Utah Providers Can Make a Difference

Prescription opioids can lead to dependence, misuse, addiction, and overdose.

Utah Clinical Guidelines for Prescribing Opioids

Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain were produced and made available to medical providers. These guidelines were developed by a multidisciplinary consensus panel after a review of existing evidence-based guidelines. Common recommendations were compiled and presented to the panel for review. The guidelines consist of a set of recommendations for both acute and chronic pain. A second panel reviewed existing tools for providers and determined the need for any new tools. The final guidelines include 20 tools for providers to use in their practice.

Screen for mental illness

Don’t guess, assess. Research shows that when anxiety and depression are treated first, pain symptoms go down. Screen patients for opioid use disorder and mental health disorders. 65% of prescription opioid deaths involve someone with a current mental health issue. Risk assessment tools can help identify these individuals.

Risk Assessment Tool

Check the database

The Utah Controlled Substance Database program (CSD) is a prescription monitoring program that can be used to identify potential cases of drug abuse and over-prescribing. But the database is underutilized. Physicians fail to identify opioid abusers 86% of the time.

Get Access to Database

Explain the risks

Take time to make sure your patients understand the potential risks of opioids, even when taking as prescribed. If you do prescribe, start low and go slow. Talk about the warning signs of dependency and addiction. Discuss non-opioid treatment methods.

Stop the Opidemic Brochure

Provide safeguards

Review the signs and symptoms of an overdose with the patient and their family. Make sure everyone understands what naloxone is, where to get it, and how to administer it. Remind them to always call 9-1-1 in case of an overdose, even if they have naloxone.

Learn About Nalaxone

Key Legislation

Controlled substance prescribers will be required to receive a one-time training. View legislation at 2017 H.B. 175, Eliason

Opioid prescriptions for acute, non-complex, non-chronic conditions will be limited to 7 days. View legislation at 2017 H.B. 90, Ward

Certain Insurances are required to report annually on their adoption of opioid risk-reduction policies. View legislation at 2017 H.B. 90, Ward

Certain Insurances are required to report annually on their adoption of opioid risk-reduction policies. View legislation at 2017 S.B. 258, Mayne

Department of Health to create guidelines for prescribers to co-prescribe naloxone with an opioid. View legislation at 2017 S.B. 258, Mayne

Establishes a process for an individual suffering from a substance use disorder to receive court-ordered essential treatment and intervention. View legislation at 2017 H.B. 286, Christensen

"WE, AS CLINICIANS ARE UNIQUELY POSITIONED TO TURN THE TIDE ON THE OPIOID EPIDEMIC."
Former US Surgeon General
Vivek H. Hurthy, M.D., M.B.A.

Since 2000, the U.S. has seen a large increase in opioid drug misuse resulting in elevated numbers of overdose cases and deaths. These numbers have reached epidemic levels and drug poisoning is currently the leading cause of deaths due to injuries for adults in the U.S. Utah has ranked top 10 in the nation for overdose deaths over the last 10 years. This website is designed to provide comprehensive information regarding the distribution, possession, and usage of the drug naloxone which acts as an antidote for opioid overdose. The content is based on laws that are pertinent primarily to the state of Utah.

On December 8,2016 the executive director of the Utah Department of Health signed a statewide standing order allowing to dispense naloxone, without a prior prescription, to anyone at increased risk of experiencing or witnessing an overdose. Through this standing order, anyone can walk into a pharmacy and purchase naloxone without a prescription.

Naloxone Distribution and Dispensing for High Risk Patients

Naloxone should be considered for all patients exposed to opioids, whether they are prescribed or coming from another source.
Other risk factors for opioid overdose include:
- History of alcohol or substance use
- High daily doses of opioids
- Switching opioid products
- Loss of tolerance to opioids (i.e. recently released from prison, detox, or substance use treatment; even after a few days, a persons tolerance for opioids decreases significantly)
- Comorbid mental illness (including post traumatic stress disorder and depression)
- Receiving multiple prescriptions from various prescribers or pharmacies
- Past history of overdose
- Those receiving opioids and benzodiazepines
- Those receiving opioids and antidepressants
- Those receiving opioids and respiratory problems
- Those receiving opioids and renal or liver disease

Comparison of Naloxone and Examples of Prescriptions

A full list and comparison of naloxone products can be found here.

