New guidelines for when to prescribe naloxone

Challenges during the COVID-19 pandemic include deteriorating mental health and increased substance use.

Deciding when to prescribe naloxone (Narcan), especially during the COVID-19 pandemic, presents unique challenges.

We must consider how these challenges can lead to deteriorating mental health and increased substance use, and therefore a higher risk of death by suicide or overdose. As stewards of our patients’ health, we seek to minimize these risks.

It is important to continuously assess our patients for misuse of controlled substances (prescribed and illicit) and prescribe naloxone to patients for potential opioid overdose reversal.

Please review the evidence-based guidelines below for prescribing. It also is widely recommended that any person who receives an opioid prescription should receive naloxone along with it, in the instance that another person who has access to the opioid prescription may also be at risk for overdose. Lastly, please include multiple refills when prescribing naloxone.

Patients who should be considered for naloxone

Patients prescribed opioids who:

  • Are receiving opioids at a dosage of 50 morphine milligram equivalents (MME) per day or greater (see this link for more information) OR
  • Have respiratory conditions such as chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (regardless of opioid dose) OR
  • Are concurrently taking prescribed or illicit benzodiazepines (regardless of opioid dose) OR have a nonopioid substance use disorder, report excessive alcohol use, or have a mental health disorder (regardless of opioid dose)

Patients at high risk for experiencing or responding to an opioid overdose, including those who:

  • Are using heroin, illicit synthetic opioids or misusing prescription opioids
  • Are using other illicit drugs such as stimulants, including methamphetamine and cocaine, which potentially could be contaminated with illicit synthetic opioids such as fentanyl
  • Are receiving treatment for opioid use disorder, including medication-assisted treatment (MAT) with methadone, buprenorphine or naltrexone
  • Have a history of opioid misuse and were recently released from incarceration or other controlled settings where tolerance to opioids has been lost

The cost of prescribing naloxone

  • Medicaid will pay 100% for naloxone prescription.
  • Medicare and private insurance coverage are based on individual plans.

Local options to get free naloxone

St. Matthews Community Pharmacy
3922 Willis Ave.
Louisville, Kentucky

Kentucky Harm Reduction Coalition
10708 Kings Crown Drive
Prospect, Kentucky
(Will also mail Narcan free of charge via a web request)

Louisville Recovery Community Connection
620 S. Third St., Suite 102
Louisville, Kentucky

Louisville Metro Department of Public Health & Wellness
400 E. Gray St.
Louisville, Kentucky

Louisville’s Syringe Exchange Program sites
Narcan can be obtained at no cost Monday through Saturday.
Various locations

Kelly C. Cooper, M.D., MPH, is an addiction medicine physician with Norton Behavioral Medicine.

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