.com

Establish Training

Additional Resources – NCHRC.org/law-enforcement

  • Initial training content
  • Continuing education content
    • Enduring and online
Establish physician standing order for LE departments for direct ordering or utilize state naloxone standing order.
See NARCANDirect.com
Establish maintenance/replacement and documentation protocols

The Bureau of Justice Assistance (BJA) National Training and Technical Assistance Center (NTTAC) has established a law enforcement naloxone toolkit as a clearinghouse of resources to support law enforcement agencies in establishing a naloxone program.

You can access the toolkit at the BJA NTTAC website.

Ultimately, a naloxone program can be set up in just a few weeks.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has prepared a downloadable resource for first responders and others to prepare for naloxone distribution.

Click here for the SAMHSA resource.

There are naloxone programs in law enforcement that can serve as best-practice examples of these programs in the U.S.

One such example is the North Carolina Harm Reduction Coalition (NCHRC), which you can learn more about by visiting its website.

According to the NCHRC, since its Overdose Prevention Project became operational on August 1, 2013, it has dispensed over 69,000 free overdose rescue kits that include naloxone, and has received 11,000 confirmed reports that the medication was administered successfully by lay individuals.

Another example is the Police Assisted Addiction and Recovery Initiative in Gloucester, MA. Visit the website at www.paariusa.org.

For qualifying group purchasers

All first responders (EMS, Fire Department, and Police) may now purchase NARCAN® Nasal Spray as a qualified group purchase, at a 40% discount off the Wholesale Acquisition Cost (WAC) of $125 per carton.

  • $37.50 per 4 mg dose ($75 per carton of 2 doses)

If you would like to make a group qualified purchase, call 1-844-4NARCAN (1-844-462-7226) or click here.

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INDICATION AND IMPORTANT SAFETY INFORMATION

WHAT IS NARCAN® NASAL SPRAY?

  • NARCAN® Nasal Spray is a prescription medicine used for the treatment of a known or suspected opioid overdose emergency with signs of breathing problems and severe sleepiness or not being able to respond.
  • NARCAN® Nasal Spray is to be given right away and does not take the place of emergency medical care. Get emergency medical help right away after giving the first dose of NARCAN® Nasal Spray, even if the person wakes up.

NARCAN® Nasal Spray is safe and effective in children for known or suspected opioid overdose.

IMPORTANT SAFETY INFORMATION

Who should not use NARCAN® Nasal Spray?

Do not use NARCAN® Nasal Spray if you are allergic to naloxone hydrochloride or any of the ingredients in NARCAN® Nasal Spray.

What is the most important information I should know about NARCAN® Nasal Spray?
NARCAN® Nasal Spray is used to temporarily reverse the effects of opioid medicines. The medicine in NARCAN® Nasal Spray has no effect in people who are not taking opioid medicines. Always carry NARCAN® Nasal Spray with you in case of an opioid overdose.

  • Use NARCAN® Nasal Spray right away if you or your caregiver think signs or symptoms of an opioid overdose are present, even if you are not sure, because an opioid overdose can cause severe injury or death. Signs and symptoms of an opioid overdose may include:
    • unusual sleepiness and you are not able to awaken the person with a loud voice or by rubbing firmly on the middle of their chest (sternum)
    • breathing problems including slow or shallow breathing in someone difficult to awaken or who looks like they are not breathing
    • the black circle in the center of the colored part of the eye (pupil) is very small, sometimes called "pinpoint pupils," in someone difficult to awaken
  • Family members, caregivers, or other people who may have to use NARCAN® Nasal Spray in an opioid overdose should know where NARCAN® Nasal Spray is stored and how to give NARCAN® Nasal Spray before an opioid overdose happens.
  • Get emergency medical help right away after giving the first dose of NARCAN® Nasal Spray. Rescue breathing or CPR (cardiopulmonary resuscitation) may be given while waiting for emergency medical help.
  • The signs and symptoms of an opioid overdose can return after NARCAN® Nasal Spray is given. If this happens, give another dose after 2 to 3 minutes using a new NARCAN® Nasal Spray device and watch the person closely until emergency help is received.

