DMHAS: Naloxone

Opioid Overdose Prevention/Naloxone (Narcan) Initiative
 
For more information contact Susan Bouffard, Ph.D., 860-418-6993, susan.bouffard@ct.gov
Naloxone, also known as narcan, is a prescription medication that reverses opioid overdoses. It is a safe and easy to use medication that you can get from your doctor or a certified pharmacist. CT Medicaid and most commercial insurance cover naloxone, although there may be a co-pay or deductible.

All 50 states now have naloxone access laws designed to make the medication more available. It is impossible to abuse naloxone as its only job is to reverse opioid overdoses. Naloxone is only effective on opioids (heroin, OxyContin, Vicodin, fentanyl, etc.) Persons given naloxone who have not overdosed on opioids will not be harmed. Persons dependent on opioids who are given naloxone will experience opioid withdrawal. In any overdose situation, 9-1-1 should be called and naloxone should be administered if opioids are involved or suspected to have been involved.
 
Current CT Laws Related to Narcan:
  • In 2011, a “good Samaritan law” (Public Act 11-210) was passed in an attempt to address people’s unwillingness to call 911 for an overdose situation. This law protects people who call 911 seeking emergency medical services for an overdose from arrest for possession of drugs/paraphernalia. The law limits protection to this situation. It doesn’t protect someone from other charges or stop the police from serving a search or arrest warrant if that was already in process.
  • The 2012 Narcan law (Public Act 12-159) allows prescribers (physicians, surgeons, Physicians’ Assistants, APRNs, dentists, and podiatrists) to prescribe, dispense or administer Narcan to any person to prevent or treat a drug overdose and the prescriber is protected from civil liability and criminal prosecution.
  • In 2014, protection from civil liability and criminal prosecution was extended to the person administering the Narcan in response to an overdose (Public Act 14-61).
  • The 2015 legislation (PA 15-198) allows pharmacists who have been trained/certified to prescribe and dispense Narcan directly to customers requesting it. The pharmacist is required to educate the person on how to use the Narcan. The law also requires one hour of continuing education for physicians, PAs (Physicians’ Assistants), APRNs (Advanced Practice Registered Nurses) and Dentists in a risk management topic that includes prescribing controlled substances and pain management. Prescribers are required to check the electronic Connecticut Prescription Monitoring and Reporting System (CPMRS) before prescribing greater than a 72 hour supply of a controlled substance and, for those persons prescribed opiates long-term, at least every 90 days.
  • The 2016 legislation (Public Act 16-43) put a 7-day limit on all opioid prescribing for minors and for adults at their first outpatient visit, but exceptions could be made if documented by the prescriber. More real time data entry was required by pharmacies into the Connecticut Prescription Monitoring and Reporting System (CPMRS) for controlled substances dispensed. Veterinarians are now required to submit information weekly to the CPMRS if issuing controlled substance prescriptions. To make it easier for prescribers to check the CPMRS as required by previous legislation, the range of authorized agents who can check on their behalf was broadened. Insurers were prohibited from requiring pre-authorization for the opioid overdose antidote naloxone (Narcan).
  • Legislation passed in 2017 (Public Act 17-131) entitled An Act Preventing Opioid Diversion and Abuse modified earlier legislation and added some new items. Highlights are below:
    • DCP can share CPMRS data with other state agencies under certain conditions
    • Additional strategies to reduce diversion of controlled substances include Nursing Homes and Outpatient Surgery Centers being allowed to dispose of excess controlled substances if 2 or more leadership staff do it together and Home Health Care Agency RNs may destroy/dispose of controlled substances  with the permission of the patient’s designated representative
    • Controlled substance prescriptions must be electronically transmitted from the prescriber to the pharmacy with a few exceptions such as emergencies, technological/electrical lack or loss, and potential negative impacts on patient care
    • Persons who don’t want to be given opioids can complete a Voluntary Non-Opioid Directive Form available from DPH: https://portal.ct.gov/DPH/Health-Education-Management--Surveillance/The-Office-of-Injury-Prevention/Opioids-and-Prescription-Drug-Overdose-Prevention-Program. The VNOD form must be filed with the prescriber. The VNOD form allows the patient to appoint another person to speak on their behalf who can override the form. The patient or their appointee may revoke the form at any time verbally or in writing. 
    • The previously established 7-day opioid prescribing limit for minors is reduced to 5-days and the prescriber must discuss the reason the opioid is being prescribed and the risks of addiction, overdose, and combining opioids with benzodiazepines with the patient and their caregiver, if the caregiver is present.
    • DPH has posted on their website information about how a prescriber can become certified to prescribe take-home medication to treat persons with Opioid Use Disorder (OUD): https://portal.ct.gov/en/DPH/Health-Education-Management--Surveillance/The-Office-of-Injury-Prevention/Prescription-Drug-Overdose-and-the-Role-of-Health-Care-Providers
    • The Alcohol and Drug Policy Council (ADPC) will:
    • Insurance companies covering persons with substance use disorders are required to cover medically necessary inpatient detox services
    • Each municipality will have at least one EMS provider equipped with and trained on naloxone
    • Standing orders can be established between prescribers and pharmacies so that pharmacists can dispense naloxone. The pharmacist in this agreement has to be certified to prescribe naloxone.
  • In 2018, legislation entitled An Act Concerning the Prevention and Treatment of Opioid Dependency and Opioid Overdoses in the State (PA 18-166) was passed and following are highlights:
    • The feasibility of drug courts will be studied
    • Persons who have leftover unused/unwanted controlled substances from their prescriber may return them to the prescriber or the DCP Commissioner
    • In an emergency and when no other prescriber is available, prescribers can prescribe, dispense or administer up to 72 hours of a controlled substance to themselves, their family members, and to other relatives residing in their  household
    • Agreements between prescribers and organizations interested in training/distributing naloxone can be established. Staff who will conduct the training/distribution of naloxone must first be trained. The agreement must include: storage, handling, labeling, recalls and record keeping of the naloxone.
    • The ADPC will create a workgroup to investigate a variety of other strategies for responding to the opioid crisis and will report back by January 1, 2019.
    • Hospitals and EMS staff responding to an opioid overdose will report overdose data to DPH and, by January 1, 2020, DPH will report this data back to the respective health departments where the overdoses occurred
    • By January 15, 2019, the Department of Correction (DOC) will review the pilot program that provides medication assisted treatment (e.g., methadone) to inmates and  will report on a plan for expanding the program, including related costs, and the feasibility of incorporating treatment of OUD in their system
    • DOC will determine if federal funds are available to expand medication assisted treatment to inmates in correctional facilities. If federal funds are available, DOC will expand the program by adding correctional facilities, inmates, and/or other medications (e.g., buprenorphine) to the program and will report by January 1, 2020 on availability of funds and expansion plans.
Naloxone (Narcan) Providers in your area

