The Opioid Crisis and Naloxone Pharmacy Access in the US
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The Opioid Crisis and Naloxone Pharmacy Access in the US

Tarik Brakta - Pharmacy Intern - KROGER PHARMACY | LinkedInTarik Barakta, PharmD Candidate 2023, Belmont University College of Pharmacy

August 2022, for more information please visit, and

Patients visit their community pharmacies about two times as often as they do with their own physician.1 Pharmacists are a major point of intervention for patients, and they can have a long-standing impact on their health. This translates into prescription consultations, immunizations, and complete medication reviews (CMR). As the prescription opioid epidemic increased in severity in the 2000s, pharmacists were one of the first of many health care professionals to realize the severity of the situation and were in an optimal position to reconcile.

In 2011, the opioid crisis reached astounding levels with over 21,000 deaths adding to the urgency of providing aid to those who most need it. This resulted in the establishment of the first naloxone collaborative drug therapy agreement in 2012. The collaborative drug therapy agreement allowed pharmacists to dispense naloxone without a prescription to high-risk patients that were in danger of overdosing. In due course, this rationale spread to all 50 states and the District of Columbia but under different legislative authority. The pharmacist’s prescription or dispensing authority on naloxone is determined by each individual state’s law on whether they can prescribe naloxone independently, dispense naloxone under a standing order, or under a Collaborative Practice Agreement (CPA).2,3

Naloxone Pharmacist Prescribing/Dispensing Authority 4

Statewide Protocol/Pharmacist Prescribing

Allows the pharmacist independent prescribing autonomy or the capability to dispense naloxone.

Statewide Standing Order

Allows for the pharmacists to dispense naloxone secondary to a blanket authorization from a state health officer

Dispense without a prescription

Allows a pharmacist to dispense to anyone without a prescription

Standing Order

Allows pharmacists to dispense under a blanket prescription authorization by either a healthcare provider with prescribing privileges or a state health officer. Naloxone can then be obtained at all pharmacies that are participating in the naloxone standing order


While all 50 states and the District of Columbia have passed laws that allow access to naloxone in pharmacies through either statewide protocol or standing order, there will be some differences according to the state in which you reside. Some states require pharmacies to enroll into their standing order, and others will require that their pharmacists be trained before they are able to have autonomy in prescribing naloxone. To better understand your states laws on obtaining Narcan/naloxone from a pharmacy, visit:,6 

Considerations for Naloxone Use

People eligible to receive naloxone

  • Using opioids regardless of whether they are obtained via prescription or not.

  • Anyone who is in a position to aid another patient who is taking opioids and is at risk of overdosing.

Factors that can increase a patient’s risk of overdosing

  • Chronic (longer than 3 months) use of opioids.

  • Using high dosage opioids

  • History of opioid overdose

  • Relapsing into opioid use

  • Concurrent use of opioids and other CNS depressants

Contraindications to naloxone

  • Known hypersensitivity reaction to naloxone that may present as anaphylaxis: (Hives, swelling of lips, tongue, throat or face, trouble breathing, low blood pressure, chest tightness, anxiety, dizziness, or confusion).


Naloxone was first approved by the FDA for treatment of opioid overdoses in 1971 and the Narcan  nasal spray was approved in 2015 by the FDA for the treatment of emergency overdoses. Naloxone can be given to anyone who is overdosing regardless of the age from infants to elders. This makes naloxone a great choice for children who overdose by accidently taking opioids. Currently there are two modes of administration: injection and nasal spray. In order to be an effective healthcare professional, it is the responsibility of all pharmacists to know how to administer naloxone. Below is an illustration with the proper steps required to administer naloxone from the San Francisco Department of Health.


The Dispensary of Hope is committed to serving and saving lives through the opioid crisis by providing access to medicine. Naloxone is currently available in our inventory and is a key medication to saving countless lives. Patients must meet eligibility requirements–uninsured and at or below 300% Federal Poverty Level (FPL)– to receive Dispensary of Hope medications.


  1. Valliant SN, Burbage SC, Pathak S, Urick BY. Pharmacists as accessible health care providers: quantifying the opportunity. J Manag Care Spec Pharm. 2022;28(1):85-90. doi: 10.18553/jmcp.2022.28.1.85

  2. Cutcliff A, Stringberg A, and Atkins C, As Naloxone Accessibility Increases, Pharmacist's Role Expands. Pharmacy Times. 2016.

  3. U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose. U.S. Department of Health & Human Services, Office of the Surgeon General. Updated April 8, 2022. Accessed August 3, 2022. 

  4. Characteristics of Statewide Naloxone Distribution Mechanisms. The Network for Public Health Law. Updated August 2020. Accessed August 3, 2022.

  5. Pharmacy Prescribing: Naloxone. NASPA. January 17, 2019. Updated March, 2022. Accessed August 3, 2022.

  6. State Naloxone Access Rules and Resources. SafeProject. Accessed August 3, 2022.

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