Opioid Overdose Information for Pharmacists
NEW: Pharmacist Protocol for Prescribing and Dispensing Naloxone HCl Outside the Licensed Pharmacy Premise
Steps:
- Download the Protocol
- Download and complete the Protocol Request for Approval
- Email (preferred) or Mail the Protocol Request for Approval along with the Protocol to DCP.DrugControl@ct.gov or the mailing address on the form. (This should be completed 30 days prior to the event)
- Wait for the Approval Letter from the Drug Control Division (Sent via email)
- Report the total number of naloxone units prescribed and dispensed to DCP.DrugControl@ct.gov.
Helpful forms:
- Sample Atomizer Inventory Form
- Sample Auto-injector form
- Sample Nasal Spray form
- Sample Vial Form
Certification Program
-
University of Connecticut School of Pharmacy (ACPE #0009-9999-15-073-H03-P)
-
Pharmacist Letter (ACPE # 0422-0000-15-652-H01-P and 0422-0000-16-242-H01-P)
-
Walgreens Connecticut Naloxone Training
Handouts and Forms
- Notice: Pharmacists May Continue to Prescribe Naloxone (9/27/2023)
- Naloxone Handout
- Treatment Providers Handout (By Region)
- Counseling Documentation Form (For Pharmacists)
- Frequently Asked Questions
- Naloxone Flyer
- Naloxone Pharmacy Flyer
Suggested Intranasal Naloxone Kit Components
- 2 x 2 mg/2 mL prefilled naloxone cartridges
- 2 plastic syringes
- 2 mucosal atomization devices
- A rescue breathing mask
- Step-by-Step instructions for responding to an opioid overdose (See Naloxone Handout above)
- Directions for naloxone administration (See Naloxone Handout above)
- Sample Prescription for Intranasal Kit (use Adobe Acrobat for best results)
- VA Intranasal Counseling Video
Suggested Intramuscular Naloxone Kit Components
- 2 naloxone 0.5 mg/mL vials
- 2 intramuscular plastic syringes
- A rescue breathing mask
- Step-by-Step instructions for responding to an opioid overdose (See Naloxone Handout above)
- Directions for naloxone administration (See Naloxone Handout above)
- Sample Prescription for Intramuscular Kit (use Adobe Acrobat for best results)
- VA Intramuscular Counseling Video
Suggested Auto Injector Naloxone Kit Components
- Commercially available as a twin pack with audio instructions in English from the device
- NOTE: If the naloxone auto-injector is prescribed a copy of the Naloxone Handout may still be provided
- A rescue breathing mask
- Sample Prescription for Auto Injector Kit (use Adobe Acrobat for best results)
- VA Auto Injector Counseling Video
Resources