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Table 1 Naloxone distribution models in the USA: prescription specifications, targeted at-risk populations, and geographic reach

From: Orienting patients to greater opioid safety: models of community pharmacy-based naloxone

  Community-based organization Naloxone distribution Traditional prescription Pharmacy-based Naloxone models
CPA Standing medication order Protocol order Pharmacist prescribing
Who issues prescription? Prescriber via standing order Prescriber Non-pharmacist prescriber Non-pharmacist prescriber Licensing board Pharmacist
Medical professionals required Varies by state: prescriber, state/local health department Prescriber + pharmacist Prescriber + pharmacist Prescriber + pharmacist Pharmacist Pharmacist
Potential recipients Individuals served by the community-based organization Patients of the prescriber Varies by state Anyone meeting criteria specified by prescriber Anyone meeting criteria specified by licensing board Anyone for whom medication is indicated
Target overdose risk population served People who use drugs (prescription opioids, heroin) who access the community-based organization* People who use drugs who are in treatment/visit a prescriber* People who use drugs (prescription opioids, heroin) who visit a pharmacy* People who use drugs (prescription opioids, heroin) who visit a pharmacy* People who use drugs (prescription opioids, heroin) who visit a pharmacy* People who use drugs (prescription opioids, heroin) who visit a pharmacy*
Patients prescribed opioids who are at risk of overdose* Patients filling a prescription for opioids at a pharmacy who are at risk of overdose* Patients filling a prescription for opioids at a pharmacy who are at risk of overdose* Patients filling a prescription for opioids at a pharmacy who are at risk of overdose* Patients filling a prescription for opioids at a pharmacy who are at risk of overdose*
Geographic reach Limited to where community-based organizations are located and operate Limited to where the prescriber practices Any participating pharmacy within the state Any participating pharmacy within the state Any participating pharmacy within the state Limited to where the pharmacist practices
  1. *A majority of states now permit prescriptions to be written for third parties (e.g., friends, staff of organizations that provide services to individuals at risk of overdose) as well as the person at risk of overdose
  2. CPA collaborative practice agreement