# Title 61 — State Board of Pharmacy

## Article 61-04 — Professional Practice

## Chapter 61-04-12 — Limited Prescriptive Authority for Opioid Antagonists

### § 61-04-12-01. Definitions.

For purposes of this chapter:
1. "Opioid-related drug overdose" means a condition including extreme physical illness,
decreased level of consciousness, respiratory depression, coma, or death resulting from the
consumption or use of an opioid or another substance with which an opioid was combined.
This would include an overdose that requires medical assistance or a coroner, clinical
suspicion for drug overdose (respiratory depression, unconsciousness, altered mental status),
and either a urine toxicology screen positive for opiates or negative urine toxicology screen
without other conditions to explain the clinical condition.
2. "Patient" means both an individual who is at risk of opioid overdose and a person who is not at
risk of opioid overdose but who may be in a position to assist another individual during an
overdose who has received patient information.
3. "Patient information" means the information provided to the patient on drug overdose
prevention and recognition, opioid antidote dosage and administration, the importance of
calling 911, care for the overdose victim after administration of the overdose antidote, and
other issues as necessary.
History: Effective April 1, 2016.
General Authority: NDCC 28-32-02, 43-15-10
Law Implemented: NDCC 23-01-42, 43-15-10(23)
### § 61-04-12-02. Pharmacists furnishing opioid antagonists.

1. Protocol.
a. Pharmacists are authorized to furnish opioid antagonist drug therapy solely in
accordance with the written protocol for opioid antagonist drug therapy approved by the
board.
b. Any pharmacist exercising prescriptive authority for opioid antagonist drug therapy shall
maintain a current copy of the written protocol for opioid antagonist drug therapy
approved by the board.
2. Procedure. When a patient requests an opioid antagonist, or when a pharmacist in his or her
professional judgment decides to advise of the availability and appropriateness of an opioid
antagonist, the pharmacist shall complete the following steps:
a. Screen for the following conditions:
(1) Whether the potential recipient currently uses or has a history of using illicit or
prescription opioids (if yes, skip to subdivision b and continue with procedure);
(2) Whether the potential recipient is in contact with anyone who uses or has a history
of using illicit or prescription opioids (if yes, continue with procedure); and

(3) Whether the person to whom the opioid antagonist would be administered has a
known hypersensitivity to opioid antagonist (if yes, do not furnish).
b. Provide training in opioid overdose prevention, recognition, response, and administration
of the antidote opioid antagonist.
c. When an opioid antagonist is furnished:
(1) The pharmacist shall provide the patient with appropriate patient information and
counseling on the product furnished, including dosing, effectiveness, adverse
effects, storage conditions, shelf-life, and safety. A pharmacist furnishing an opioid
antagonist drug therapy may not permit the patient to whom the drug is furnished to
waive the patient information required by the board.
(2) The pharmacist shall provide the patient with any resources and referrals to
appropriate resources if the patient indicates interest in addiction treatment,
recovery services, or medication disposal resources at this time.
(3) The pharmacist shall answer all questions the recipient may have regarding an
opioid antagonist.
3. Authorized drugs.
a. Prescriptive authority is limited to all opioid antagonists and includes any device
approved for the administration of an opioid antagonist.
b. Those administering an opioid antagonist should choose the route of administration
based on the formulation available, how well they can administer it, the setting, and local
context.
4. Education and training. Prior to furnishing an opioid antagonist, pharmacists who participate in
this protocol shall successfully complete a minimum of one hour of an approved continuing
education program specific to the use of an opioid antagonist, or an equivalent curriculum-
based training program completed in a board-recognized school of pharmacy.
5. Records. The prescribing pharmacist must generate a written or electronic prescription for any
opioid antagonist dispensed and the pharmacist shall record themselves as the prescriber or
the protocol practitioner if appropriate. Documentation shall be made in a medication record
for the patient. The prescription shall be kept on file and maintained for five years as required
in North Dakota Century Code section 43-15-31.
6. Notification. If the patient is the potential individual to whom the opioid antagonist will be
administered, the pharmacist shall notify the patient's primary care provider of any drugs and
devices furnished, or enter the appropriate information in a record system shared with the
primary care provider.
If the patient does not have a primary care provider, the pharmacist shall provide a written
record of the drugs and devices furnished and advise the patient to consult an appropriate
health care provider of the patient's choice.
History: Effective April 1, 2016; amended effective January 1, 2024.
General Authority: NDCC 43-15-10
Law Implemented: NDCC 23-01-42, 43-15-10(23)
