Example community health center naloxone distribution plan
This Naloxone Distribution Plan will detail the policies and procedures for the distribution, tracking, and inventory of naloxone received from the NDP. This Plan will ensure the sufficient availability and proper distribution of naloxone to individuals through our Community Health Center, thereby addressing the impact of overdose on our community, reducing overdose deaths, and empowering individuals and groups in our communities to be safer and healthier.
This policy applies to all Community Health Center staff members.
Our Community Health Center will provide naloxone to every individual who either (a) requests naloxone or (b) is determined to be at higher risk of overdose or witnessing an overdose. Naloxone received from the NDP will be provided at no cost to individuals.
- All staff members will receive training and education on how to administer naloxone. This staff training video is a helpful resource for educating staff.
- All staff members will receive training on how to properly distribute naloxone to individuals.
- Naloxone will be kept at the front desk and provided to any and all individuals, regardless of patient status, who request the medication.
- During health care visits, clinicians will assess patients for their risk of overdose and offer naloxone to patients determined to be at higher risk of overdose.
- Naloxone will always be provided to recipients in a confidential, non-judgmental manner.
- Naloxone will always be provided to recipients with training and education on how to administer and store naloxone.
- When a staff member distributes naloxone to an individual, the staff member will document the distribution, with all required information, in the clinic’s Naloxone Distribution Log.
- All naloxone will be stored in a temperature-controlled environment in the clinic.
- Staff members will regularly check the expiration dates of the clinic’s naloxone to ensure that naloxone is replaced before its expiration date.
- When the clinic’s naloxone inventory is running low, staff members will notify the clinic’s manager, who will then re-apply to the NDP to order more naloxone.
How to document harm reduction supply distribution
When a clinic is re-applying for the program, the documentation required for a subsequent NDP application can be gathered and submitted in the form of a detailed distribution log (an example of one is included below). Importantly, the documentation of the number of overdose reversals reported using naloxone received through the NDP, while a required section of the reapplication, can be sufficiently answered by writing that the clinic does not know how many reversals occurred. The Department of Health Care Services (DHCS) understands that the number of overdose reversals reported can only truly be captured when an individual receiving naloxone is a repeat patient who returns to the clinic and reports their use of naloxone to reverse an overdose; therefore, clinics will not be penalized for this lack of knowledge, since many recipients of a clinic’s naloxone receiving through the NDP may maintain anonymity as individuals who are not patients or repeat patients.
Community health centers can document their distribution of naloxone and fentanyl test strips through a distribution plan that includes the organization’s policies and procedures for distribution, tracking, and inventory of the harm reduction supplies received through the NDP. In practice, a naloxone or fentanyl test strip distribution tracking/inventory log often contains the following information:
● the date naloxone or fentanyl test strips were distributed,
● the quantity of naloxone or fentanyl test strips distributed, and
● the signature of the staff member who distributed the naloxone or fentanyl test strips.
Example naloxone distribution log entry:
Best practices for naloxone and fentanyl test strip distribution in community health settings
The distribution of overdose prevention supplies, including naloxone and fentanyl test strips, at community health centers is rooted in the empowerment of individuals and communities in preventing overdose. Best practices for the distribution of naloxone and fentanyl test strips at community health centers are centered around a low-barrier, needs-based approach to distribution.
- A low-barrier approach to distribution aims to make overdose prevention supplies easily accessible and available at no cost to individuals who could benefit from their use. This approach helps to ensure that community members of all backgrounds can get the supplies they need to be safer without having to overcome existing barriers to access supplies.
- A needs-based approach to distribution takes into account the fact that some individuals in our community are at higher risk of overdose or are more likely to witness an overdose than others. This approach aims to make naloxone and fentanyl test strips more available and accessible to these individuals at higher risk.
Community health centers should implement distribution strategies using a low-barrier, needs-based approach with the goal of increasing overdose prevention supplies within communities, thereby providing community members with the tools to make safer, healthier choices.
Recommended best practice strategies for supply distribution at clinics
Here are several recommendations for low-barrier, needs-based overdose prevention supply distribution strategies during walk-ins and clinical visits.
Community health centers can increase the accessibility of overdose prevention supplies through the distribution of harm reduction supplies to community members at the front desk or through self-serve distribution methods.
- Policies are in place to ensure that individuals with or without an appointment can walk into the clinic, ask for naloxone or fentanyl test strips or approach a harm reduction supply self-serve kiosk, and receive them immediately at no cost.
- All clinic staff members are trained and educated on the distribution and administration of naloxone and fentanyl test strips.
