Naloxone Standing Order - for Pharmacist Use Only

For Michigan pharmacists interested in providing naloxone to Michigan families under the Standing Order issued by the State of Michigan’s Chief Medical Executive Dr. Eden Wells, please register by filling out the form below in its entirety.

Naloxone hydrochloride (naloxone) is a medication intended for reversal of opioid overdose in the event of a drug overdose that is the result of consumption or use of one or more opioid- related drugs. This standing order was issued pursuant to Michigan law which allows the chief medical executive to issue a standing order that does not identify particular patients at the time it is issued, for the purpose of a pharmacist dispensing the opioid antagonist naloxone. MCL 333.17701 et seq.

This standing order is intended to ensure that individuals within the State of Michigan who are at risk of experiencing an opioid-related overdose, or who are family members, friends or other persons who are in a position to assist a person at risk of experiencing an opioid-related overdose, are able to obtain naloxone. This order is not intended to be used by organizations who employ or contract with a prescriber who are authorized to write prescriptions. Such organizations should utilize the medical professionals with whom they have a relationship to write prescriptions specific to personnel who would be expected to administer naloxone.

Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review

Sample Unsigned Naloxone Standing Order - Note: You must secure a signed copy of the standing order, using the form below, before dispensing Naloxone in Michigan.

List of Pharmacies Approved to Dispense Naloxone

Map: Pharmacies Approved to DIspense Naloxone

Note: Dr. Wells does not do prior authorizations for this medication. We do not see patients, nor have any patient data. Patients must go through their primary care provider for all prior authorizations.

 

You Must Complete All Form Fields Before Submitting

When you submit the form, a response message with further instructions will appear.




  





* Spam Block: (What's this?)