Pharmacists who have been trained and certified are now able to prescribe and dispense naloxone/Narcan to you from a pharmacy. A list of naloxone prescribing pharmacists in Connecticut is available by clicking this link. In addition to certified pharmacists, Connecticut law allows other prescribers, including physicians, surgeons, Physician Assistants (PAs), Advanced Practice Registered Nurses (APRNs), and Dentists to prescribe, dispense and/or administer the medication.     

 

Training materials:  Any of the following materials can be printed. For convenience, the one-page two-sided brochure listed below contains information for identifying and responding to an opioid overdose with naloxone.

Helpful Resources and Links


 
Frequently Asked Questions
 

What are the risks associated with naloxone (Narcan) use?

Naloxone (Narcan) is a safe prescription medication. Its sole purpose is to reverse an opioid overdose. Unless a person is known to be allergic to naloxone (Narcan), it is safe to administer.

 

How quickly does naloxone (Narcan) work?

Properly administered, naloxone (Narcan) usually works within 2 – 5 minutes. If there is no response during this time, a second dose should be administered.

 

Who in the state of CT is authorized to prescribe naloxone (Narcan)?

In CT, authorized prescribers are physicians, surgeons, PAs, APRNs, dentists, podiatrists and, with the 2015 legislation, Pharmacists who have been trained and certified.

 

Where can I go for training and a prescription kit?

