t l:l
I
Kathleen
E.Toomey,
M.D.,M.P.H.,
Commissioner BrianKemp,Governor
f
2 Peachtree
Street,NW,15thFloor
Atlanta,
Georgia30303-3142
dph.ga.gov
STANDINGORDERFORPRESCRIPTION
OF NALOXONEFOROVERDOSE
PREVENTION
l. Authority.
ThisStandingOrderis issuedpursuant vestedin me as the Commissioner
to authority of Public
Healthand StateHealthOfficer,actingunderGeorgiaCodeSections31-1-10(bX2), 31-2A-2(b),
31-24-4,and 16-13-71(bX635)and(c)(14.25).
ll. Purpose.
The purposeof thisStandingOrderis to facilitate
thewidestpossibleavailabilityof naloxone
amongthe residentsof this State,to ensurethatfamilymembers,friends,co-workers, first
responders,schools,painmanagement clinics,harmreduction organizations,andanyother
personsor entities("Eligible are in a position
Personsor Entities") to provideassistance to a
personexperiencing an opioid-related
overdose throughthetimelyadministration of the opioid
naloxone.
antagonist
lll. Authorization.
ThisStandingOrdermaybe usedby EligiblePersonsor Entitiesas a prescription
to obtain
naloxonefroma licensedPharmacy. ThisStanding
Orderis authorizationfor a Pharmacy to
dispensenaloxonein anyof theformsshownon the attachedExhibitA.
Priorto obtaining
naloxoneunderthisStandingOrder,EligiblePersonsandEntitiesare
a trainingprogramin the administration
stronglyadvisedto complete of opioidantagonists,
suchas the courseavailable
fromthe GeorgiaDepartment of PublicHealththroughthisportal:
https://dph.qeorqia.sov/approvedtrai
ninq
EligiblePersonsandEntitiesarefurtheradvisedto becomefamiliarwiththefollowing
Signs
and Symptomsof Opioid Overdoseandthe appropriate useof naloxoneas directedby the
manufacturerandthe pharmacist.
lV. Signs and Symptomsof Opioid Overdose.
Thefollowing
aresignsandsymptoms
of an opioidoverdose:
o The victimhasa historyof useof narcoticsor opioids(eitherin prescription
drugformor illegaldrugs,suchas heroin).
o Fentanyl patchesor needlepunctures in the skin.
. The presence of nearbydrugparaphernalia suchas needlesor rubbertubing.
o Thevictimis unresponsive or unconscious.
. Breathing is slow,or shallow,or notpresent.
. Snoringor gurglingsoundsfromthethroatdueto partialupperairway
obstruction.
o Lipsand/ornailbedsareblue.
. Pinpointpupils.
. Skinis clammyto thetouch.
Notethatthesesymptomsmayalsoindicatecardiacarrest.lf the victimhas no discernable
pulse,theyare likelyin cardiacarrestandrequireimmediate
CPR.
In all cases,EligiblePersonsand Entitiesare advisedto call 911immediatelvupon
discoveringa possiblecaseof opioid overdose.
V. Duration.
ThisStandingOrdershallremainin effectuntilrevokedby me or my successorin office.
I
This-. ( f dayof March,2019.
ia Department
of PublicH
NPI No. 1407293889
DEA No. AT8967424
ExhibitA tOSTANDINGORDERFORPRESCRIPTION
OF NALOXONEFOROVERDOSEPREVENTION
of Pharmaceuticallv
EouivalentProduct
Naloxone HCI Route Strength Rx and Quantity Sig.( for suspected opioid overdose) Supplied
(other pacl€ge sizes acceptable)
2 pre-filled2 ML Luer-JetLuer-Lock
needlelessyringes Sprayt ML(112syringe(1MG)into each
Boxof 10 Luer-JetLuer-Lock
Pre-filledsyringe Nasal 1 M G / M L( 2 M L ) PLUS nostril).Repeatafter 2-3 minutesif no or
prefilledsyringes
2 Teleflexmucosalatomizer minimalresponse.
devices(MAD-300)
O . 4 M G / M(L1 M L )a n d 1
2 pre-filled2 ML syringes
0.4MG/ML:lnject1 ML in outerthigh.Repeat MG/ML(2ML) Boxof
(1ML) EITHER
0.4MG/ML after2-3 minutesif no or minimalresponse. 25 singledose pre-filled
fixedwith needle
Pre-filledsyringe IM oR1 OR syringeswith needlesOR
(2ML) OR
MG/ML 1MG/ML: Inject2 ML in outerthigh.Repeat shrinkwrappedpackagesof
withoutfixed needleprovide
after2-3 minutesif no or minimalresponse. 10 Luer-JetLuer-Lockpre-
2 1 - 2 5g a u g e1 - 1 . 5i n c hn e e d l e s
filledneedlelessyringes
Spraythe contentsof 1 device,intranasallyin
1 MG/MLprefilledsyringes
2MG/O.1ML OR one nostrilas a singledose.May repeatin 2 to
Intranasal
Liquid Nasal 2 intranasaldevices box of 25 X 2ML with21GX
4 MG/O.1ML 3 minuteswith contentsof anotherdevicein the
1.5 inchneedle
alternatingnostrilif no or minimalresponse.
2 single-use
1 ML vialsPLUS2
Injeci1 ML in outerthigh.Repeatafier 2-3 Boxof 10 or packageof 25
InjectionSolution IM 0 . 4 M G / M L( 1 M L ) syringes3ML w/ 21-25 gauge 1-
minutesif no or minimalresponse. single-doseMals(1 ML)
1.5inchneedles
1 multidose1OMLvialPLUS2
Injdct1 ML in outerthigh.Repeatafter2-3 Caseof 25 multidosevials
InjectionSolution IM 0 . 4 M G / M L( 1 o M L ) syringes3MLW 21-25gauge 1
minutesif no or minimalresoonse. ( 1 0M L )
1.5inchneedles
Injec'tinto outerthigh as direc{edby English
0.4MG/0.4M1 voice-promptsystem.Placeblacksidefirmlyon
Boxof 2 EA of singleuse
Autolnjeclor IM oR2 2 prefilledauto-injecfor
devices outerthighand depressand holdfor 5 seconds.
+ 1 trainer
autoinjectors
MG/O.4ML Repeatwith seconddevicein 2-3 minutesif no
or minimalresponse.