Dose of Reality: Opioid Overdose Reversal Medication Standing Orders
DHS established standing orders to serve as the prescription for naloxone so Wisconsin nurses and pharmacists can dispense or distribute naloxone to Wisconsinites who need it. The standing orders are intended to ensure Wisconsinites have access to naloxone, the opioid overdose reversal medication.
People should carry naloxone if they are at risk of experiencing an opioid-related overdose or may be in a position to assist a person at risk of experiencing an opioid-related overdose. See where naloxone is available for free or for purchase in Wisconsin.
Statewide standing order for nurses
The statewide naloxone standing order for nurses 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; and administer naloxone to a person who is experiencing an opioid overdose.
Statewide naloxone standing order for nurses (PDF)
Statewide standing order for pharmacists
The statewide naloxone standing order for pharmacists delegates authority to pharmacists and outlines the policies and procedures necessary for dispensing naloxone without a prescription to patients at risk of an opioid overdose or to people in a position to assist a person at risk for overdose.
Requirements, Procedures, and Sample Statewide Standing Order, F-01802 (PDF)
Obtain the signed standing statewide
Local standing order for pharmacists
The local standing order for naloxone for pharmacists is for pharmacists interested in using their own medical provider to issue a prescription order for naloxone necessary for dispensing naloxone without a prescription to patients at risk of an opioid overdose or to people in a position to assist a person at risk for overdose.
Local Prescriber Naloxone Standing Order for Pharmacists, F-01802A (Word)
Long-acting/high-dose overdose reversal medication
The standing orders for opioid reversal medication authorizes select nurses and 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 orders for opioid reversal medication standard dosing include 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 state's standing orders 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.