Yep, we're at that point. They all get narcan now, even tramadol.

[emd123]

My thinking has evolved on narcan Rx's for opiate patients. My initial impression, when this started first being recommended, was, "Why would I prescribe narcan to my patient? If I thought they had a significant chance of overdosing, I'd just stop their opiate." And I do stop, or refuse to start opiates often, when the risks outweigh the potential gains (if any).

But as time goes on, and we're seeing this more and more recommended as a "safety measure" by the regulators, I've decided to start prescribing it, not only to my highest dose patients (I don't Rx over 90 MME/day, anyways, or allow an co-prescribed benzos) but for anyone on an opiate, no matter how low a dose.

Yes, we've come to the point, that any patient, even those on hydrocodone 5 mg per day, and even those only on a drug that 5 years ago wasn't even controlled and could be prescribed and refilled as freely as water 5 years ago (tramadol), are getting prescriptions for Narcan.

Do I think any of my patients are ever likely to need it used on them?

Not likely. But anything with as little downside as narcan, that the Feds, medical boards or a jury could potentially view as a safety measure, I'm not going to leave on the table. Everyone gets it now. They get a one time Rx, for "safety," and because the "Feds recommend it," to everyone. And since no one has a zero risk of overdose, even patients on low doses, you could argue there's really no dose too low to justify not at least considering prescribing it. Now, if the patients don't fill it, then that's on them. I can't control that, but anything that the Feds hang out there as safety measure-carrot, we'd be stupid not to prescribe it. I just gives more support to the statement, "I did everything I could."

Yes, it's utterly ridiculous that it's come to this, but that's where we are.

---

Members don't see this ad.

 

[lobelsteve]

My thinking has evolved on narcan Rx's for opiate patients. My initial impression, when this started first being recommended, was, "Why would I prescribe narcan to my patient? If I thought they had a significant chance of overdosing, I'd just stop their opiate." And I do stop, or refuse to start opiates often, when the risks outweigh the potential gains (if any).

But as time goes on, and we're seeing this more and more recommended as a "safety measure" by the regulators, I've decided to start prescribing it, not only to my highest dose patients (I don't Rx over 90 MME/day, anyways, or allow an co-prescribed benzos) but for anyone on an opiate, no matter how low a dose.

Yes, we've come to the point, that any patient, even those on hydrocodone 5 mg per day, and even those only on a drug that 5 years ago wasn't even controlled and could be prescribed and refilled as freely as water 5 years ago (tramadol), are getting prescriptions for Narcan.

Do I think any of my patients are ever likely to need it used on them?

Not likely. But anything with as little downside as narcan, that the Feds, medical boards or a jury could potentially view as a safety measure, I'm not going to leave on the table. Everyone gets it now. They get a one time Rx, for "safety," and because the "Feds recommend it," to everyone. And since no one has a zero risk of overdose, even patients on low doses, you could argue there's really no dose too low to justify not at least considering prescribing it. Now, if the patients don't fill it, then that's on them. I can't control that, but anything that the Feds hang out there as safety measure-carrot, we'd be stupid not to prescribe it. I just gives more support to the statement, "I did everything I could."

Yes, it's utterly ridiculous that it's come to this, but that's where we are.

Nope. Thats where you are.

Based on your fears, not science or reality.

 

[bedrock]

I’m not there at all. Ridiculous to prescribe narcan with tramadol

 

[painfree23]

How do u write for it? Had a patient tell me once it was a $$$

 

[oreosandsake]

please share your Rx

also, do you bring in the patient's family member and have them trained on it?

 

[drusso]

Nope. Thats where you are.

Based on your fears, not science or reality.

Our group has a grant to study this: We've been funded by a non-profit and an Angel scientist...


ABSTRACT

Oregon has experienced a dramatic increase in deaths from opioid overdose, opioid use disorder (OUD),

and other harms in parallel with increases in the prescribing of opioid medications for pain management.

Life-saving medication for treating opioid overdose is available. Naloxone, administered intra-nasally, is

a non-controlled, non-toxic medication that can be obtained via any medical provider with prescription

authority and through pharmacies. Research shows that laypeople and caregivers can be trained in 5–10

minutes to appropriately identify an overdose, and intervene. This project’s specific aims are to educate

community stakeholders on the availability of intra-nasal naloxone medication to prevent fatal opioid

overdoses; provide patients and caregivers direct one-on-one instruction on how to administer naloxone;

train other provider groups on how to develop naloxone programs within their organizations; and

disseminate best program practices to ensure long-term sustainability.

