Table 1.

Naloxone distribution models in the USA: prescription specifications, targeted at-risk populations, and geographic reach

	Community-based organization Naloxone distribution	Traditional prescription	Pharmacy-based Naloxone models
			CPA	Standing medication order	Protocol order	Pharmacist prescribing
Who issues prescription?	Prescriber via standing order	Prescriber	Non-pharmacist prescriber	Non-pharmacist prescriber	Licensing board	Pharmacist
Medical professionals required	Varies by state: prescriber, state/local health department	Prescriber + pharmacist	Prescriber + pharmacist	Prescriber + pharmacist	Pharmacist	Pharmacist
Potential recipients	Individuals served by the community-based organization	Patients of the prescriber	Varies by state	Anyone meeting criteria specified by prescriber	Anyone meeting criteria specified by licensing board	Anyone for whom medication is indicated
Target overdose risk population served	People who use drugs (prescription opioids, heroin) who access the community-based organization*	People who use drugs who are in treatment/visit a prescriber*	People who use drugs (prescription opioids, heroin) who visit a pharmacy*	People who use drugs (prescription opioids, heroin) who visit a pharmacy*	People who use drugs (prescription opioids, heroin) who visit a pharmacy*	People who use drugs (prescription opioids, heroin) who visit a pharmacy*
		Patients prescribed opioids who are at risk of overdose*	Patients filling a prescription for opioids at a pharmacy who are at risk of overdose*	Patients filling a prescription for opioids at a pharmacy who are at risk of overdose*	Patients filling a prescription for opioids at a pharmacy who are at risk of overdose*	Patients filling a prescription for opioids at a pharmacy who are at risk of overdose*
Geographic reach	Limited to where community-based organizations are located and operate	Limited to where the prescriber practices	Any participating pharmacy within the state	Any participating pharmacy within the state	Any participating pharmacy within the state	Limited to where the pharmacist practices

*A majority of states now permit prescriptions to be written for third parties (e.g., friends, staff of organizations that provide services to individuals at risk of overdose) as well as the person at risk of overdose

CPA collaborative practice agreement