Dose of Reality: Resources for Professionals

Doctors can help prevent opioid misuse by safely reducing opioid prescriptions and becoming trained to treat opioid use disorder in their practice.

Key principles for patient care and safety

• Take a medical history and perform a physical examination.
• Perform a screening to assess potential risk for a substance use disorder.
• Make a treatment plan after talking about the risks and benefits of all options—opioid medications and nonopioid therapies.

Guidance for prescribing opioids

• Check the Wisconsin Enhanced Prescription Drug Monitoring Program to assess risk and prevent misuse.
• Use immediate-release opioids instead of extended-release or long-acting opioids for fewer days.
• Use the lowest possible effective dosage to start and reassess benefits and risks when considering dose increases.
• Add a prescription for naloxone.

Consult the opioid prescribing guidelines from the Wisconsin Medical Examining Board for more information.

Know opioid use disorder treatment options

• If you are unable to support the opioid use disorder treatment needs of a patient in your practice, clinic, or health system, contact the UW Addiction Consultation Provider Hotline to discuss next steps. This hotline is open to all health care professionals.
• You also can encourage patients to contact the Wisconsin Addiction Recovery Helpline to explore treatment options available to them.
• If you are seeking drug-free housing for a patient, consult the Wisconsin Recovery Residence Directory (PDF).

TIP 63: Medications for Opioid Use Disorder

This document from the Substance Abuse and Mental Health Services Administration reviews the use of three Food and Drug Administration-approved medications used to treat opioid use disorder—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with an opioid use disorder. Read the full document now or order a printed copy.

Education and training opportunities

Information for Oral Health Professionals
We've created a library of resources for oral health professionals to support services that respect the health and dignity of people who use drugs.

Opioid Treatment and Recovery in the Emergency Department
We've partnered with Wisconsin Voices for Recovery and UW-Madison's School of Medicine and Public Health on a six-part video series that provides treatment tools and recommendations for treating opioid use disorder in the emergency department.

Person-Centered Planning Training
We've created a recorded webinar that provides an overview of the core components and elements of Person-Centered Planning practice.

Substance Use Treatment Project ECHO®
We've partnered with UW-Madison's School of Medicine and Public Health to share information on substance use treatment strategies for all populations. Live webinars are held the third Friday of every month from 12:15 p.m. to 1:15 p.m.

Statewide naloxone standing order for nurses

The statewide naloxone standing order for nurses (PDF) authorizes trained registered nurses and licensed practical nurses who work outside of traditional health care settings in Wisconsin such as local public health departments and schools to:

• Possess and maintain a supply of naloxone for the purposes of distribution.
• Distribute naloxone to any person at risk of experiencing an opioid-related overdose or a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid related overdose.
• Administer naloxone to a person who is experiencing an opioid overdose.

Do you have a question about the naloxone standing order? Send an email to: dhsopioids@dhs.wisconsin.gov.

Naloxone Direct Program

Our Naloxone Direct Program provides naloxone at no cost to community agencies. These organizations distribute the naloxone they receive at no cost to people at risk for an opioid overdose and people who may witness an opioid overdose.

Do you have a question about the Naloxone Direct Program? Send an email to: DHSDCTSNaloxoneDirect@dhs.wisconsin.gov.

View a map showing all naloxone access points

View a spreadsheet of all naloxone access points (Excel).

On the front lines of dispensing opioid pain medications and providing medication-related services, pharmacists serve as a first line of defense by engaging in prevention and treatment efforts of opioid use disorder and overdose. Pharmacists should:

• Assess. Look for “red flags” that patients might have an opioid use disorder or be diverting medications. Promote the Wisconsin Addiction Recovery Helpline as a resource for patients who may be misusing drugs.
• Verify. Validate prescriber Drug Enforcement Administration registration and patient identification.
• Consult. Check the Wisconsin Enhanced Prescription Drug Monitoring Program as well as patient records.
• Communicate. Contact the prescriber with questions or concerns, talk to the patient, and submit information to the Wisconsin Enhanced Prescription Drug Monitoring Program.

Pharmacists can educate patients about:

• Proper use: Discuss how to take medication(s) exactly as prescribed and the risks of using medication(s) inappropriately.
• Side effects: Review most common side effects and stress the importance of reporting them to their prescriber or pharmacist for effective management.
• Medication fills: Discuss and manage expectations regarding refill requirements and the importance of using one pharmacy for all medications.
• Safe storage: Explain why locking up medications at home can prevent misuse, theft, or accidental ingestion by a child or pet.
• Stockpiling medication: Counsel patients about the dangers of saving unused medication. Explain why disposing unused medication at a local take back site or drop box can prevent misuse and accidental ingestion by a child or pet. Share information about safe disposal options.

HIPAA and the opioid epidemic

Guidance from the U.S. Department of Health and Human Services Office for Civil Rights explains when HIPAA permits health care providers and other covered entities to share a patient’s health information with loved ones and others involved in a patient’s care.