What should I tell my healthcare provider before using NARCAN® Nasal Spray?
Before using NARCAN® Nasal Spray, tell your healthcare provider about all of your medical conditions, including if you:

  • have heart problems
  • are pregnant or plan to become pregnant. Use of NARCAN® Nasal Spray may cause withdrawal symptoms in your unborn baby. Your unborn baby should be examined by a healthcare provider right away after you use NARCAN® Nasal Spray.
  • are breastfeeding or plan to breastfeed. It is not known if NARCAN® Nasal Spray passes into your breast milk.
Tell your healthcare provider about the medicines you take, including prescription and over-the-counter medicines, drugs, vitamins, and herbal supplements.

What are the possible side effects of NARCAN® Nasal Spray?
NARCAN® Nasal Spray may cause serious side effects, including:
Sudden opioid withdrawal symptoms which can be severe. In someone who has been using opioids regularly, opioid withdrawal symptoms can happen suddenly after receiving NARCAN® Nasal Spray and may include:

  • body aches
  • diarrhea
  • increased heart rate
  • fever
  • runny nose
  • sneezing
  • goose bumps
  • sweating
  • yawning
  • nausea or vomiting
  • nervousness
  • restlessness or irritability
  • shivering or trembling
  • stomach cramping
  • weakness
  • increased blood pressure

Some patients may show aggressive behavior upon abrupt reversal of an opioid overdose.

In infants under 4 weeks old who have been receiving opioids regularly, sudden opioid withdrawal may be life-threatening if not treated the right way. Signs and symptoms include: seizures, crying more than usual, and increased reflexes.

These are not all of the possible side effects of NARCAN® Nasal Spray. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

NNS CON ISI 08/2020

Please see full Prescribing Information.

References: 1. Vital signs—Prescription painkiller overdoses in the US. Centers for Disease Control and Prevention website. https://www.cdc.gov/vitalsigns/painkilleroverdoses/index.html. Accessed April 13, 2020. 2. Opioid overdose. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/index.html. Accessed April 13, 2020. 3. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. 4. Bratberg JP. Opioids, naloxone, and beyond: The intersection of medication safety, public health, and pharmacy. J Am Pharm Assoc. 2017;57:S5-S7. 5. NARCAN® Nasal Spray [prescribing information]. Plymouth Meeting, PA: ADAPT Pharma, Inc.; 2020. 6. Mell HK, Mumma SN, Hiestand B. Emergency medical services response times in rural, suburban, and urban areas. JAMA Surg. 2017;152(10):983-984. 7. Coffin PO, Behar E, Rowe C, et al. Nonrandomized intervention study of naloxone coprescription for primary care patients receiving long-term opioid therapy for pain. Ann Intern Med. 2016;165(4):245-252. 8. San Francisco Department of Public Health. Naloxone for opioid safety: a provider’s guide to prescribing naloxone to patients who use opioids. January 2015. https://prescribetoprevent.org/wp2015/wp-content/uploads/CA.Detailing_Provider_final.pdf. Accessed April 13, 2020. 9. Management of substance abuse: information sheet on opioid overdose. World Health Organization website. http://www.who.int/substance_abuse/information-sheet/en. Updated August 2018. Accessed April 13, 2020. 10. Calculating total daily dose of opioids for safer dosage. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed April 13, 2020.

INDICATION AND IMPORTANT SAFETY INFORMATION

WHAT IS NARCAN® NASAL SPRAY?

  • NARCAN® Nasal Spray is a prescription medicine used for the treatment of a known or suspected opioid overdose emergency with signs of breathing problems and severe sleepiness or not being able to respond.
  • NARCAN® Nasal Spray is to be given right away and does not take the place of emergency medical care. Get emergency medical help right away after giving the first dose of NARCAN® Nasal Spray, even if the person wakes up.

NARCAN® Nasal Spray is safe and effective in children for known or suspected opioid overdose.

IMPORTANT SAFETY INFORMATION

Who should not use NARCAN® Nasal Spray?

Do not use NARCAN® Nasal Spray if you are allergic to naloxone hydrochloride or any of the ingredients in NARCAN® Nasal Spray.

What is the most important information I should know about NARCAN® Nasal Spray?
NARCAN® Nasal Spray is used to temporarily reverse the effects of opioid medicines. The medicine in NARCAN® Nasal Spray has no effect in people who are not taking opioid medicines. Always carry NARCAN® Nasal Spray with you in case of an opioid overdose.

