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U.S. Department of Health and Human Services
Opioid Stewardship in the Indian Health Service

Co-prescribing

Over the last 10 years, early access to naloxone—an opioid overdose reversal agent— has demonstrated positive outcomes on reducing opioid related deaths. Patients at risk for an overdose and their loved ones can be educated on opioid overdose symptoms and naloxone administration in the community setting. Trained prescribers and pharmacists can identify patients at risk for an overdose and educate patients and family on opioid overdose symptoms and naloxone administration. In some states, by independently prescribing or co-prescribing under a collaborative practice agreement or standing order, pharmacists are able to increase access to this life-saving medication.

Consider co-prescribing naloxone in these situations:

  • Voluntary request by patient or caregiver
  • Receiving emergency medical care for opioid intoxication or overdose
  • Suspected history of substance use disorder or non-medical opioid use
  • Receiving higher dose opioid prescriptions (>50mg morphine equivalents/day)
  • Receiving medications for opioid use disorder (MOUD) such as methadone or buprenorphine
  • Patients who have difficulty accessing emergency medical services (distance, remoteness, lack of transportation, homelessness, and/or without phone services)
  • Recent mandated substance use treatment, incarceration, or period of abstinence with history of substance use disorder.
  • Those receiving any opioid prescription for pain plus:
    • When rotating from one opioid to another because of possible incomplete cross tolerance
    • Known or suspected concurrent alcohol use
    • Kidney, liver, or chronic lung diseases
    • Concurrent prescription or over-the-counter medications such as:
      • Benzodiazepines
      • Antipsychotics
      • Antiepileptics
      • Muscle relaxers
      • Hypnotics
      • Sedatives
      • Antihistamines
      • Antidepressants

Mentor Resources

Download and customize this naloxone sign [PDF 203 KB] and post throughout your community.

Substance Abuse and Mental Health Services Administration (SAMHSA) provides a behavioral health treatment services finder, the SAMHSA Treatment Locator Exit Disclaimer: You Are Leaving www.ihs.gov .

According to the 2020 National Drug Control Strategy, only 1 in 10 Americans needing substance use disorder treatment actually received it. The Find Narcan Near You card was created to target this gap in treatment and is recommended to be attached or included with dispensed naloxone.

Download and customize these naloxone documents and post at your facility and throughout your community.

The National Harm Reduction Coalition provides harm reduction resources, including a local syringe access program finder and a naloxone finder. Find Harm Reduction Resources near you.Exit Disclaimer: You Are Leaving www.ihs.gov 

State Naloxone Access Rules and Resources can be found on the Safe Project website.Exit Disclaimer: You Are Leaving www.ihs.gov  This site gives an overview of naloxone access within each state in the United States and summarizes information regarding statewide standing order status and summarizes pharmacy access status.

Educate your community on "Good Samaritan" laws. Good Samaritan laws Exit Disclaimer: You Are Leaving www.ihs.gov  create immunities or other legal protections for people who call for help in the event of an overdose. Some states have passed comprehensive Good Samaritan overdose prevention laws that provide broad protection. Other states have passed laws that consider seeking medical assistance for a person experiencing an overdose as an affirmative defense, or as a mitigating factor during sentencing.

See what others are doing by visiting our Best and Promising Practices | Opioid Response at IHS webpage.

Naloxone Electronic Health Record (EHR) Considerations

Consider adding naloxone to your EHR menu or include it in an order set to encourage providers to order naloxone along with an opioid prescription. For technical assistance, contact Katie Johnson or John Lester.

Video

Naloxone Reversal IHS video
Opioid Overdose and Naloxone Reversal

Virtual, On-Demand, Naloxone Train-The-Trainer Course

Northwest Area Indian Health Board (NPAIHB) and the IHS HOPE Committee launched a virtual, on-demand naloxone train-the-trainer course that medical professionals, first responders, and community members can all use to become official naloxone trainers. This 18-minute course discusses the rise in opioid-related deaths, identifying an overdose, how to properly administer nasal and injectable naloxone, as well as shares best practices and highlights the importance of harm reduction strategies. Be a naloxone champion in your community - visit NPAIHB and get trained. [PDF - 225 KB] Exit Disclaimer: You Are Leaving www.ihs.gov 

Resources