LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 352.01 Intranasal Opioid Antagonist Prescribing Requirements and Administration in Clinic Settings - Naloxone
 
  PROCEDURES
  1. Inventory
     
    1. The acquisition, storing, dispensing, and accounting of the intranasal naloxone kit shall follow Los Angeles County Department of Mental Health (DMH/Department) guidelines:
       
      1. For programs utilizing an Automated Medication Dispensing System (e.g. Pyxis System):
        1. Intranasal naloxone will be provided by DMH pharmacy.
        2. Inventory will be tracked by the automated medication dispensing machine.
        3. For each intranasal naloxone either administered or prescribed and dispensed at clinic sites, the data must be documented in the Patients' Own Medication Log.
      2. For programs NOT utilizing an Automated Medication Dispensing System (e.g. Pyxis System):
        1. Intranasal naloxone is available for pick up by each DMH program by authorized personnel. Programs shall request intranasal naloxone from DMH pharmacy headquarters located at 510 S. Vermont Ave, Pharmacy Warehouse, 21st Floor, Los Angeles, CA 90020.
        2. Once intranasal naloxone is obtained, each program must document in the Clinic Medication Inventory Log (Clinic Stock).
        3. For each intranasal naloxone either administered or prescribed and dispensed at clinic sites, the data must be documented in the Clinic's Medication Inventory Log (Clinic Stock) and client-specific Medication Administration Record (MAR).
           
    2. Each intranasal naloxone box contains the following:
       
      1. Two (2) single-dose intranasal sprays containing 4 mg of naloxone hydrochloride in 0.1 mL.
      2. Administration instructions.
  2. Administration
     
    1. Upon discovery of a person who is unresponsive, assess the person for probability of an opioid overdose. If another person is present, instruct them to call 911.
    2. If any features of an opioid overdose are present, intranasal naloxone shall be administered.
    3. Once naloxone is administered, call 911 if medical emergency services have not yet been contacted.
    4. If the person does not respond after three (3) minutes, a second dose of intranasal naloxone shall be administered.
  3. Prescribing
     
    1. In accordance with Assembly Bill No. 2760 (Wood, Chapter 324) and Assembly Bill No. 714, prescribers are required to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a client when the following conditions are met:
       
      1. The prescription dosage for the client is 90 or more milligram equivalents of an opioid medication per day.
      2. An opioid medication is prescribed within a year from the date a prescription for benzodiazepine has been dispensed to a client.
      3. The client presents with an increased risk of overdose, including a client with a history of overdose.
      4. A client with a history of a substance use disorder, or a client at risk for returning to a high dose of opioid medication to which the client is no longer tolerant.
    2. Consistent with standards of care, a prescriber shall provide education on opioid overdose prevention and the use of naloxone or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid-induced respiratory depression to:
       
      1. For a client who is a minor, the minor's parent or guardian
      2. The client
      3. One or more persons designated by the client
    3. Information on naloxone is available for the loved ones of a client with an opioid use disorder.
    4. A prescriber is not required to provide the education specified in C.2. and C.3. if the client receiving the prescription declines the education or has received the education within the past 24 months.
  4. Documentation
     
    1. Inventory - shall be documented as described above.
    2. Administration - if emergency naloxone is administered to a client, the provider shall document the administration in the client's chart.
    3. Prescribing - If naloxone is provided and education performed, provider shall document date of service in client’s chart.
       
      1. If a client declines the offer for intranasal naloxone, the refusal and date of refusal must be documented in client’s chart.