Naloxone Education, Training, Certification and Dispensing
Andrea Mathias MD MPH
Deputy Health Officer
Worcester County Health Department
High Risk for Opioid Death
Doctor Shoppers
PolyPharmacy
Low-income and living in rural areas.
Medicaid : 2X rate of Rx painkillers
6X the risk of Rx painkillers overdose.
People with mental illness, a history of substance abuse.
White, female (NEW)
**Youth : accidental combinations**
Naloxone Harm Reduction Program
1. GOAL: (Like Epi-Pens): place rescue dose in
proximity to opioid user- as bridge to EMS (Caregiver, family , layperson=First responder)
2. As of 2010, there were 48 known programs in the United States , 188 community-based sites in 15 states and Washington, DC
3. Since 2004, the Baltimore City Health Department’s Staying Alive Drug Overdose Prevention and Response Program has trained more than 3,000
4. NC: Project Lazarus
Maryland’s Naloxone Law
1. Certificate and Training Entity
2. Self Identified Applicant for Training
3. Third Party Prescriber
4. A Dispensing Source
5. Reporting Requirements
6. Liability Issues
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Health-General Article,
Title 13, Subtitle 31,
Annotated Code of Maryland
Sections 13-3101 – 3109
Code of Maryland Regulations,
Title 10, Subtitle 17, Chapter 08,
Regulations .01-.11
Training/ Certifying Entity
The Department of Health and Mental Hygiene (the Department) may authorize private or public entities, including local health departments, HG §13-3101, to issue and renew certificates and conduct educational training programs. HG §13-3102(b)(2) & (b)(3).
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Eligible for Training & Certificate
Is at least 18 years old. HG §13–3104(b). Expects to have, as a result of his/her occupation
or volunteer work or family or social experience, the ability to assist an individual who is experiencing an opioid overdose. HG §13–3104(c); COMAR 10.47.08.05.B.(2).
Successfully completes an educational training program offered by an authorized entity. HG §13–3104(d)(1). Submits a completed application to the authorized entity on the form that the Department requires. HG §13–3105; COMAR 10.47.08.05.
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Obtaining a Prescription & Naloxone • Qualified trainees are entitled to receive a certificate.
• Show your certificate to get a prescription for naloxone from a physician or nurse practitioner (NP).
• A certificate is NOT a prescription
• Naloxone & delivery devices may be dispensed from:
• A pharmacy that stocks or can order naloxone
• An authorized training entity that dispenses naloxone
• A qualified health care provider, including:
• A physician or NP in private practice or at local health department
• A registered nurse (RN) at local health department with approval for nurse dispensing of naloxone.
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Third Party Prescribing & Dispensing
Physicians who prescribe and dispense naloxone in accordance with authorized entity protocols may not be subject to disciplinary action by the Maryland Board of Physicians solely for the act of dispensing (or prescribing) naloxone.
HG §13-3109. Physician dispensing is otherwise governed by Heath Occupations (HO) §12-102 and COMAR 10.13.01-.05.
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Certificate Holder’s Responsibilities
Certificates are valid for two years. Apply for renewal no later than 90 days before your certificate expires.
An entity may charge you a reasonable fee to replace a lost certificate; keep it in a safe place.
Administer naloxone in accordance with training procedures.
Make a good faith effort to get emergency medical help for the person experiencing an opioid overdose.
Please remember to contact the Poison Center or training entity after administering naloxone.
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DHMH May Suspend or Revoke a Certificate If:
A certificate holder improperly uses or administers naloxone, or DHMH determines it’s necessary in order to protect public health or safety.
The training entity doesn’t meet DHMH requirements or has issued someone an invalid certificate.
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Opioid user has a Prescriber Relationship?
No Yes
Certificate Holder (caregiver) Training taken at Worcester County Health Department
Narcan RX given by Health Department MD in Certificate
Holder’s Name
Pt Receives Narcan Prescription from own
Provider
Narcan Kit dispensed to Certificate Holder
Insurance Covers Narcan dispensed in Patient’s name from Pharmacy
Voucher for Narcan Kit
Screen HIGH RISK Patients
LOOK for med interactions – PDMP (Rx)or OTC-
Ask about mixed drugs to potentiate drug of choice
WARN of potential for accidental overdose with opioids when other medications are added, or switching opioid forms.
Offer addictions treatment programs, Naloxone training for family, caregivers at Health Department
Meds which increase opioid effect
Prescriptions OTC’s
All antipsychotics
Antidepressants
Blood pressure meds
Antibiotics (zithromax)
Benzo’s (valium etc)
Cholesterol meds
Other opioids (methadone, suboxone)
Stimulants (ritalin)
Cough/cold
Antihistamine/decongestants (Claritin-D)
Antacids (Prilosec)
Tylenol and Aleve
Tagamet HB (Cimetidine) is a broad CYP450 inhibitor. This basically means it 'clogs' the enzymes that metabolize opiates\opioids out of the body.
Quinine is an ingredient in tonic water, and inhibits the CYP450 set, more specifically, CYP2D6.
CYP2D6 is the MAIN enzyme for opiates like oxycodone, heroin, hydromorphone, etc.
White grapefruit juice contains three ingredients that clog the CYP450 set.
Dextromethorphan HBr, Robitussin, Zicam, etc. has a special effect in this formula.
contributes to analgesia and euphoria for all major opiates.
prevents build up of tolerance with opiates,
30mg of DXM a half hour before dosing will slow tolerance build up.
Good Samaritan Law H.B. 416 – Criminal Procedure – Limited Immunity – Alcohol- or Drug-Related Medical Emergencies Provides that a person who, in good faith, seeks, provides or assists with medical
assistance for another person experiencing an alcohol- or drug-related medical emergency shall be immune from prosecution for certain minor enumerated crimes, if the evidence for the criminal prosecution was obtained solely as a result of the person’s actions in rendering or obtaining aid for the victim. This immunity extends to the person who experiences the medical emergency.
Crimes included from the Code of Maryland, Criminal Law Article:
§5-601: possessing/administering a controlled dangerous substance (CDS);
§5-619: use of/intent to use drug paraphernalia;
§10-114: underage possession of alcohol;
§10-116: obtaining alcohol for underage consumption; and
§10-117: furnishing alcohol for underage consumption.
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