 

[emd123]

Nope. Thats where you are.

Based on your fears, not science or reality.

In two years, you'll be doing the same. And I'll be two years ahead of the curve. How do I know?
Because opiate ODs are going to continue and the drug control crew is going to get more and more oppressive with their regulations. And yes, it's 100% about fear. And there's plenty of docs that could have used a healthy dose of "fear" of the Feds, that have been made statistics. They probably wish now, that had a healthy dose of fear.

I few years ago I met a super old school Pain doc. I mean, way old. He started way before any of this opiate crisis stuff. He thought drug screens, Rx agreements, and prescription monitoring programs were all stupid and based on fear, because he started back in the days before we did any of that. But we all do that stuff now, that docs used to thing were stupid and fear based.

So, yeah. Whatever. CYA.

 

[emd123]

please share your Rx

also, do you bring in the patient's family member and have them trained on it?

Narcan nasal spray
Dispense 1 blist pack of 2
1 spray nasally prn

Use explained. Handout given. EMR marked with "Naloxone nasal spray has been prescribed and instructions given, as a safety measure (per CDC guidelines) ____(date)______."

Added "Narcan Rx" to history tab on EMR under "Drug Screen" and above "State Rx report check" where I add the dates done, for tracking.

One and done. Never have to worry about this one again.

File it under, "Easy stuff I can do, to show I went the extra mile for safety."

 

[emd123]

I’m not there at all. Ridiculous to prescribe narcan with tramadol

I think it was ridiculous to make Tramadol controlled. And I think it's ridiculous to assign tramadol the Morphine equivalent dose my state Rx monitoring website does. And I think most of the stuff we have to deal with is ridiculous. But I do it, because the only thing more ridiculous than jumping through regulatory hoops, is to not cover my a$s by jumping through regulatory hoops. So, since the people that allow me to prescribe opiates at their pleasure (Feds, DEA) are ridiculous about Tramadol, I write a ridiculous narcan Rx for all my patients, and that includes a few on tramadol.

But that's actually not the main reason. The main reason is that the easiest way for me to keep track of which opiate patients I write a tramadol rx for, is to just do it once, for everyone. Then I don't have to remember some MME dose target that will change yearly, monthly. And I don't have to keep track of whether low dose, moderate dose, patients on the borderline, or if their dose went up 1 MME/day after an opiate rotation their now in the CDC's range of needing one and I forgot to do it, or whatever.

Look, this is not ground breaking stuff. I just tell people, "Today you're going to see a second Rx with your pain medicine Rx. It's narcan. It's a nasal spray that can reverse the effects of pain medicine. Although I don't think you will ever do this, the government recommends that people on opiates have a reversal agent around if they were to accidentally take too much medicine. Again, I don't think you'd ever do that. If I did I wouldn't have prescribed you this medicine. But if your insurance covers it, and it's a reasonable price, it might not be a bad idea to keep it around, even if you never need it. After all, with as much drug abuse that is out there, you never know if you might possibly have to use it on someone else, sometime. And it could save a life. That being said, if the pharmacy wants to charge you an outrageous amount of money, and you can't afford it, then I understand. It's just a one time prescription. It's for safety. Just a recommendation from the drug control people because of all the medication abuse out there. Your decision if you want to buy it."

Just like it looks good to have a chart that documents multiple passed drug screens, an opiate Rx agreement, regular state Rx report checks, imaging with verifiable pain generators, no drug/etoh crimes on criminal background, it looks good to document a safety measure that the Feds think is important.....when something goes wrong.

But yeah, whatever. I really don't care if you guys prescribe your patients narcan or not. But myself, personally, there no amount of cover-my-a$s-ness that goes too far, in this day and age.

 

[pastafan]

What percentage of patients actually fill the prescriptions for narcan? I bet single digits. Definitely CYA.

 

[BobBarker]

Very few. It isn’t covered on most Medicare plans which is really humorous considering everything.

 

[emd123]

What percentage of patients actually fill the prescriptions for narcan? I bet single digits. Definitely CYA.

It’s irrelvant. The fact that you prescribed it is a box checked, in the world of Cover Your A$S. The fact that the patient opted not to fill it, tilts the scale of blame towards them if something bad happens.