Any pharmacist who has been trained and certified can prescribe and dispense naloxone (Narcan). The pharmacist will educate the person requesting the naloxone (Narcan) on its use. Additionally, your primary care provider (physicians, surgeons, PAs, APRNs, dentists, and podiatrists) would be able to prescribe naloxone (Narcan) to you. Many programs providing treatment for substance use also have mechanisms in place to provide education and access (through prescriptions or kits) to naloxone (Narcan). You may also check the map of pharmacies with pharmacists approved to prescribe naloxone on the Department of Consumer Protection's website.

 

Will I be arrested if I call 911 when there’s been an overdose?

Public Act 11-210 An Act Concerning Emergency Medical Assistance for Persons Experiencing an Overdose and the Designation of Certain Synthetic Stimulants as Controlled Substances concerns consequences for possession of different substances, but makes an exception in section g, for persons who in good faith seek medical assistance for a person that they reasonably believe is overdosing. Consequently, you should be protected from arrest by this “Good Samaritan” law.

 

What do I do if I come across someone who has overdosed?

If someone you are close to uses opiates, you could, in fact, find yourself in this situation. The first step is to determine whether the person has overdosed on Opioids. Look for the following signs:

  • Person is unresponsive or limp
  • Person is awake but unable to talk
  • Their breathing is slow or erratic or they are not breathing
  • Their pulse is slow or erratic or they have no pulse
  • Their skin is pale gray or blue, especially around the fingernails and lips
  • They are making deep, slow snoring, choking or gurgling sounds
  • They are vomiting
If you cannot wake or get a response from the person, call 911. If they aren’t breathing, start “Rescue Breathing” by moving them onto their back, tilting their head back and lifting their chin, and giving them 2 normal breaths. Give one breath every 5 seconds after this until they begin breathing on their own or help arrives. If you have a naloxone (Narcan) kit, have someone bring it to you and administer the naloxone (Narcan). If you have to leave the person for any reason, put them into the “Recovery Position” by rolling them onto their side so that they won’t choke if they begin vomiting.
 
How does naloxone (Narcan) work?
In the brain, naloxone (Narcan) competes with the opioids the person used for the same receptor sites. Since naloxone (Narcan) has a greater affinity for the binding sites, the opioids the person used are replaced by the naloxone (Narcan) which reverses the overdose effects of the opioids.
 
What increases/decreases risk of an opioid overdose?
These factors increase risk of an opioid overdose:
  • Using too much (because you haven’t used that amount before or because it was stronger than what you are used to, or because your tolerance decreased while you weren’t using or were in a detox/program/jail/hospital)
  • Using alone
  • Mixing opiates with alcohol, pills or cocaine
  • Other health issues (Hepatitis, HIV, infections, malnutrition/dehydration, liver disease, kidney disease, heart disease or respiratory disease, asthma, sleep apnea, etc.)
  • Previous overdose
  • Mode of administration (Smoking and IV use are riskier)
  • Age (older people and those with longer histories of drug use are more likely to die as a result of an overdose)
These factors decrease risk of an opioid overdose:
  • Using a consistent source/supplier
  • Testing a small amount first
  • Using a less rapid mode of administration (snorting)
  • Using with someone else
  • Using less if you haven’t used in some time, for any reason
  • Not letting anyone else prepare your drugs for you
What are commonly used opioids?
Heroin, Oxycontin, fentanyl, morphine, Vicodin, and Percocet. Methadone is also an opioid.
 
Can a person overdose on a prescription opioid?
Certainly a person can overdose on any opioid, regardless of whether it is a prescription medication or not.
 
Where can a person go for treatment of an addiction?
People who need treatment for an addiction have a number of choices. If they have insurance, they should call the number on the insurance card for a referral. Those who don’t have insurance or who have a program like Husky or Medicaid LIA should check the DMHAS website for a list of programs. All programs receiving funding from DMHAS must take some clients without insurance. Also, some programs are designed to treat individuals without insurance (like Blue Hills and CVH Merritt Hall).  Programs range from detox to outpatient to inpatient. Most programs should begin by asking you about your substance use so they can try to match you to the level of care that best meets your needs. DMHAS has a 1-800 number for persons struggling with opioids who want to be connected to services: 1-800-563-4086.
 
