• Naloxone Prescribing Pharmacists
• Naloxone Prescribing Pharmacies (Map)

• Current CT Laws Related to naloxone (Narcan):

  • In 2019, Public Act 19-191: An Act Addressing Opioid Abuse was passed which included the following features:
    • Persons picking up prescriptions for themselves will be offered consultation with the pharmacist
    • Pharmacists may authorize a Pharmacy Technician to access the Connecticut Prescription Monitoring and Reporting System on their behalf
    • Drug manufacturers and wholesalers will notify DCP of suspicious drug orders for controlled substances (unusual size, frequency or pattern of ordering) and of potential diversion of controlled substances
    • A person cannot be denied life insurance solely because they received a prescription for naloxone (Narcan)
    • If a prescriber prescribes more than 12 weeks of opioids for pain, s/he will establish a treatment agreement with the patient or will discuss a care plan with the patient which is documented in the patient’s medical record and includes:
      • Treatment goals
      • Risks of opioid use
      • Urine drug screening
      • Non-opioid treatment options
      • Behaviors associated with continuing to prescribe or discontinuing the prescribing of opioids
    • By January 1, 2020, colleges/universities will develop naloxone policies that:
      • Identify a medical or public safety professional responsible for purchase, storage (per manufacturer’s guidelines) and distribution of naloxone on each campusIdentify location(s) of naloxone on each campus where students and staff can retrieve it
      • Require calling 911 by a college/university representative unless the person who overdosed has already received medical care
    • DMHAS will work with DSS and DPH to study the effectiveness of in-home treatment and recovery services for persons with opioid use disorder (OUD) by licensed substance use disorder treatment providers (specifically, home health agencies providing medication assisted treatment (MAT) to Medicaid recipients who went to the ED with an opioid overdose or OUD and are deemed at risk by an ED physician). DMHAS will report their findings by January 1, 2020.
    • Programs that detoxify or treat persons with OUD will educate clients about naloxone and its administration at admission or when the client first receives services. This education will also be provided to the client’s family or significant others if they are involved. If the program has prescriber services, at least one dose of naloxone or a prescription for naloxone will be provided to the client at the same time.
    • Hospitals must report to DPH when they treat an opioid overdose. By January 1, 2020, DPH will share this overdose data with local health departments based on the location of the overdose.
    • By January 1, 2020, hospitals will conduct a mental health screening or assessment on patients they treat for nonfatal opioid overdose and will share the results with the patient/legal guardian.
    • DMHAS will work with DPH and others to study the protocol for a Police Officer to detain a person with a suspected opioid overdose and the implications of involuntarily transporting a person with a suspected opioid overdose to the ED and referring them to a Recovery Coach to help them access recovery resources. DMHAS will report their findings by January 1, 2020.
      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.
  • 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. 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.
  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:
    
    • Develop a fact sheet describing the risks of opioids, symptoms of OUD, and services available in CT for persons with or affected by OUD to be posted on the DMHAS website: https://www.ct.gov/dmhas/lib/dmhas/prevention/opioid_factsheet.pdf
    • Look into what is now called the Change the Script Campaign: https://www.ct.gov/dmhas/cwp/view.asp?a=2912&q=600280
    • Look into an electronic single port of entry for information on detox, rehab, and outpatient treatment availability: https://www.ct.gov/dmhas/cwp/view.asp?q=599312
    • Look into disposal of a person’s opioid drugs upon their death, the result of which appears to clarify that medical professionals may provide direction to the decedents’ next of kin on how to dispose of the medications, but may not take possession of the medications themselves
    • Look into police department programs that refer people with OUD to substance use treatment programs: https://www.ct.gov/dmhas/lib/dmhas/adpc/022018_minutes.pdf
  • 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.
  • 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).
  • 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.
  • 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 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 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.

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.

• The Opioid Epidemic and Naloxone (Narcan) (PowerPoint)
• "Using Naloxone to Reverse an Opioid Overdose" - Video!
• How to Use Naloxone (Narcan) Brochure

Helpful Resources and Links

• 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

• 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)

• 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