View, Download, and Print PDF

Montana Statewide Standing Order
for Naloxone Opioid Antagonist
(Effective January 1, 2023)

Page 1 of 3

Authority:

This standing order is issued pursuant to the Help Save Lives From Overdose Act. Mont. Code Ann. Title
50, chapter 32, part 6. The Act authorizes the State Medical Officer to prescribe on a statewide basis an
opioid antagonist by standing order to eligible recipients. Mont. Code Ann. § 50-32-604.
This standing order supersedes the Montana Standing Order for Naloxone Opioid Antagonists, dated
January 4, 2022, which has expired and is hereby withdrawn.


Purpose:

The purpose of this standing order is to aid persons experiencing an opioid-related overdose by
facilitating the distribution of the opioid antagonist naloxone to eligible recipients in Montana. A
suspected opioid-related overdose can be reversed and death prevented by timely administration of
the opioid antagonist naloxone.


Eligible Recipient:

Eligible recipient is defined in Mont. Code Ann. § 50-32-603(5)(a)-(i) as:

  • A person who is at risk of experiencing an opioid-related drug overdose;
  • A family member, friend, or other person who is in a position to assist a person who is at risk
    of experiencing an opioid-related drug overdose;
  •  A first responder or a first responder entity;
  •  A harm reduction organization or its representative;
  • The Montana State Crime Laboratory or its representative;
  • A person who, on behalf of or at the direction of a law enforcement agency or officer, may
    process, store, handle, test, transport, or possess a suspected or confirmed opioid;
  •  A probation parole, or detention officer;
  • A county or other local public health department or its representative; or
  •  A veterans’ organization or its representative.


Authorization:

This standing order shall be considered a naloxone prescription for an eligible recipient. This standing
order authorizes a pharmacist to dispense naloxone to an eligible recipient, as defined above, in
accordance with the requirements of this standing order.

--Page 2 of 3--

Pursuant to Mont. Code Ann. § 50-32-607(1)-(3), an eligible recipient to whom an opioid antagonist is
prescribed, dispensed, or distributed and who has received the requisite instruction and information
(set forth below) may do any of the following:

  •  Possess and store the opioid antagonist. The storage of an opioid antagonist is not subject to
    pharmacy practice laws or other requirements that apply to the storage of drugs or
    medications.
  • In good faith, administer or direct another person to administer the opioid antagonist to a
    person who is experiencing an actual or reasonably perceived opioid-related drug overdose; or
  •  Distribute the opioid antagonist to a person who is an eligible recipient under Mont. Code
    Ann. § 50-32-603(5)(a) or (b).


Terms and Conditions:

Any prescription issued pursuant to this standing order must designate the eligible recipient as the
patient, regardless of the recipient’s status as an individual, organization, agency, or other entity. A
pharmacist using this standing order to dispense naloxone must:

  • Maintain a copy of the standing order at the pharmacy.
  •  Designate the prescriber as the State Medical Officer.
  • Comply with all Montana Board of Pharmacy requirements for prescription orders, labeling,
    recordkeeping, and counseling.
  • Provide the eligible recipient with basic instruction and information, the content of which has
    been developed by DPHHS and is available at: www.naloxone.mt.gov
    Formulations:

Naloxone is available through the standing order in two formulations – a nasal spray and a prefilled
syringe with atomization device. The intranasal naloxone nasal spray is the most accessed formulation
by eligible recipients in Montana, likely related to the ease of administration. Emergency medical
services personnel, first responders, or other medical professionals may prefer the prefilled syringe
with atomizer.

A pharmacist dispensing a prescription from this standing order must enter the prescription as one of
the following orders and must indicate the quantity to dispense:


Prescriber: Margaret Cook-Shimanek, MD, MPH
Address: 1400 East Broadway St
Cogswell Building, Rm 201 PO Box 202951
Helena MT 59620
Phone: 1-406-329-1690
NPI # 1295907210


Intranasal naloxone HCL (Narcan®)
Naloxone Nasal Spray 4 mg
Administer a single spray into one nostril upon signs of opioid overdose. Call 911. May repeat every 2-3
minutes until EMS arrives.
Quantity: (minimum 2 units) 

--Page 3 of 3--

Intranasal naloxone with atomizer device (2 prescriptions):
Naloxone 2 mg/2ml Prefilled Syringe
Spray one-half the content of each syringe into each nostril upon signs of opioid overdose. Call 911.
May repeat one time.
Quantity: (minimum 2 syringes)

Mucosal Atomization Device (MAD)
Use as directed for nasal naloxone administration. Call 911. Quantity: (minimum 2 devices)


Training, Instruction, and Information:

The DPHHS Opioid Overdose Recognition and Response Guide includes information on the recognition
of signs and symptoms of an opioid-related drug overdose, indications for the administration of an
opioid antagonist, administration technique, and the need for immediate follow-up and care by a
medical profession, including calling 9-1-1. The Guide is publicly available at www.naloxone.mt.gov
If your organization or agency would like a designated staff to be trained on how to train other staff to
administer naloxone, master level training program information is available at www.naloxone.mt.gov.
While training is recommended, eligible recipients are not required to complete these trainings prior to
accessing or administering naloxone through the standing order.


Eligible recipients can order naloxone directly from the DPHHS dedicated website
www.naloxone.mt.gov and find additional information for community organizations that offer the
medication.


This standing order is effective January 1, 2023, through December 31, 2023, unless otherwise updated
by the Acting State Medical Officer or her replacement.

 

Margaret Cook-Shimanek, MD, MPH 
Acting State Medical Officer
Montana Department of Public Health and Human Services

Date signed (12/21/2022)

Back to Top