Sample Prescriptions:

Educate Patients When Prescribing Opioids

All patients should be educated by their physician if they are prescribed opioids. Explain to the patient:

Safe storage of opioid prescriptions
The risk of opioid overdose, especially if mixed with other substances
The dangers of drug dependence associated with opioids
How to identify an opioid overdose
- Pale face, blue lips/fingernails
- Limp body
- Slow or no breathing
- No response after physical stimulation (rub hard in the middle of the person’s chest)
- Pinpoint pupils
- Slow heart rate
- Low blood pressure
How to administer naloxone during an opioid overdose
That free naloxone kits may be available in their area (contact naloxone@utah.gov for more information)

Physicians should complete the Drug Abuse Screening Test (DAST-10) for patients at risk of overdosing. Consider using a Screener and Opioid Assessment for Patients with Pain (SOAPP) for pain patients. For stable patients, physicians may use the Current Opioid Misuse Measure (COMM).

Physicians may also use Screening Brief Intervention and Referral to Treatment (SBIRT) as well as the Utah Controlled Substance Database (UCSD) for laws and advisory warnings involving prescribing many medications.

Resources for Dispensing Naloxone

The Executive Director of the Utah Department of Health (UDOH) signed a statewide standing order, as authorized by the Opiate Overdose Response Act, which allows pharmacists to dispense naloxone to patients without a prior prescription. Having naloxone more readily available is a public health measure that can potentially reduce the number of deaths related to opioid or heroin overdoses.

Opioid Overdose Response Act (Chapter 55 of Utah Code)

Passed in May of 2016, the Opiate Overdose Response Act contains provisions that expand access to naloxone to Utahns. Under the act, a health care provider may prescribe by means of a standing order, an opioid antagonist to an individual or individual’s family member or friend, who is at high risk for an opioid overdose.

Standing Order

For pharmacies that wish to enroll in the standing order, please click on the link to the enrollment form, fill out the information requested, and hit send. Your information will be sent to administrators at the UDOH and they will contact you with further information.

Reporting Requirement

As required in R156-17b-625, the pharmacist-in-charge (or a responsible corporate officer) for each pharmacy licensee that dispenses naloxone under the standing order shall affirm that the pharmacy licensee has complied with the protocol in UCA §26-55-105 and shall report the following information no later than 15 days after December 31 of each calendar year:

1. The total number of single doses of naloxone dispensed during the reporting period, and
2. The name of each naloxone product dispensed along with the total number of single doses of that particular product.

If you have any questions or need assistance completing the enrollment form, please contact us.

About Naloxone

Naloxone hydrochloride is a medication that blocks opioid receptors and displaces opioids already attached to these receptors. It works in approximately 2-5 minutes, and lasts in the body around 30-90 minutes. Always call 911 before or after naloxone is given because the person may fall back into overdose once the effects of naloxone wear off.

The timely administration of naloxone reverses opioid effects, including respiratory depression, which allows time for emergency personnel to arrive. Naloxone is available as intramuscular and intranasal administration. Types of opioids that naloxone works to reverse include oxycodone, hydrocodone, hydromorphone, oxymorphone, morphine, fentanyl, methadone, meperidine, codeine, tapentadol, tramadol, buprenorphine and heroin.

Naloxone has no addictive or psychoactive properties and has no effect if a person does not have opioids in their system. Individuals who regularly use opioids may experience immediate withdrawal symptoms if given naloxone, which may be uncomfortable, but are almost never life threatening.

All AEMT and Paramedic responders in the state of Utah are required to carry naloxone. Naloxone is an optional drug for the quick response and EMT level responders, so a few ambulances may not have naloxone on hand.

Since few police and fire stations are considered EMS providers, they do not fall under the same regulations as AEMTs and Paramedics, but many of these agencies are starting to carry naloxone during response efforts.

All responders who carry naloxone know the appropriate use, dose, and indications of an overdose patient.

If your station is interested in receiving training for naloxone, contact us here.

Guidance for Law Enforcement and First Responders Administering Naloxone

According to Utah Code Title 26 Chapter 55 Section 102, an Overdose Outreach Provider means:

A law enforcement agency;
A fire department;
An emergency medical service provider, as defined in Section 26-8a-102;
Emergency medical service personnel, as defined in Section 26-8a-102;
An organization providing treatment or recovery services for drug or alcohol use;
An organization providing support services for an individual, or a family of an individual, with a substance use disorder;
An organization providing substance use or mental health services under contract with a local substance abuse authority, as defined in Section 62A-15-102, or a local mental health authority, as defined in Section 62A-15-102;
An organization providing services to the homeless;
A local health department; or
An individual.

Where can I find an Overdose Outreach Provider?

There are several Overdose Outreach Provider’s in Utah who disseminate kits in their communities or who have kits available to disseminate through their profession, such as local health departments and substance use treatment centers. There is a statewide effort to increase the number of Overdose Outreach Providers who can provide naloxone kits and training on the proper administration of naloxone. Overdose Outreach Providers can enroll here to be included on the list of enrolled providers and to assist with tracking naloxone dissemination and reversals for Utah. If you have trouble accessing this form, please contact us.

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