  • Use NARCAN® Nasal Spray right away if you or your caregiver think signs or symptoms of an opioid overdose are present, even if you are not sure, because an opioid overdose can cause severe injury or death. Signs and symptoms of an opioid overdose may include:
    • unusual sleepiness and you are not able to awaken the person with a loud voice or by rubbing firmly on the middle of their chest (sternum)
    • breathing problems including slow or shallow breathing in someone difficult to awaken or who looks like they are not breathing
    • the black circle in the center of the colored part of the eye (pupil) is very small, sometimes called "pinpoint pupils," in someone difficult to awaken
  • Family members, caregivers, or other people who may have to use NARCAN® Nasal Spray in an opioid overdose should know where NARCAN® Nasal Spray is stored and how to give NARCAN® Nasal Spray before an opioid overdose happens.
  • Get emergency medical help right away after giving the first dose of NARCAN® Nasal Spray. Rescue breathing or CPR (cardiopulmonary resuscitation) may be given while waiting for emergency medical help.
  • The signs and symptoms of an opioid overdose can return after NARCAN® Nasal Spray is given. If this happens, give another dose after 2 to 3 minutes using a new NARCAN® Nasal Spray device and watch the person closely until emergency help is received.

What should I tell my healthcare provider before using NARCAN® Nasal Spray?
Before using NARCAN® Nasal Spray, tell your healthcare provider about all of your medical conditions, including if you:

  • have heart problems
  • are pregnant or plan to become pregnant. Use of NARCAN® Nasal Spray may cause withdrawal symptoms in your unborn baby. Your unborn baby should be examined by a healthcare provider right away after you use NARCAN® Nasal Spray.
  • are breastfeeding or plan to breastfeed. It is not known if NARCAN® Nasal Spray passes into your breast milk.
Tell your healthcare provider about the medicines you take, including prescription and over-the-counter medicines, drugs, vitamins, and herbal supplements.

What are the possible side effects of NARCAN® Nasal Spray?
NARCAN® Nasal Spray may cause serious side effects, including:
Sudden opioid withdrawal symptoms which can be severe. In someone who has been using opioids regularly, opioid withdrawal symptoms can happen suddenly after receiving NARCAN® Nasal Spray and may include:

  • body aches
  • diarrhea
  • increased heart rate
  • fever
  • runny nose
  • sneezing
  • goose bumps
  • sweating
  • yawning
  • nausea or vomiting
  • nervousness
  • restlessness or irritability
  • shivering or trembling
  • stomach cramping
  • weakness
  • increased blood pressure

Some patients may show aggressive behavior upon abrupt reversal of an opioid overdose.

In infants under 4 weeks old who have been receiving opioids regularly, sudden opioid withdrawal may be life-threatening if not treated the right way. Signs and symptoms include: seizures, crying more than usual, and increased reflexes.

These are not all of the possible side effects of NARCAN® Nasal Spray. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

NNS CON ISI 08/2020

Please see full Prescribing Information.

References: 1. Vital signs—Prescription painkiller overdoses in the US. Centers for Disease Control and Prevention website. https://www.cdc.gov/vitalsigns/painkilleroverdoses/index.html. Accessed April 13, 2020. 2. Opioid overdose. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/index.html. Accessed April 13, 2020. 3. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. 4. Bratberg JP. Opioids, naloxone, and beyond: The intersection of medication safety, public health, and pharmacy. J Am Pharm Assoc. 2017;57:S5-S7. 5. NARCAN® Nasal Spray [prescribing information]. Plymouth Meeting, PA: ADAPT Pharma, Inc.; 2020. 6. Mell HK, Mumma SN, Hiestand B. Emergency medical services response times in rural, suburban, and urban areas. JAMA Surg. 2017;152(10):983-984. 7. Coffin PO, Behar E, Rowe C, et al. Nonrandomized intervention study of naloxone coprescription for primary care patients receiving long-term opioid therapy for pain. Ann Intern Med. 2016;165(4):245-252. 8. San Francisco Department of Public Health. Naloxone for opioid safety: a provider’s guide to prescribing naloxone to patients who use opioids. January 2015. https://prescribetoprevent.org/wp2015/wp-content/uploads/CA.Detailing_Provider_final.pdf. Accessed April 13, 2020. 9. Management of substance abuse: information sheet on opioid overdose. World Health Organization website. http://www.who.int/substance_abuse/information-sheet/en. Updated August 2018. Accessed April 13, 2020. 10. Calculating total daily dose of opioids for safer dosage. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed April 13, 2020.