It’s a box check world we live in folks. Check the boxes. This ain’t hard.

 

[oreosandsake]

really good read

The Opioid Crisis Is Not Just An American Epidemic


also, a really interesting documentary on codeine cough syrup

 

[emd123]

really good read

The Opioid Crisis Is Not Just An American Epidemic


also, a really interesting documentary on codeine cough syrup

Yep. It's going to get a lot worse before it gets better. And so are the Feds, and their regulations.

Stay ahead of the curve.

 

[Ducttape]

1. Narcan in some states are available without prescription.
2. narcan is not without risk.
3. CYA is not what the feds want a proper medical care. in fact, it may show a lack of thinking about specific patients as it is going to be a universal knee jerk reaction for you.
4. Narcan is not without cost
5. Technically, Narcan "lasts" for 2 years. it is not an indefinite prescription.
6. you may be harming those people you want to help. I have, a couple of times, recommended narcan for LOL on low dose opioids who subsequently refused to try low dose (im talking hydrocodone-acetaminophen 2.5/325, 2-3 times a day) because of the fear of overdose.
7. narcan is only as good as the person giving it - and it wont be the patient.
8. narcan may not improve the situation from a tramadol overdose. it might work from a mu agonist ie respiratory standpoint, but it may increase seizure risk, which is from the serotonin overdose aspect.


things to think about...

 

[emd123]

1. Narcan in some states are available without prescription.
2. narcan is not without risk.
3. CYA is not what the feds want a proper medical care. in fact, it may show a lack of thinking about specific patients as it is going to be a universal knee jerk reaction for you.
4. Narcan is not without cost
5. Technically, Narcan "lasts" for 2 years. it is not an indefinite prescription.
6. you may be harming those people you want to help. I have, a couple of times, recommended narcan for LOL on low dose opioids who subsequently refused to try low dose (im talking hydrocodone-acetaminophen 2.5/325, 2-3 times a day) because of the fear of overdose.
7. narcan is only as good as the person giving it - and it wont be the patient.
8. narcan may not improve the situation from a tramadol overdose. it might work from a mu agonist ie respiratory standpoint, but it may increase seizure risk, which is from the serotonin overdose aspect.


things to think about...

None of those is as bad as a fatal overdose, being held accountable for a fatal overdose, or as bad as being accused of not doing all one could have done to prevent a fatal overdose.

Plus, you all can poo-poo tramadol as "no big deal," but you're missing a huge and important point. Physicians have been held accountable, when an addict overdoses on another medication you haven't ever prescribed them, or a street drug you never prescribed them. Follow these cases. Many of them go back years, after a patient has left one's practice, and OD'd on someone else's Rx, meds bought off the street, or illicits. They go back and tie the past doc(s) to the patient and the overdose and try to assign a share of blame.

Again, you all are making valid points, but as far as I'm concerned, if the Feds are putting narcan out there as a potential life saving safety measure, it's only a matter of time until they start using the lack of having prescribed it, against doctors. It's just a matter of time.

Example: Doc starts tramadol because he thinks "Tramadol is not big deal." The patient likes the opiate effect, albeit small. The patient progresses quickly to schedule IIs, maybe even heroin. Maybe at some point they move on to a different doc, maybe they don't. But at some point they OD and die. Maybe not on tramadol, but some other opiate. Or maybe they OD on a bunch of opiates, benzos and your tramadol. Boom. All of a sudden there's a link between the patient's death, and you. I'm not saying this is likely to happen. But take Murphy's law, add lawyers and prosecutors, and family members in dire need of money, and it you bet that the potential is there.

Find me one example of a pain doctor successfully being sued, or losing their license for prescribing narcan.
Or better yet, find me an example of a doctor charged or convicted for homicide for prescribing narcan.
And while you're looking, searching, digging to find even one, I'll be able to find dozens of examples of MDs who've lost their licenses, being sued or even charged and convicted of either enabling, or "not doing enough" to prevent, opiate overdoses.

I'd bet the latter, out numbers the former 1000 to 1, if not more.

My nurse tee's up the rx. One click I approve it. Done. Box checked. "Dr EMD did what's required, an even more."

So narcan expires in two years and I have to do it again. Lol. Who cares?
Easy.

Again, not a big deal. It's certainly not "required" to Rx narcan in all opiate patients, especially low dose or schedule III-IV opiate patients. But you can't overdose on CYA.