During health care visits, clinicians can help mitigate the risks associated with opioid prescription and/or substance use while ensuring patients have access to overdose prevention supplies.
- Providers evaluate the patient’s history of overdose and substance use and whether the patient is being prescribed opioids to assess a patient’s risk of overdose.
- Providers offer education and informational materials to patients at higher risk of overdose and their family members about the risks of opioid use and/or substance use, potential signs of overdose, and how to administer naloxone.
- Patients at increased risk of overdose, including those being prescribed opioids, those using benzodiazepines in addition to opioids, or those with a history of substance use, are always offered naloxone.
- Patients with a history of substance use or overdose are also offered fentanyl test strips to encourage safer use.
- Clinicians increase the frequency of follow-ups with patients using opioids to monitor for signs of misuse and overdose risk.
- Community health center workers are non-judgmental and confidential in the distribution of harm reduction supplies to encourage individuals to use these supplies without fear of stigma or discrimination.
- Community health centers properly document their distribution of naloxone and fentanyl test strips.
By following these best practices, community health centers can effectively distribute naloxone and fentanyl test strips, ultimately helping to prevent overdose deaths, protect public health, reduce stigma in healthcare against people who use drugs, and improve health outcomes for all community members.
Frequently asked questions (FAQs)
Below is a list of frequently asked questions about requesting free naloxone and/or fentanyl test strips from the NDP.
The Naloxone Distribution Project (NDP) is administered by the Department of Health Care Services (DHCS) to combat opioid overdose-related deaths throughout California. The NDP aims to reduce opioid overdose deaths through the provision of free naloxone. Through the NDP, qualified entities can request free naloxone from DHCS and have it directly shipped to their address. The NDP’s funding comes from various sources including state, federal, and opioid settlement funds. This project is subject to normal state legislative appropriation and budgetary processes and is subject to available funding for naloxone distribution. To learn more about ordering naloxone through the NDP, please visit the Naloxone Distribution Project website.
Yes. Fentanyl is a synthetic opioid, so naloxone can be used to reverse a fentanyl overdose.
Yes. The NDP distributes both intranasal and intramuscular naloxone.
Intranasal naloxone is sprayed into the nostrils using a pre-measured spray device, while intramuscular naloxone is injected into the body using a syringe. Intranasal is generally easier for bystanders and non-medical personnel to administer, while intramuscular naloxone requires some training to properly administer. Both forms of naloxone are proven to be effective methods to reverse an opioid overdose.
The NDP currently distributes 4mg naloxone nasal spray from two manufacturers – generic naloxone nasal spray and Narcan naloxone nasal spray. The NDP also distributes 0.4mg/mL intramuscular naloxone from a third manufacturer.
To request intramuscular naloxone, eligible entities must submit a standing order or valid prescription for naloxone as part of the online application form. A standing order can be obtained from the California Department of Public Health’s website. Note that a standing order for naloxone nasal spray is no longer required due to the over-the-counter status.
After an application is approved, the entity will receive an approval letter from [email protected]. The approval letter will indicate whether the entity’s order will be fulfilled by generic naloxone nasal spray or Narcan naloxone nasal spray. The email will include contact information for the manufacturer fulfilling the order. Generic naloxone nasal spray will be labeled either as “CalRx” or “Amneal” and is manufactured by Amneal Pharmaceuticals. Narcan naloxone nasal spray will be labeled as “Narcan” and is manufactured by Emergent BioSolutions.
The shelf life of Narcan naloxone nasal spray is four years. The shelf life of generic naloxone nasal spray is two years. Please follow the expiration date as printed on the package you receive.
Online training resources can be found at https://getnaloxonenow.org or the Harm Reduction Coalition’s Overdose Prevention and Naloxone Manual.
No. Eligible entities must apply directly to DHCS for their program.
Yes. You may request more naloxone by submitting a new application to DHCS via the online form. Prior approval does not guarantee automatic approval of the secondary request for additional naloxone.
Yes. Hospital emergency departments are eligible entities for the NDP and may provide take-home doses of naloxone to patients and visitors. Emergency departments should provide the following supplemental documentation with the application:
- FEIN, business license, or a tax-exempt letter.
- Policies and procedures for naloxone distribution. Example policies and procedures are located here: https://cabridge.org/resource/guide-to-naloxone-distribution.
Yes. Substance use disorder recovery facilities (outpatient, residential, and sober living homes) are eligible entities for the NDP and may have naloxone onsite in case of overdoses or provide take-home naloxone to clients leaving the facility. SUD recovery facilities should provide the following supplemental documentation with the application:
- Copy of the program’s DHCS license (if applicable).
