NALOXONE ADMINISTRATION IN SCHOOL SETTINGS TOOLKIT
Resources for Obtaining Naloxone

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121A.224 Opiate Antagonists.

1. A school district or charter school must maintain a supply of opiate antagonists, as defined in section 604A.04, subdivision 1, at each school site to be administered in compliance with section 151.37, subdivision 12.
2. Each school building must have two doses of nasal naloxone available on-site.
3. The commissioner of health shall identify resources, including at least one training video to help schools implement an opiate antagonist emergency response and make the resources available for schools.
4. A school board may adopt a model plan for use, storage, and administration of opiate antagonists.

Steps to obtaining naloxone medication for your district or school.

Step One: A Standing Order for Distribution for a Prescribed Medication

A standing order for distribution of naloxone is required for Minnesota schools to obtain naloxone from a vendor who can dispense prescription medication. A licensed prescriber cannot write a prescription for a “school” or “district”. By law, prescriptions are patient specific (MN Statute 151.01 Definitions, Subd. 16a. Prescription). Therefore, schools as entities require a standing order for distribution of naloxone medication. Schools may be distributed to, but not prescribed to.

The Minnesota Department of Health offers a standing order for distribution. Schools may request to use the standing order for distribution by completing the Naloxone Standing Order and Protocol Registration Form. 

The State of Minnesota offers a statewide distribution program to obtain nasal naloxone for Minnesota groups that are now required by law to carry nasal naloxone, which includes schools (including public, charter, and private schools). 

There is no cost to ordering through the state. 

Minnesota Statewide Naloxone Distribution Program – all schools (public, charter, private) in Minnesota are eligible for this program. More information about this program can be found on the Naloxone Standing Order and Portal web site. 

To access this program, schools must complete the following actions.: 

Action 1: Sign up for the standing order and the condition specific protocol.

• If you are going to order the medication through this program you must sign up for the standing order and the condition specific protocol.
• If you only need a signed condition specific protocol for nasal naloxone that you have already received or purchased, you can just receive the condition specific protocol.

Action 2: Sign up for the web portal to order naloxone

Action 3: Login and order

Annual Renewal of Standing Order for Distribution and Condition Specific Protocol

It is best practice to review and renew standing orders and condition specific protocols annually.  

To obtain a new standing order for distribution and condition specific protocol through the Minnesota Statewide Naloxone Distribution Program:

Action 1: Fill out the Naloxone Standing Order and Protocol Registration Form

• When renewing, click “no” on Question 13.
• Note: Even by clicking “no” you will still have your login on naloxone ordering portal should you need to order more naloxone during the school year.  

Action 2: Download the updated standing order and protocol from the link on the next page you were directed or have it emailed by using the email option.  

Schools may also work with an organizations/vendors that is not the state program.  These organizations/vendors each have different ways related to the standing orders and distribution of the naloxone.  When working with the organization/vendor you should understand what type of naloxone can be ordered (nasal versus IM injection) and cost (free or price).

Two most common methods are:  

• Organization/vendor provide the school with a signed standing order (from their provider) and distribute the naloxone to the school.
• Organization/vendor provide the school with a template of the standing order. The school must find a local provider to sign and then return the signed standing order. Once that is complete, they will then distribute the naloxone to the school.
  • Schools may partner with their local EMS, clinics, or hospital to identify a medical provider who can write a standing order for naloxone distribution. 604A.04 Good Samaritan Overdose Prevention addresses health care professional release from liability.
  • Schools may sign up for a standing order from the State, using the actions above and provide the State signed standing order to the vendor/organization.

Step 2: Condition Specific Protocol

Condition specific protocols are required for nurses and all school personnel administering naloxone. 

The law requiring schools to maintain a supply of naloxone [121A.224] Opiate Antagonists states that the naloxone must be “administered in compliance with section 151.37, subdivision 12 .”
151.37 Subd. 12. Administration of opiate antagonists for drug overdose.
(b) For the purposes of this subdivision, opiate antagonists may be administered by one of these individuals only if:

1. the licensed physician, licensed physician assistant, or licensed advanced practice registered nurse has issued a standing order to, or entered into a protocol with, the individual; and
2. the individual has training in the recognition of signs of opiate overdose and the use of opiate antagonists as part of the emergency response to opiate overdose.

(c) Nothing in this section prohibits the possession and administration of naloxone pursuant to section 604A.04.

The purpose of a protocol is to define who should be given the medication, under what conditions (symptoms), how to give the medication, describe any precautions or warnings when giving the medication, the dosage of medication to be given, the route (nasal), when to given and when to repeat if needed, and any specific actions such as always calling 911 when naloxone is given.

The Guidance for a Naloxone Protocol in a School Setting provides further information especially as how it relates to nursing practice.  School nurses should become familiar with this document.

The Minnesota Department of Health offers a condition specific protocol. Schools may request to use the condition specific protocol by completing the Naloxone Standing Order and Protocol Registration Form (state.mn.us).  

Minnesota Statewide Naloxone Distribution Program – all schools (public, charter, private) in Minnesota are eligible for this program. More information about this program can be found on the Naloxone Standing Order and Portal web page. 

• Sign up for the condition specific protocol which has been signed by the MDH Medical Director by completing the Naloxone Standing Order and Protocol Registration Order Form. 
  • This condition specific protocol is only to be used with naloxone nasal spray 4 mg.  It does not cover naloxone given by IM injection or other strengths/dosages.
  • Schools can use this condition specific protocol even if they are not getting their naloxone through the State distribution program.

A Naloxone Condition Specific Protocol template for the school setting has been developed for schools who are working with a local medical provider.

Many schools have a relationship with a licensed prescriber (MD, NP, PA), local EMS medical director, local clinic, or hospital who is willing to sign a condition specific protocol.

Schools choosing to use the MDH template should work with the licensed prescriber and review the components of the template. The prescribed actions in the template are examples and may not suit your school situation and may not include all possible actions or meet the prescriber’s preference and direction. A licensed prescriber must review the criteria, actions and complete the prescription section (in red). It is recommended that the condition specific protocol be reviewed annually.

Other organizations/vendors that offer naloxone to schools

These are other organizations/vendors in addition to the State’s standing order distribution program.

Steve Rummler HOPE Network (SRHN) – Naloxone in Schools toolkit offers a standing order for distribution. Schools may work directly with SRHN to obtain naloxone, either through their free intramuscular naloxone program or facilitated purchase of nasal naloxone under their standing order.

Direct Relief’s Community Narcan Donation Program – all schools K-12 are eligible for this program and may sign up to be included on their waitlist for when they have available supply.

Emergent BioSolutions (formerly Adapt Pharma Inc.) Free Narcan Program – a program in which schools, libraries, YMCAs, and colleges can apply for free Narcan. Inquirers should email EmergentGives@ebsi.com to apply for their Free Narcan Program.

Emergent BioSolutions also offers a NARCAN Direct program where schools can register for a direct purchasing account. Schools will need to upload a signed Letter of Authorization to their portal to be eligible order the NARCAN brand at the public interest purchase price. This program will remain the same once NARCAN is available Over the Counter (OTC).