 

[lobelsteve]

Yep. It's going to get a lot worse before it gets better. And so are the Feds, and their regulations.

Stay ahead of the curve.

The only way you can fix this is to turn in your DEA registration. After that you can stop practicing pain and go back to the ER. Other than that I see no way out of this mess for you.

 

[Doctodd]

it seems that the state of Florida just mandated Narcan for all patients on opioids. So what stock are we buying?

 

[RM38]

Part of the law that recently passed here in FL states that we must co prescribe narcan for people with a trauma severity score greater than 9. It seems to me that they want everyone given chronic opiates that are schedule II on it, so I am going to start giving it to everyone staring July 1 to be sure I am in compliance.

 

[lobelsteve]

Part of the law that recently passed here in FL states that we must co prescribe narcan for people with a trauma severity score greater than 9. It seems to me that they want everyone given chronic opiates that are schedule II on it, so I am going to start giving it to everyone staring July 1 to be sure I am in compliance.

Overdose-reversal drug naloxone now available in Florida without an individual prescription
Been OTC for 2 years.

And apologies TO @emd123.

Prescribing opioids and antidote at the same time to prevent overdose deaths

Lobbyists and media hysteria have made it so in some states you are required to give Narcan with opiates.
Looks good on paper for them, not based in reality.

 

[emd123]

double post

 

[emd123]

And apologies TO @emd123.

Thank you. Good article and very appropriate to the discussion.


"A growing number of states are requiring doctors to prescribe a drug overdose antidote alongside prescription opioid painkillers to try to reduce drug deaths.

Under the laws, doctors are to prescribe naloxone when they give patients a certain dose of pills for drugs such as Percocet, Vicodin, OxyContin, and Tramadol or if patients have ever overdosed before. Naloxone can come in the form of a nasal spray, known as Narcan, or an auto-injector known as Evzio.

Arizona, Virginia, and Vermont already have the co-prescribing laws on the books, and lawmakers in California, Florida, New York, Ohio, Texas, and Utah are considering them.

The laws are one of several ways that states are trying to stave off the wave of deaths from opioids,..."

 

[244913]

What are you reversing by giving narcan to someone on tramadol

 

[lobelsteve]

What are you reversing by giving narcan to someone on tramadol

Psychology?

 

[Ducttape]

if you are so concerned about the possibility of an overdose, then your only solution is to stop all opioid prescribing.

Narcan will not prevent an overdose. it may help reduce the likelihood that it will be fatal, but narcan wont stop the OD.

61N, the narcan might reverse the centrally acting mu activity of tramadol.

 

[244913]

if you are so concerned about the possibility of an overdose, then your only solution is to stop all opioid prescribing.

Narcan will not prevent an overdose. it may help reduce the likelihood that it will be fatal, but narcan wont stop the OD.

61N, the narcan might reverse the centrally acting mu activity of tramadol.

How much tramadol would you have to take to get mu associated resp. depression. Mu potency is extremely low even with metabolite

 

[geauxg8rs]

This states if they have overdosed before? If there is history of O/D, why are they getting opioids again?? That is a false sense of security and could lead to death.

 

[Cholula]

Very few. It isn’t covered on most Medicare plans which is really humorous considering everything.

I did just have a Medicare patient with SilverScript Choice PDP where narcan was first denied because it is non-formulary, then we got a notice that it was approved without a PA. We didn't do anything, it just got approved without a PA. So I just want to share that with everyone.

 

[emd123]

What are you reversing by giving narcan to someone on tramadol

You'd be reversing any opiate the patient every OD'd on, not just tramadol, assuming someone was around to give it. But you're missing the point. I don't prescribe opiates to people who've OD'd before, or people I think would ever OD. I don't rx those people narcan, OR opiates. And I search for every reason possible not to prescribe opiates and I never start them on the opiate naive. The people I'm prescribing narcan to are precisely the people I think would never OD. I'm prescribing it to make the Feds happy. To check a box. And to cover my a$s if the unexpected did happen. And to create a track record of instituting one more safety measure than the next guy.

You think I'm using narcan as an excuse to keep high risk patients on opiates?

No, no, no, no, no. That's not a risk management reduction for yourself and your practice. You prescribe it to your already low risk, opiate patients, and don't take on, or prescribe opiates to the high risk patients, at all. Leave that to addiction/psych, with their suboxone.

