Table 1 State-level naloxone access laws

Liability policies

Liability protections for prescribers

Provide legal protections for healthcare professionals who prescribe naloxone in accordance with state law. Protections can extend to criminal liability; civil liability; and administrative, licensing, and professional disciplinary action by the prescriber’s professional licensure (or similar) entity

Liability protections for dispensers

Provides liability protections for pharmacists who dispense naloxone in accordance with state law. Protections can extend to criminal liability; civil liability; and administrative, licensing, and disciplinary action by the state board of pharmacy (or similar entity)

Liability protections for administration of naloxone

Provide liability protections to laypersons or nonmedical professionals (e.g., law enforcement officers) who administer naloxone. Protections can extend to criminal liability; civil liability; and professional sanctions

Education/training requirements

Prescriber provision of education or training to naloxone recipients

Requires prescribers of naloxone to offer overdose training and/or education to the recipient of a naloxone prescription

Dispenser provision of education or training to naloxone recipient

Requires pharmacists to offer overdose training and/or education to the recipient of a naloxone prescription

Co-prescribing naloxone

Co-prescribing laws based on opioid dosage only

Require doctors to prescribe naloxone to patients taking high doses of opioid painkillers

Co-prescribing laws based on more than opioid dosage

Require doctors to prescribe naloxone to patients who have other risk indicators for opioid overdose above and beyond taking high doses of opioid painkillers (e.g., patients in opioid treatment programs, patients with a prior history of opioid use disorder or overdose)

Layperson accessibility

Third party prescription

Allows a healthcare provider with naloxone-prescribing authority to prescribe to an at-risk person’s family member, friend, and/or other person in a position to assist the at-risk person in the event of an opioid-related overdose

Over-the-counter pharmacy supply

Makes naloxone available as an ordinary retail purchase that does not require a prescription. For this policy, assume that the US Food and Drug Administration has changed the prescribing status of naloxone from prescription‐only to over‐the‐counter status

Expanded pharmacy access

Population-based collaborative agreement

Pharmacists are given permission to voluntarily enter into collaborative agreements (or standing orders) with physicians and other providers to dispense naloxone to eligible patients without a patient-specific prescription according to patient criteria and instructions defined by the authorizing prescriber

Statewide standing or protocol order

Establish a statewide framework that allows any pharmacist in the state (who meets qualifications specified in the protocol) to dispense naloxone without a patient-specific prescription under the pre-defined conditions outlined in the order. Unlike collaborative practice agreements, this policy does not require pharmacists to have a partnering prescriber

Pharmacist prescriptive authority

Involves the legislature expanding pharmacist scope of practice to allow pharmacists to directly prescribe or furnish naloxone to patients without any physician involvement

Cost subsidization

Insurance coverage

Requires health insurance plans to provide coverage for at least one generic opioid antagonist and device approved to treat opioid overdose (e.g., naloxone) without prior authorization

State subsidies for naloxone purchase through insurance

Involves states providing co-pay assistance to individuals purchasing naloxone through health insurance plans that include prescription coverage, including Medicaid and Medicare as well as commercial insurance

Statewide “free naloxone”

Allows any resident to visit any pharmacy across the state and anonymously obtain naloxone at no cost without an individual prescription or appointment