The Board of Pharmacy Newsletter explains legislative updates regarding naloxone (including the standing order), as well as detailed information on dispensing naloxone.

What is naloxone?

Naloxone is a competitive antagonist at opioid receptor sites with a primary purpose of reversing respiratory depression and death associated with an overdose. It has been used by EMS and emergency department clinicians for over 40 years to save patient lives. The antidote is highly effective at reversing an overdose of heroin as well as prescription opioids, but it must be administered within minutes of an overdose.

Naloxone for take home

Naloxone should not just be in hospitals and ambulances — it should be in homes and other settings where overdoses occur. It is essential that ALL patients who are at risk of experiencing or witnessing an opioid overdose have access to naloxone.

Naloxone for take home use is most commonly prescribed and/or dispensed as a nasal spray or intramuscular (IM) device. Missouri Medicaid currently provides coverage for the naloxone nasal spray as well as generic IM naloxone vials.

As of August 28th, 2017, all Missouri pharmacies can dispense naloxone under a statewide standing order to any patient without an outside prescription. Physician protocols are no longer needed.

Dispensing Naloxone in Missouri Using Statewide Protocol

  1. Review laws on Missouri Board of Pharmacy website regarding the naloxone standing order.
  2. Fill the prescription for the person requesting the naloxone and use the physician name from the statewide protocol (Dr. Randall Williams).
  3. Document all sales, including: transaction, date, product name/strength/dosage form, quantity and name of the person, if known. If unknown, document “John/Jane Doe”

**Note: If a prescription for naloxone is brought in, it should be filled per standard prescription regulations NOT according to the statewide protocol procedures. **

For additional information on how to implement the naloxone standing order at your pharmacy, see the regulations at:

  • Counseling Guide
    • Pharmacists should counsel recipients about overdose and naloxone. A summary document including a guide to naloxone administration should be provided.
    • Things to note when discussing naloxone:
      • According to Missouri’s standing order, anyone who requests naloxone at a pharmacy can receive it.
      • Patients will vary in their knowledge about their risk, the medication, and overdose response protocols — be sure they feel prepared to use the naloxone device before leaving the pharmacy. It is very simple – a little instruction goes a long way.
      • Patients may be self-conscious when requesting or discussing naloxone. Choosing non offensive language will help (e.g., say “person who uses opioids” instead of “addict” or “junkie”).

For printable patient education handouts created by the Missouri State Targeted Response to the Opioid Crisis (Opioid STR) grant, click here. To receive FREE expert pharmacy training on overdose education and naloxone dispensing for your staff through STR, contact:

                              Lauren Green
                              Overdose Prevention Coordinator
                              Missouri Institute of Mental Health

Additional Resources