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June 10, 2016

NMDOH to Allow Registered Pharmacists to Dispense Naloxone

Presbyterian Health Plan, Inc. (Presbyterian) is committed to keeping you informed about requirements and

regulations that may affect your practice. This communication is to provide information regarding New

Mexico pharmacists prescribing, dispensing, and/or distributing naloxone, a medicine used to treat a

narcotics overdose in an emergency situation.

The New Mexico Department of Health (NMDOH) issued a statewide standing order to allow all New

Mexico registered Centennial Care pharmacists to dispense naloxone to individuals at risk of experiencing

an opioid overdose. Naloxone may be dispensed to anyone who uses an opioid regardless of how the opioid

is used or obtained, or anyone in a position to asses a person at risk of an opioid overdose.

Enclosed are informational documents from NMDOH regarding the standing order and dispensing

naloxone.

If you have any question, please contact your Provider Network Management relationship executive. You

can find their contact information at www.phs.org/ContactGuide.

Sincerely,

Louanne Cunico

Executive Director of Pharmacy

Presbyterian Health Plan

Enclosures: NMDOH Letter to Pharmacists, New Mexico Statewide Standing order for Naloxone, Naloxone

User Guide, Pharmacist Naloxone Dispensing Guide

Last Updated 03/10/2016 – BH NMDOH

Information on Opioid Safety and How to Use Naloxone Accidental opioid overdose death is preventable

What are opioids? Most opioids are narcotic pain relievers such as:

Oxycodone (PERCOCET®, OXYCONTIN®, ROXICET®, etc.)

Hydrocodone (VICODIN®, NORCO®, LORTAB®, etc.)

Oxymorphone (OPANA®, OPANA® ER)

Hydromorphone (DILAUDID®, EXALGO®, etc.)

Codeine (TYLENOL® #3)

Morphine (MS CONTIN®, KADIAN®, AVINZA®, etc.)

Fentanyl (DURAGESIC®)

Methadone (METHADOSE®)

Buprenorphine (SUBOXONE®, BUTRANS®, SUBUTEX®, ZUBSOLV®, etc.)

*Heroin is also an opioid drug.

What is an opioid overdose? Opioids, like all medications, can have

adverse reactions. Opioids can cause harmful and severe reactions that slow or even stop breathing. This can happen when a person ingests too much of the opioid medication or when a person mixes an opioid with another substance.

Because opioids slow or even stop breathing, opioid overdoses can be fatal.

How to prevent accidental overdose: Tell the pharmacist about all prescription and non-

prescription medications.

Do not mix opioids with alcohol, benzodiazepines (alprazolam, clonazepam, diazepam, etc.), or other drugs.

Do not take opioids more often or in higher quantities than prescribed.

Taking opioids after a period of abstinence may decrease tolerance and increase overdose risk.

Talk to the pharmacist about naloxone.

What is naloxone? Naloxone is a safe medication the reverses and blocks the effects of opioids and can be used to treat a

known or suspected opioid overdose.

Naloxone is easy to use. Ask the pharmacist how to use naloxone for an opioid overdose.

Naloxone only reverses the effects of opioids. It will not have an effect on an overdose caused by another substance (e.g. alcohol, benzodiazepines, stimulants, etc.).

Are there any adverse effects from naloxone? Naloxone may cause opioid withdrawal symptoms such as: nausea/vomiting, diarrhea, chills, sweating,

anxiety, and combativeness/disorientation. People who take opioids chronically are more likely to experience these effects.

Opioid overdose complications, such as brain damage or death from lack of oxygen, are more alarming than potential side effects from naloxone administration.

If naloxone is given to a person who has not taken opioids, it will not have any effect on that person.

Additional information: Naloxone is usually not self-administered. Tell others about the possible need to use naloxone, how to

use it, and where it’s kept in case of overdose.

Using expired naloxone will not hurt the individual but it may have lost some of its effectiveness. Keep naloxone in date and protect it from too much heat or cold.

See your doctor or pharmacist if you have questions or want additional information about opioid safety, naloxone, or opioid treatment programs.

Last Updated 03/10/2016 – BH NMDOH

Opioid Overdose and How to Use Naloxone How to recognize an opioid overdose:

Unresponsive or unconscious; will not wake up even when shaken.

Not breathing or breathing is slow and shallow.

Lips or fingernails are blue or grey. Skin is pale and clammy.

What to do in case of an overdose: 1. Call 911 as soon as possible and follow dispatcher instructions. 2. Administer naloxone. If no response in 3 minutes, give a second dose. 3. Follow dispatcher instructions for rescue breathing if appropriate. 4. Stay with the person until help arrives.

How to administer naloxone (follow instructions for the product you have): Intranasal naloxone: 1. Remove all colored caps. 2. Screw white cone on to syringe. 3. Gently screw naloxone vial into barrel of syringe. 4. Insert white cone into nostril; give a short, strong push on end of naloxone vial. Spray half of naloxone vial in each nostril.

5. If no reaction in 3 minutes, give a second dose.

Narcan®Nasal Spray (naloxone): 1. Open NARCAN®Nasal Spray and peel back tab to open. 2. Hold nasal spray with thumb on plunger and first and middle finger on either side of nozzle. 3. Insert nozzle into one nostril and press plunger firmly with thumb to give dose of NARCAN®. If no response after 3 minutes, open second NARCAN® and spray in other nostril. Evzio® Auto-injector: Follow audio instructions from purple and yellow Evzio® device. Place on thigh and inject 0.4 mL. Repeat after 3 minutes if no response.