• Providers can share information with an individual patient's loved ones in certain emergency or dangerous situations, such as when the patient is in a crisis and incapacitated, or is facing a serious and imminent threat of harm.
• Patients with decision-making capacity retain their right to decide when and whether their information will be shared, unless there is a serious and imminent threat of harm.
• Patients' personal representatives, who have authority under state law to make health care decisions for patients, may request and obtain information on behalf of patients.

Standing orders for naloxone

Standing orders for naloxone are intended to ensure Wisconsin residents have access to naloxone, the opioid overdose reversal drug. People who are at risk of experiencing an opioid-related overdose or who may be in a position to assist a person at risk of experiencing an opioid-related overdose should carry naloxone.

Standing order training requirement

All pharmacists dispensing naloxone under a standing order must complete a one hour training developed by the Pharmacy Society of Wisconsin.

Follow these steps to access this training:

1. Go to the Pharmacy Society of Wisconsin's Online CE webpage
2. Type “Naloxone Statewide Standing Order Training" in the search box.
3. Select the “Naloxone Statewide Standing Order Training" course title in the list of options that appear.
4. Select the "Register" button in the course description screen and follow the prompts to register.

Long-acting/high-dose overdose reversal medication

The statewide standing order for opioid reversal medication authorizes pharmacists to dispense standard dose naloxone to any individual at risk for an opioid overdose or to any individual in a position to assist an individual at risk for overdose. Wisconsin's standing order for opioid reversal medication standard dosing includes the following options: intramuscular naloxone hydrochloride (0.4mg/ml), intranasal naloxone hydrochloride (4mg/0.1ml), or naloxone hydrochloride via mucosal atomization (2mg/2ml).

All opioid reversal medications cause precipitated withdrawal symptoms. Precipitated withdrawal symptoms range in severity from mild dysphoria or gastrointestinal upset to life-threatening conditions including acute respiratory distress syndrome, severe agitation, dysrhythmias, and stress cardiomyopathy.

A second medication used to reverse opioid overdose, nalmefene, is a long-acting overdose reversal medication. Evidence shows increased risks with nalmefene and high-dose naloxone than standard dose naloxone, as there is higher likelihood of severity of symptomology and elongated duration of the precipitated withdrawal.

Currently, there is no evidence to demonstrate nalmefene or high-dose naloxone is more effective than standard dosing of naloxone.

For the reasons stated above, Wisconsin does not include nalmefene or high-dose naloxone in the Wisconsin standing order for opioid reversal medication. People who would like to consider nalmefene or high-dose naloxone as an option should consult with a health care provider.

Do you have a question about the standing orders for naloxone? Send an email to: dhsopioids@dhs.wisconsin.gov.

Naloxone Direct Program

Our Naloxone Direct Program provides naloxone at no cost to community agencies. These organizations distribute the naloxone they receive at no cost to people at risk for an opioid overdose and people who may witness an opioid overdose.

Do you have a question about the Naloxone Direct Program? Send an email to: DHSDCTSNaloxoneDirect@dhs.wisconsin.gov.

View a map showing all naloxone access points

View a spreadsheet of all naloxone access points (Excel).

Naloxone Direct Program agencies are required to have at least one staff member attend a naloxone train-the-trainer course and use the curriculum provided to train others on how to administer naloxone. This course is not designed for people who only want to learn how to administer naloxone. The course is designed for people employed by a Naloxone Direct Program agency who want to learn how to train others to administer naloxone.

This course is presented virtually.

Registration is required.

• January 15, 2025: 12:30 p.m. to 2:30 p.m.
• February 11, 2025: 1:00 p.m. to 3:00 p.m.
• March 12, 2025: 10:00 a.m. to 12:00 p.m.
• April 20, 2025: 12:00 p.m. to 2:00 p.m.
• May 13, 2025: 9:00 a.m. to 11:00 a.m.
• June 18, 2025: 10:00 a.m. to 12:00 p.m.
• July 9, 2025: 10:00 a.m. to 12:00 p.m.
• August 21, 2025: 12:00 p.m. to 2:00 p.m.
• September 17, 2025: 10:00 a.m. to 12:00 p.m.

Register now for one of these courses.

Fentanyl Test Strip Direct Program agencies are required to have at least one staff member attend a fentanyl test strip train-the-trainer course and use the curriculum provided to train others on how to use fentanyl test strips. This course is not designed for the general public. The course is designed for people employed by a Fentanyl Test Strip Direct Program agency who want to learn how to train others to use fentanyl test strips.

This course is presented virtually.

No courses are scheduled at this time.

Contact dhsdcts@dhs.wisconsin.gov if you need to complete this course.

Go to the Dose of Reality: Get the Facts page for information that you can share in your community regarding fentanyl test strips.

• Fentanyl Test Strip Instructions, P-03360A (PDF)
• Social media posts