Are all overdoses the same?
All overdoses are not the same. An overdose on a stimulant like Cocaine would potentially have some of the same signs like difficulty breathing, vomiting and loss of consciousness, but unlike an opioid overdose, might also have: chest pain, dizziness, foaming at the mouth, lots of sweating or no sweating, racing pulse and seizures.  naloxone (Narcan) will not work on a cocaine overdose and there is no comparable naloxone (Narcan)-like medication to reverse it.
 
Where do I store the naloxone (Narcan)?
Naloxone (Narcan) should be stored at room temperature (neither too hot nor too cold) and should be kept out of sunlight; but not in the refrigerator.
 
What is an overdose “kit”?
Overdose kits are a handy way to be prepared by having everything needed in one place. A container of some sort is necessary to keep all the pieces together. The kit should include 2 doses of naloxone (Narcan), 2 alcohol wipes for cleaning the injection site, a pair of gloves, and a set of instructions. Some kits include other items, such as a Rescue Breathing mask.
 
Who do I call if I use my prescription or if my naloxone (Narcan) expires and I need a refill?
Prescriptions for naloxone (Narcan) are generally written in multiples of two, because of the possibility that the first dose may not work and a second dose may need to be given. Prescribers will vary in terms of how many refills they will be willing to write. Those individuals currently in a program should be able to get refills where they are receiving services. They could also ask their primary care physician. This website also has a list of providers who can write prescription refills.
 
Should I report if I use the naloxone (Narcan) and reverse the overdose?
If you reverse an opioid overdose, congratulations! You can report this good news to the agency where the naloxone (Narcan) was prescribed and/or email susan.bouffard@ct.gov.
 
Will insurance cover the cost of the naloxone (Narcan)?
Insurance may very well cover the cost of the prescription. You can check with your insurance company. If you have Husky C or Medicaid LIA, the cost is covered by these plans.
 
Will naloxone (Narcan) work if the person overdosed on something other than an opioid
Naloxone (Narcan) will only work to reverse the effects of opioids.
 
Will the person who recovers from an overdose be violent?
People who overdose generally don’t realize what has happened to them. They just come out of it feeling sick. They may misinterpret the situation to think that someone took their drugs and be agitated or upset. The best thing to do is to explain what happened.
 
Can a person re-overdose after the naloxone (Narcan) has been given?
Yes, depending on how much the person used. The naloxone (Narcan) lasts for about 30 – 90 minutes, so it is possible that at the end of that time, the person could re-overdose. The other possibility is that the person will want to use more drugs now that they are feeling sick after the naloxone (Narcan). Under no circumstances should they do this as it will increase the chances of re-overdosing.

My family doctor won’t prescribe me naloxone (Narcan). What are my options? 
Sometimes doctors aren’t familiar with naloxone (Narcan) or are unwilling to prescribe it. You can still obtain naloxone by going to one of the pharmacies in the state with a pharmacist who has been trained/certified to prescribe and dispense it. Just click on the Naloxone Prescribing Pharmacists link. The list is organized in alphabetical order by name of pharmacy. If you click the tab across the top of the page labeled “more views”, you can access a map with each red dot identifying a pharmacy in that location. If you click on the red dots near your location, you can see which pharmacies in your area have pharmacists willing to prescribe and dispense it to you. Most insurance will cover naloxone, although a co-pay or deductible may apply. The pharmacist will educate you on how to use the Narcan.

What is fentanyl?
Fentanyl is both an opioid medication that can be prescribed to treat pain (it can be prescribed as a transdermal patch worn on the skin) and an illicitly manufactured opioid that can be created in a lab similar to how methamphetamine is created in “meth labs”. It’s the illicitly manufactured fentanyl that is playing a significant role in the current opioid epidemic. Fentanyl and its many analogues are dangerous because they are much stronger than heroin and can be pressed into pills and passed off as other medications or mixed into heroin without the user’s knowledge. Many overdoses now involve fentanyl or fentanyl analogues.
 




Content Last Modified on 9/19/2018 9:24:51 AM