Thank you for committing to engage pharmacists regarding the incredible opportunity for them to prevent opioid overdose deaths by providing naloxone!

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1 Thank yu fr cmmitting t engage pharmacists regarding the incredible pprtunity fr them t prevent piid verdse deaths by prviding nalxne! If yu encunter cmplicated questins that yu are unable t answer, please direct the pharmacists t OperatinNalxne.rg fr mre infrmatin and recmmend they OperatinNalxne@gmail.cm (r yu can reach ut t us yurself). After yu cmplete an utreach encunter, we wuld be extremely thankful t knw the details f where it ccurred and hw it went. Please cmplete this Qualtrics survey each time (tinyurl.cm/onutreach) Be sure t recrd the fllwing details and ask these questins f the pharmacist with whm yu speak, even if yu knw the answer. - Pharmacy Name (e.g. Walgreens, CVS) - Pharmacy Address (street, city, state, zip) - Did the pharmacy have an active standing rder t dispense nalxne? - Did the pharmacy have at least ne frmulatin f nalxne in stck? - Had the pharmacy ever dispensed nalxne under a standing rder? - What additinal actin related t nalxne dispensing was the pharmacist willing t cmmit t based n yur discussin (e.g. seek a standing rder, keep nalxne in stck, pst the nalxne pharmacy flyer)

2 Nalxne Frmulatins Suggested rder sentences fr currently available piid antagnist frmulatins are listed belw. Dispensing tw dses is generally recmmended in case the first dse is insufficient. Prescriptins shuld be issued t the Recipient, even if the Recipient is nt the individual at risk fr piid verdse. Intranasal Prefilled Syringe 1. Nalxne Prefilled Syringe (2mg/2mL), #2 bxes, PRN refills Instill 1mL int each nstril as needed fr suspected piid verdse, repeat in 2 minutes if necessary 2. Mucsal Atmizatin Device with Luer-lck, #2 devices, PRN refills Attach t prefilled nalxne syringe as needed fr suspected piid verdse Nasal Spray 1. Narcan Nasal Spray (4mg/0.1mL), #1 tw-pack, PRN refills Instill 4mg int nstril as needed fr suspected piid verdse, repeat in 2 minutes if necessary Intramuscular Vial & Syringe 1. Nalxne Vial (0.4mg/mL), #2 vials, PRN refills Inject 1mL int uter thigh as needed fr suspected piid verdse, repeat in 2 minutes if necessary 2. IM Needle & Syringe (3mL, 25g, 1ʺ), #2 syringes, PRN refills Use t administer nalxne as needed fr suspected piid verdse Prefilled Syringe 1. Nalxne Prefilled Syringe (2mg/2mL), #1 bx, PRN refills Inject 1mL int uter thigh as needed fr suspected piid verdse, repeat in 2 minutes if necessary 2. IM Needle with Luer-lck (25g, 1 ), #2 devices, PRN refills Attach t prefilled nalxne syringe as needed fr suspected piid verdse Aut-Injectr 1. Evzi Aut-injectr (2mg/0.4mL), #1 tw-pack, PRN refills Inject int uter thigh as needed fr suspected piid verdse, repeat in 2 minutes if necessary 2. Evzi Aut-injectr (0.4mg/0.4mL), #1 tw-pack, PRN refills Inject int uter thigh as needed fr suspected piid verdse, repeat in 2 minutes if necessary