Last Updated 03/18/2016 – BH NMDOH

Pharmacist Naloxone Dispensing Guide The New Mexico Department of Health has issued a statewide standing order allowing for all registered pharmacists in New Mexico to dispense naloxone to individuals at risk of experiencing or witnessing an opioid overdose. Expanding access to naloxone is a key component of opioid overdose prevention. As trusted and accessible health care professionals, pharmacists are in a unique position to educate individuals on opioid overdose and dispense naloxone when indicated.

I. Eligible Candidates for Naloxone

Naloxone may be dispensed to:

Anyone who uses an opioid regardless of how the opioid is used or obtained.

Anyone in a position to assist a person at risk of an opioid overdose.

Factors to consider that increase risk for overdose:

Using opioids for more than 3 months.

Using opioids and benzodiazepines simultaneously.

Being treated for opioid use disorder with buprenorphine or methadone.

History of opioid overdose.

Returning to opioid use after a period of abstinence.

Contraindications:

Known hypersensitivity to naloxone. Anaphylactic shock may occur in those allergic to naloxone or any of its components.

II. Dispensing Information

The following naloxone products may be dispensed to individuals eligible to receive naloxone: Product Selection and Labeling

Naloxone Product and Quantity: Dispense one of the three following naloxone products based on product availability and individual’s request.

Naloxone HCl Solution 1 mg/mL; 2 mL pre-filled Luer-Lock Syringe Dispense: 2 x 2 mL syringes (4 mL total) with two nasal mucosal atomization devices. Directions for use: Spray 1 mL (one-half of prefilled syringe) in each nostril. Repeat after 3 minutes if no response.

Narcan®Nasal Spray (naloxone HCl) 4 mg/0.1 mL Nasal Spray Dispense: 1 box containing two 4 mg/0.1 mL doses of naloxone Directions for use: Administer a single spray of Narcan® in one nostril. Repeat after 3 minutes if no response.

Evzio® (naloxone HCl) 0.4 mg/0.4 mL auto-injector Dispense: 1 box containing two auto-injectors Directions for use: Follow audio instructions from device. Place on thigh and inject 0.4 mL. Repeat after 3 minutes if no response.

Prescription Label Requirements: Prescriptions for naloxone should be labeled and processed in the same manner as all other prescriptions. Label must include: Name of recipient/person requesting naloxone, date dispensed, naloxone product and quantity, licensed prescriber name and information, directions for use (sig), and refills: PRN. Licensed Prescriber Information: Name: Michael Landen, MD, MPH Address: 1190 S St. Francis Dr., Ste. N1320, Santa Fe, NM 87505 NPI: 1811198732 License#: 97-297

Last Updated 03/18/2016 – BH NMDOH

III. Naloxone Products and Insurance Billing

Naloxone HCl Solution 1 mg/mL; 2 mL pre-filled LL Syringe – NDC 76329-3369-01 Narcan® (naloxone HCl) 4 mg/0.1 mL Nasal Spray – NDC 69547-0353-02 Evzio® (naloxone HCl) 0.4 mg/0.4 mL auto-injector – NDC 60842-0030-01 Mucosal atomization devices can be purchased from pharmacy, DME, and online vendors (e.g. HealthCare Logistics, major wholesalers, Amazon.com, etc.).

New Mexico Medicaid (Centennial) plans- Naloxone claims should adjudicate for reimbursement without prior authorization. Please see MCO billing information available on the NMPhA website: http://www.nmpharmacy.org/naloxone-resources Medicare Part D and other non-Medicaid plans- Currently some of these plans do cover naloxone products and the member pays a copay for the prescription. Help with naloxone prescription processing and dispensing is available. For more information or questions concerning naloxone billing and reimbursement, please contact: Kate Morton, PharmD, PhC Southwest CARE Center (505)989-8200 Ext 1077 kmorton@southwestcare.org

IV. Opioid Overdose and Naloxone Education

The pharmacist should be familiar with opioid overdose prevention, using opioid medications safely, and naloxone

administration instructions. Please use the following handout as a guide to educate and counsel individuals

receiving naloxone. Review the information with the individual and provide a written copy of the handout with each

naloxone product being dispensed.

User Guide - Information on Opioid Safety and How to Use Naloxone

Pharmacist training information: While current pharmacist naloxone training offered by NMPhA is not required to

dispense naloxone under the NMDOH standing order, pharmacists are highly encouraged to take advantage of the

valuable training programs NMPhA has to offer to further their education. NMPhA will be providing Naloxone

Continuing Pharmacy Education and will continue to offer the Pharmacist Certification for Prescribing Naloxone

training. Please see their website for further details.

V. Additional Resources

New Mexico Department of Health website: http://nmhealth.org New Mexico Pharmacists Association website: http://nmpharmacy.org Prescribe to Prevent website: http://prescribetoprevent.org Link to SB 262/HB 277 Administration of Opioid Antagonists: http://www.nmlegis.gov/Sessions/16%20Regular/final/SB0262.pdf

If you have any questions, please contact:

Brianna Harrand, PharmD Prescription Drug Overdose Prevention New Mexico Department of HEALTH (505)476-3541 Brianna.Harrand@state.nm.us