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Drug overdose is a continuing epidemic that claimed the lives of over 67,000 Americans in 2018. Opioids, either alone or in combination with other substances,  were responsible for approximately 70% of these deaths. Many of these lost lives and other opioid-related harms are preventable through the timely administration of the opioid reversal drug naloxone and, where needed, the provision of ancillary emergency care. To help reverse this unprecedented increase in overdose-related harm, all fifty states and the District of Columbia have modified their laws to increase access to naloxone, the standard first-line treatment for opioid overdose.

The majority of these laws permit the medication to be distributed under a blanket directive without the prescriber having examined the patient, a process technically referred to as “non-patient specific prescription”. In most states this takes the form of a standing order issued by a physician or other prescriber, while in a few states the same objective is accomplished via a protocol issued by one or more regulatory or licensing boards. One state utilizes a Collaborative Practice Agreement (CPA) that acts as the functional equivalent of a standing order.

While most state laws permit any prescriber who is authorized to prescribe medications to issue a standing order for naloxone distribution, a piecemeal approach whereby each business, organization, or agency that wishes to distribute naloxone must secure their own standing order is time-consuming and inefficient. To streamline this process, in many states a state health official or other government official has issued a standing order or other directive that applies to all entities in the state, subject to the restrictions in the directive. The specifics of these directives vary on such characteristics as the individual or body that issued it, which individuals can access naloxone under its provisions, the formulations of naloxone it permits to be distributed, and where the naloxone can be accessed. These variations can have important implications for both the individuals who would be helped by increased naloxone access and researchers studying the effects of these directives.

To provide clarity on these questions, we systematically collected and categorized each statewide directive for naloxone distribution that had been issued by a state official or licensing board as of December 31, 2019.