State Legislation/Standing Orders

According to the Open Society Foundation, a Standing Order is “a physician's order that can be exercised by other health care workers when predetermined conditions have been met. Under this model, a doctor with prescriptive authority issues a written order that naloxone can be distributed by designated people, such as trained employees of a harm reduction program, to those who meet the criteria outlined in the document. Some standing orders are written so that distribution is not limited to people at personal risk for overdose. In these cases, a potential bystander, such as a family member, could procure and administer naloxone in case of an emergency. In fact, in many places, ambulance workers who do not have prescriptive authority already administer naloxone under a standing order from their medical supervisors.”

• The Council of State Governments (CSG) Knowledge Center and the Chooper’s Guide both provide detailed information about state legislation. The CSG’s Opioid Overdose Protection Note released January 27, 2016 lists 8 states that allow the dispensing of naloxone without a prescription, 34 states allow pharmacists to dispense under a standing order, North Dakota legislation allows the Board of Pharmacy to establish rules for pharmacists to have limited prescriptive authority to provide naloxone rescue kits to treat an opioid overdose, and Utah’s “Emergency Administration of Opiate Antagonist Act allows the direct dispensing of an opiate antagonist to someone who is “reasonably believed” to be experiencing an overdose.” 
• The National Association of State Alcohol and Drug Abuse Directors (NASADAD) September 2015 Overview of State Legislation to Increase Access to Treatment for Opioid Overdose, provides a state by state (and Washington, DC) break down of current policies to improve access to naloxone and emergency medical services including 911 Good Samaritan Laws, naloxone prescribing and administration protections, naloxone distribution programs, standing orders, liability protections, and educational strategies. 
• CVS pharmacy issued a press release on 9/29/15 that pharmacists in its stores would be allowed to provide naloxone without a prescription in 14 states.

Specific Standing Orders Regarding States Mentioned Duing NDEWS Network Discussion