- Policies and procedures for naloxone distribution, including:
- Separate storage of naloxone received through the program from other medications that may be billed to patient insurance.
- Inventory and tracking of naloxone received through the program.
- Distribution plan for naloxone received through the program.
If you operate a harm reduction or community outreach program out of a health care site, please provide supplemental documentation to your application that explains the program, and how naloxone provided through the NDP will be stored separately from naloxone used in the health care site.
The product is free and is shipped directly to approved applicants.
There is a minimum order of 24 naloxone nasal spray units (two 4mg devices per unit) per application. There is a minimum of 1000 vials of intramuscular naloxone per application. Orders for intramuscular naloxone must be placed in increments of 1000.
The maximum that an entity can request is currently 2,400 naloxone nasal spray units per application. The maximum request is determined by the ability of the NDP to meet projected demand with available funding and is subject to change. There is no maximum request for intramuscular naloxone.
For any order requesting over 240 units of naloxone nasal spray you must provide a comprehensive summary that justifies your request.
No. The NDP was established to allow community organizations and other entities that are in possession of naloxone to distribute it, and to allow individuals that receive naloxone to administer it.
The product may only be used by the applicant and may not be submitted for reimbursement of any type, including and not limited to, private pay, commercial, government authority, agency, or otherwise.
Entities participating in the program agree to maintain and report information regarding the number of reversals that occurred using the naloxone provided by the NDP. Please report reversals to [email protected] with each incident, or submit the total number of reversals using the previous shipment of naloxone with subsequent applications to the NDP via the online form. Entities that are re-applying for the program are required to submit information about overdose reversals using naloxone received through the NDP.
Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl is a major contributor to fatal and nonfatal overdoses in California and the United States.
There are two types of fentanyl: 1) pharmaceutical fentanyl and 2) illicitly manufactured fentanyl (illicit fentanyl or IMF). Doctors prescribe pharmaceutical fentanyl to treat severe pain, such as while in the hospital for and after surgery or for advanced-stage cancer. Illicit fentanyl is unregulated and distributed through illegal drug markets for its heroin-like effect.
Fentanyl is extremely potent relative to other opioids and can more rapidly cause respiratory depression and arrest. Illicit fentanyl can be added to other drugs to make them cheaper, more powerful, and more addictive. People who use drugs may be unaware if their drugs contain fentanyl. A very small amount of fentanyl can be deadly and the amount of fentanyl in substances varies dramatically. This can lead to a life-threatening or fatal overdose event.
Fentanyl test strips received from DHCS can last one to two years. Specific shelf life details are provided directly on the fentanyl test strip kits.
Keep fentanyl test strips out of light and store them in a temperature range of 35.6°F to 86°F. This specific temperature range is required to preserve their accuracy and effectiveness.
Yes, entities can use the Naloxone Distribution Project’s online application form to apply for fentanyl test strips and/or naloxone.
Yes. You may request more fentanyl test strips by submitting a new application to DHCS via the online application form. Prior approval does not guarantee automatic approval on subsequent requests for additional fentanyl test strips.
Yes. Hospital emergency departments are eligible entities to receive fentanyl test strips from DHCS.
Yes. Substance use disorder (SUD) recovery facilities (outpatient, residential) are eligible entities to receive fentanyl test strips from DHCS and may have fentanyl test strips onsite.
SUD recovery facilities should provide a copy of the program's DHCS license and/or certification, if applicable.
The product is free and is shipped directly to approved applicants.
There is a minimum of 500 fentanyl test strips per application.
The maximum that an entity can request is 25,000 fentanyl test strips per application. The maximum request is determined by DHCS’ ability to meet projected demand with available funding and is subject to change.
Yes, applicants must order in multiples of 500.
No. The product may only be used by the applicant and may not be submitted for reimbursement of any type, including and not limited to, private pay, commercial, government authority, agency, or otherwise.
Entities receiving fentanyl test strips from DHCS agree to maintain and report information regarding the number of fentanyl test strips distributed from DHCS. Please submit the total number of fentanyl test strips distributed from the previous shipment of fentanyl test strips that your organization received from DHCS. You can submit this information in subsequent applications to DHCS via the online application form. If you are unable to include previous distribution information in a subsequent application, applicants can email [email protected] to report the number of fentanyl test strips distributed. Entities that are re-applying to receive fentanyl test strips from DHCS are required to submit this information.