6.3 Naloxone Standing Order, Overdose Prevention & Harm Reduction Dispensing

Mississippi Naloxone Standing Order

Mississippi uses a statewide standing order to expand naloxone access. The current order is effective March 2, 2026 and cites Miss. Code Ann. § 41-29-319. Pharmacies should use the current signed order from the Board website, not a prior-year copy or a generic national protocol.

Authority and eligible dispensing

The standing order supplies prescriber authority for a pharmacist to dispense covered naloxone products to an eligible recipient without obtaining a separate patient-specific prescription from that person’s usual practitioner. The recipient may be a person at risk of opioid overdose or another person positioned to assist someone at risk, as the order and statute provide.

This is dispensing pursuant to an order, not independent pharmacist diagnosis. The pharmacist must stay within the current products, directions, eligibility, and conditions. A standing order does not permit substitution of an unlisted product or performance outside pharmacist scope.

Training and records

Before using the order, the pharmacist completes the specific naloxone training approved by the Mississippi Board of Pharmacy. The pharmacy retains evidence of completion and a copy of the current standing order. General opioid CE or CPR training should not be assumed to satisfy the specific standing-order training condition unless the Board identifies it as approved.

For each dispensing, the pharmacist reduces the standing order to a prescription under the issuing physician named in the order, enters the recipient and product information, and maintains it as a legend-drug prescription record. Do not record the pharmacist as the prescriber or file it as an undocumented OTC sale. Billers should use the prescriber and product information consistent with the order and payer rules without changing the legal record.

Counseling

The pharmacist should explain:

• how to recognize unresponsiveness, slowed or absent breathing, cyanosis, and other overdose signs;
• how to administer the specific intranasal or injectable product;
• the need to call 911 or emergency medical services immediately;
• rescue breathing or CPR according to training;
• repeat dosing when the person does not respond or symptoms recur;
• positioning, observation, and the possibility that naloxone’s effect will wear off before the opioid; and
• storage, expiration, replacement after use, and avoiding delay caused by fear of withdrawal.

Counseling should be understandable to the recipient and should include demonstration where appropriate. Naloxone is not a substitute for emergency evaluation.

Legal protection and professional judgment

Section 41-29-319 contains protections for specified good-faith naloxone prescribing, dispensing, and administration. State Good Samaritan provisions may also affect an overdose response. State the protection in its actual scope. Do not promise absolute immunity for unrelated negligence, diversion, falsified records, practicing outside the order, or failure to comply with its conditions.

The statewide order does not create a universal mandate that every opioid prescription must be accompanied by naloxone. Pharmacists should identify high-risk patients—high dosage, concurrent sedatives, prior overdose, respiratory disease, loss of tolerance, or household exposure—offer access, educate, and document under policy. A person may obtain naloxone even when the person at risk is not the recipient standing at the counter.

Workflow

Confirm the pharmacy has the current order and training documentation. Assess the recipient under the order, select a covered product, create the prescription under the issuing physician, dispense and counsel, and retain the record. Monitor order updates and replace an expired or superseded copy. This workflow distinguishes legal authority, dispensing record, and emergency education.

Dispensing example

A parent requests naloxone because an adult child uses illicit opioids. The recipient need not be the person at risk if the current order covers a person positioned to assist. Verify eligibility, select a listed product, enter the parent as recipient and the standing-order physician as prescriber, counsel the parent, and file the legend prescription. Do not demand that the child appear or disclose a prescription history not required by the order.

If the pharmacy completed training under an older order, compare the certificate and curriculum with current Board approval and keep the March 2, 2026 order on file. A product change, new order, or superseding instruction should prompt policy and staff updates before dispensing.

At follow-up encounters, ask whether the prior kit was used, lost, damaged, or expired and replace it under a new standing-order prescription when appropriate. Re-teach emergency response because a prior dispensing does not prove that the recipient remembers each step.