Like I said before, don't prescribe people narcan, if you don't want. It's not a big deal, to me. I don't care if you all do or not, and right now it's not "required" or mandated by law. I'm not trying to tell you my word is gospel, or I decide what's standard of care, or anything. I'm just sharing one thing I've added, to the multitude of risk management and reduction techniques, policies and protocols, in my practice.

I am by no means putting narcan for all opiate patients as something groundbreaking or a game changer. My only point is, that right now, the feds view a narcan prescription as a safety measure. Period. That's how they view it. And as it always progresses when the Feds decide to introduce an optional safety measure, they'll soon progress to viewing not prescribing it, as an unnecessary sign of carelessness, poor judgement and perhaps negligent. I'm not saying it is, that. But that's how they are inevitably going to see it.

It's just like drug screens 30 years ago, before they were widely done. And it's just like PMP checks 10 years ago, before anyone checked them. Decades ago, they were considered unheard of, overbearing, and intrusive patient babysitting. Now, if you don't do these things, you're considered negligent. And in the case of PMP checks, which 10-15 years ago were unheard of, or at best optional or rarely checked, now it's criminal to not check them.

Of all the things the feds have foisted upon us, this is probably the easiest one. Narcan isn't even controlled. Your frickin' nurse can prescribe it, you just click the "approve" box. Done. And it's a drug with zero risk.

Don't ever, ever, ever, ever, ever prescribe it because you think your patient will OD. If you find yourself doing that, you should DEAD STOP in your tracks, and cancel the opiate Rx. Prescribe narcan for one reason and one reason only, and for every opiate patient. To make the Feds happy. Period.

To every patient, one time. Done. And if it makes you feel better, renew it in 2 years or when the drug expiration date passes, like @Ducttape suggests. But my guess is, narcan will be OTC in all 50 states by then, if not required by law for us to co-prescribe.

 

[emd123]

This states if they have overdosed before? If there is history of O/D, why are they getting opioids again?? That is a false sense of security and could lead to death.

I agree, if someone has overdosed before, the safest play is to not prescribe opiates at all, as opposed to prescribing opiates with narcan. But what the Feds are saying here is essentially, if you're dumb enough to prescribe the opiates in that patient, you sure as hell better throw some narcan at it to give them a chance. Remember, the drug control people are not MDs. They view these matters through the lens of someone without a medical degree. Looking from the outside in, they see 50,000 people dying of ODs and to them it's a forgone conclusion, that if all of those 50,000 had narcan on them and friends/family instructed in its use, that at least a few, would have survived. And they're probably right. It only takes 4-5 minutes from respiratory arrest, to brain death. Considering panicked, non-CPR trained family and friends discovering these people, combined with EMS response times which often can be 10-15 minutes or more in the areas of best EMS, it not a stretch to come to that conclusion. Right now, the Feds think it's a sign of a good, safety-conscious Pain doctor, to prescribe narcan. Again, I'm not saying that how it is. But I am saying that is how the Feds are starting to view it.

 

[emd123]

if you are so concerned about the possibility of an overdose, then your only solution is to stop all opioid prescribing.



.

That's not how I view it, but that is how a lot of people view it. But I don't think that's the best way to view it from a risk mitigation stand point. There's a subtle, but critically important difference here. Follow me:

A) Below, is how most people see it, and how the feds want us to see it, at a minimum, right now:

-Highest risk opiate patients: If you feel you must prescribe them opiates, you can do so, with caution and with narcan, because it might lower risk, some. Significant opiate-prescribing related risk (to the prescribing physician) is taken on here, unnecessarily.

-Lowest risk patient: Their risk is not as high as the high risk people, so you probably don't have to prescribe them narcan. You won't be faulted for not doing it, in a low risk patient. But you can if you want. Since these are low risk patients, the opiate-prescribing risk exposure here is low, whether narcan is prescribed or not.


B) On the other hand, this is how I propose is an even better and lower risk way of viewing it:

-Highest risk opiate patients: They're too high risk (to the physician) to prescribe opiates, so don't. If someone else wants to, you can't stop that. And maybe they need an opiate, but maybe suboxone, and only from addiction psych. And since they're not going to get opiates from you, there's not point in prescribing them narcan. As a result, no opiate prescription is given, by you, and therefore you are not exposed to any significant opiate-prescribing related risk.

