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Trending Topic: Protocols for co-prescribing naloxone

Emergency room visits due to opioid overdose jumped nearly 27 percent statewide between July and August 2017, prompting the NC Division of Public Health (NCDPH) to issue guidance to clinicians on co-prescribing rescue naloxone to patients who may be at risk.

There were 646 opioid overdose visits to emergency departments across NC in August 2017, up 136 visits from July. Overdoses from heroin, fentanyl and fentanyl analogues accounted for most of the increase in opioid overdose visits, according to NCDPH. Increased use of these drugs, in addition to widespread use of prescription opioids, underscores the need for prescribers to be aware of current recommendations for prescribing naloxone. Naloxone blocks or reverses the effects of opioids from all sources and can be administered in emergency situations to prevent death from overdose.

NC Division of Public Health recommends clinicians take the following steps:

  • Prescribe/dispense naloxone to patients discharged home after an opioid overdose to prevent death from future overdose.

  • Per CDC Guidelines, clinicians should consider offering naloxone for patients with a history of overdose, history of substance use disorder, on higher dosages (more than 50 morphine milligram equivalents/day) or with concurrent benzodiazepine use.

  • Educate patients and their family and friends that naloxone can be dispensed at participating pharmacies under NC’s standing order for naloxone. Information on participating pharmacies and use of naloxone can be found at

  • Provide information on syringe exchange. Syringe exchange programs are effective in decreasing transmission rates of HIV and hepatitis C, as well as connecting users to treatment. Information available at

  • Screen patients to determine risk for or presence of opioid use disorder, and connect to treatment services. Information on 24/7 crisis lines can be found at