A requester recently contacted the Network for guidance and clarification on who is permitted to prescribe naloxone directly or via standing order in Wisconsin. Specifically, the requester wanted to know the prescriber authority and criminal liability for advanced practice nurses versus registered or licensed nurse practitioners.
Under Wis. Stat. 441.18(2), advanced practice nurse prescribers (APNPs) are specifically authorized to both prescribe (directly or by standing order) and deliver naloxone to a person in a position to assist in an overdose. The statute does not authorize registered nurses (RN) or licensed nurse practitioners (LNPs) to deliver or dispense naloxone.
However, the Wisconsin legislature recently enacted a law permitting “any person” to deliver or dispense naloxone. Wis. Stat. 450.11(1i)(b) contains specific carve-outs for APNPs, physicians, physician assistants, and pharmacists, but does not address RNs and LPNs by name. Under a plain reading of the statute, RNs and LPNs fall under the umbrella of “any person” and are permitted to deliver and dispense naloxone pursuant to a valid order.
While Wis. Stat. 441.18(3) provides civil and criminal immunity to APNPs, physicians, physician assistants, and pharmacists who prescribe or deliver naloxone acting in good faith, this provision is again silent as to NPs and LPNs. However, Wis. Stat. 450.11 (1i)(c)(2) includes a broad catch-all liability provision that provides that "any person who, acting in good faith, delivers or dispenses an opioid antagonist to another person shall be immune from civil or criminal liability for any outcomes resulting from delivering or dispensing the opioid antagonist.” As discussed above, "any person" should include RNs and LPNs.
In conclusion, APNPs, physicians, physician assistants, and pharmacists are specifically permitted to prescribe naloxone directly or via standing order. While RNs and LPNs are not explicitly listed in the law, "any person" is permitted to deliver or dispense naloxone (and are civilly and criminally immune if acting in good faith), and there is nothing in the law to indicate that RNs and LPNs are not contained in the category of "any person.”
Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Contact a Network Attorney in your area for more information.
The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.