Naloxone Request by a 17-Year-Old for a Friend Who Uses Heroin
A 17-year-old high school student comes to a Kauai pharmacy and asks for naloxone. She says her 19-year-old boyfriend uses heroin and she wants to have naloxone at home in case he overdoses. She does not have a prescription and does not want her parents notified. The pharmacy participates in Hawaii’s naloxone standing order. The pharmacist is unsure whether a minor can consent to naloxone and whether dispensing to a third party is permitted. The patient is not the person at risk, but she is the one who will administer it. The pharmacist also considers whether to counsel on calling 911 and rescue breathing. The pharmacy has a policy of checking ID for all naloxone requests.
1. Can the pharmacist dispense naloxone to this 17-year-old under Hawaii law without a prescription and without parental consent?
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The pharmacist should look to the terms of Hawaii’s naloxone standing order and the Board of Pharmacy’s guidance. Hawaii allows pharmacists to dispense naloxone without a prescription under a standing order to persons who may be at risk of an opioid overdose or who may be in a position to administer naloxone to someone else. The standing order is a public health measure and is not limited to the person with opioid use disorder.
A 17-year-old may receive naloxone under the standing order without parental consent if the standing order and Hawaii law permit minors to consent to this preventive service. The pharmacist should not disclose the request to the parents. If the pharmacist is uncertain about the age provision, she should contact the Board or the standing-order prescriber rather than refuse a time-sensitive overdose-prevention request. The pharmacist should verify identity under pharmacy policy but should not use ID verification as a barrier to naloxone access.
2. Does it matter that the requester is not the person using opioids? Explain.
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No. Naloxone standing orders are designed to get naloxone into the hands of laypersons who may witness an overdose, including friends and family members. The requester does not need to be the person with opioid use disorder. In fact, third-party possession is a core part of overdose-prevention strategy. The pharmacist should counsel the 17-year-old on recognizing overdose, administering naloxone, calling 911, and performing rescue breathing. The pharmacist should also mention Hawaii’s Good Samaritan protections, which encourage bystanders to call for help without fear of prosecution for minor drug offenses.
3. What counseling and documentation should the pharmacist provide?
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The pharmacist should counsel on:
- How to recognize an opioid overdose, including slowed breathing and unresponsiveness.
- How to administer naloxone, including the device-specific instructions.
- The need to call 911 and start rescue breathing immediately.
- The fact that naloxone may wear off and the person may need a second dose or further medical care.
- Storage and replacement of naloxone.
- Hawaii’s Good Samaritan law and the importance of not delaying help.
The pharmacist should document the dispensing under the standing order, the counseling provided, and the identity verification performed, while keeping the record confidential. The pharmacist should not document unnecessary details about the boyfriend’s drug use beyond what the standing-order record requires.