-Lowest risk patients: Their risk is not as high as high risk people.. But since you're risk averse, and a smart doctor in the 21st century who is serious about risk reduction, you're going to lower risk even more, by instituting a risk reduction strategy (narcan) to reduce risk even further, in this already relatively lower risk patient population.


In my opinion, there is less opiate-prescribing related risk encountered by the physician, on pathway B), than A).

 

[drusso]

I agree, if someone has overdosed before, the safest play is to not prescribe opiates at all, as opposed to prescribing opiates with narcan. But what the Feds are saying here is essentially, if you're dumb enough to prescribe the opiates in that patient, you sure as hell better throw some narcan at it to give them a chance. Remember, the drug control people are not MDs. They view these matters through the lens of someone without a medical degree. Looking from the outside in, they see 50,000 people dying of ODs and to them it's a forgone conclusion, that if all of those 50,000 had narcan on them and friends/family instructed in its use, that at least a few, would have survived. And they're probably right. It only takes 4-5 minutes from respiratory arrest, to brain death. Considering panicked, non-CPR trained family and friends discovering these people, combined with EMS response times which often can be 10-15 minutes or more in the areas of best EMS, it not a stretch to come to that conclusion. Right now, the Feds think it's a sign of a good, safety-conscious Pain doctor, to prescribe narcan. Again, I'm not saying that how it is. But I am saying that is how the Feds are starting to view it.

Elections have consequences...

 

[lobelsteve]

Elections have consequences...

Harper Valley PTA?

 

[emd123]

Elections have consequences...

Yes, they do.

 

[Orin]

Yeah, I'm waiting for the Flumazenil autoinjectors before I start buying.

Regardless, it is easy to do, but definitely not cost effective. I do generally write for it for the legacy high OMEs and scenarios where there are kids/pets.

Primary, Chronic Pain and Palliative Care Settings
They have some nice pre-setup forms for prescribing and instructing.

 

[DODOCSS]

>45 MED, or pulm disease

 

[Ronin1]

I do all the recommended cya as above. Medication agreement, prescription profile, and now narcan RX added to the list. Of all these the thing that adds the most value is the pharmacy profile.

 

[Doctodd]

Overdose-reversal drug naloxone now available in Florida without an individual prescription
Been OTC for 2 years.

That article is disingenuous, or just an outright lie.

“Instead, they can purchase an autoinjector or intranasal version of naloxone through their pharmacists if the pharmacy receives a so-called blanket "standing order" from a doctor.”

Is so-called blanket “standing order” a different interpretation of a “prescription”?

 

[Ronin1]

Well I has a call from a CVS pharmacy today refusing to fill an OxyContin RX without a narcan RX on file. Well under 100 mg equivalent.

 

[bedrock]

Well I has a call from a CVS pharmacy today refusing to fill an OxyContin RX without a narcan RX on file. Well under 100 mg equivalent.

Wow.

I’m still not going to write narcan for tramadol, but I may start doing it for all schedule 2 opioids, even low doses.

 

[Ducttape]

so just fwiw, I went to the local pharmacy and got a kit "just in case" (I am not on opioids, but in case I see someone on the street that ODs....)

in my neck of the woods they cost $10 with govt coverage. 3 refills. $50 through regular insurance. make sure you tell patients to ask if the state picks up any part of the tab.

 

[Ferrismonk]

That article is disingenuous, or just an outright lie.

“Instead, they can purchase an autoinjector or intranasal version of naloxone through their pharmacists if the pharmacy receives a so-called blanket "standing order" from a doctor.”

Is so-called blanket “standing order” a different interpretation of a “prescription”?

In my state, each pharmacy has a "standing order" authorized by the state NPI or whatever to give the med. That being said, I have a certain medicaid where patients tell me it's not covered and they're being charged $200.

 

[Ducttape]

oh I forgot to mention.

all I had to give were my name and address. they did have my insurance info on file, so that's how they found out about how much it would cost through insurance (but it wasn't billed through insurance).

but this is for NY State, so check it out in your specific state...

 

[Johnathan Doeson]

I was told by a pharmacist that medicaid won't pay for the Evzio auto-injector, but they will pay for the nasal spray.

 

[EruditeDoc]

Just to clarify, Narcan is to be given to all patient 's on chronic opioids in Florida?

 

[Ronin1]

Just to clarify, Narcan is to be given to all patient 's on chronic opioids in Florida?