3 Nalxne fr Patients Yu r a lved ne may be at risk fr an accidental drug verdse. Drug verdse is the leading cause f injury death in the United States. Mst verdses invlve piids, which include certain prescriptin pain relievers and herin. Cmmn Opiids Mrphine (MS Cntin ), Oxycdne (OxyCntin /Perccet ), Hydrmrphne (Dilaudid ), Oxymrphne (Opana ), Fentanyl (Duragesic ), Hydrcdne (Vicdin /Nrc ), Cdeine, Methadne, Herin Thusands f peple die each year frm accidental verdses related t prescriptin drugs they were taking as directed. The pharmacist has determined yu r a lved ne may be at risk fr an accidental piid verdse fr ne r mre f the fllwing reasns: Risk Factrs fr Opiid Overdse Histry f piid pisning r verdse Histry f illicit r nnmedical piid use Use f methadne r buprenrphine fr piid use disrder High-dse prescriptin piid use (>50 milligram mrphine equivalents daily) Lng-term prescriptin piid use (>90 days cntinuusly fr nn-cancer pain) Lng-acting r extended-release prescriptin piid use Use f piids frm multiple prescribers r multiple pharmacies Use f interacting drugs r medicatins (alchl, sedatives, antidepressants) Underlying disease f key rgans (lung, kidney, liver, heart, HIV/AIDS) Recent release frm drug treatment/detxificatin r crrectinal facility Yu shuld have nalxne at hme t keep yu and yur lved nes safe. Nalxne is the antidte t an piid verdse. If yu take t much f an piid medicatin, yur brain will stp telling yur lungs t breathe. If this ccurs, taking nalxne can save yur life by allwing yu t breathe again. Nalxne is nt a cntrlled substance and it cannt be abused. If yu give nalxne t smene wh is nt experiencing an piid verdse, nthing will happen. The nly serius side-effect f nalxne is that it can cause withdrawal symptms if the verdse victim has develped a physical dependence t piids. While acute piid withdrawal is nt generally lifethreatening, it is still essential t call emergency medical services. If yu try t save smene s life with nalxne, yu are prtected by law frm any liability regardless f the utcme. Nalxne is available in several different versins. Sme versins f nalxne are injected int the victim s muscle, while thers can be squirted int their nse. Yur pharmacist can help yu determine which versin f nalxne is right fr yu based n cst and ease-f-use. Check ut OperatinNalxne.rg t learn mre abut staying safe with piids.

4 Nalxne fr Pharmacists Nalxne can reverse the effects f an piid verdse and save a life. Nalxne is an piid antagnist that blcks the effects f piids, including herin. If smene takes t much f an piid, they may experience fatal respiratry depressin. Nalxne can reverse the effects f piids and allw an verdse victim t breathe again. Nalxne is nt a cntrlled substance and cannt be abused. If an verdse victim is physilgically dependent n piids, administering nalxne may precipitate acute piid withdrawal. This is generally nt life-threatening, but cntacting emergency medical services is still essential. Every patient wh fills an piid prescriptin shuld be ffered nalxne. Pharmacists shuld always maintain a stck f nalxne and be prepared t dispense it. The Texas Nalxne Law (SB 1462) allws fr third-party prescribing, meaning any persn wh may be in a psitin t help smene experiencing an piid verdse may receive it. There is n medically valid reasn t refuse t dispense nalxne t a persn wh requests it. N frmulatin f nalxne has been prven mre effective than anther. Price and ease-f-use vary greatly, and these will likely be the determining factrs when yu wrk with a patient t select an apprpriate frmulatin. Sme frmulatins require separate equipment t be dispensed fr prper administratin. The persn respnding t an verdse will NOT be the victim, s assumptins abut the respnder being injectin-savvy r speaking English may be incrrect. It is pssible that high-dse frmulatins may exhibit a lnger duratin-f-actin than lwer dses. Reprts f ultra-ptent, nalxne-resistant piids are unsubstantiated. The U.S. is seeing an influx f illicitly-manufactured fentanyls (IMF), sme f which exhibit enhanced binding affinity t mu-piid receptrs. There have been islated reprts f IMF verdses in which several dses f nalxne were administered t resuscitate the victim, but it is nt clear that all dses were required. It is hypthesized that high-dse frmulatins f nalxne may exhibit superir efficacy against IMF, but this has nt yet been demnstrated in practice. Yu are authrized t administer nalxne t an verdse victim. As a pharmacist, yu have been identified as a frnt-line harm reductin prvider in the state f Texas. This respnsibility extends beynd the dispensing f nalxne t administering it in the case f an acute piid verdse. G t OperatinNalxne.rg t find nalxne administratin vides and ther educatinal resurces. Cmprehensive harm reductin cntinuing educatin mdules are currently under develpment and will be available frm The University f Texas at Austin Cllege f Pharmacy in August 2017.

5 IT SAVES LIVES NALOXONE (als knwn as Narcan ) Available Here Opiids, like prescriptin painkillers and herin, can cause a persn t STOP BREATHING. If yu r smene yu knw takes piids, ASK THE PHARMACIST abut nalxne.