Legal Requirements and Recommendations to Prescribe Naloxone

Published in: Drug and Alcohol Dependence, Volume 209 (April 2020). doi: 10.1016/j.drugalcdep.2020.107896

Posted on on February 21, 2020

by Rebecca Lee Haffajee, Samantha Cherney, Rosanna Smart

Download Support Files

OPTIC-Vetted Naloxone Policy Data

FormatFile SizeNotes
zip file 0.1 MB

The file(s) provided above are ZIP-formatted archives, which most modern systems can natively unpack. If your computer does not unpack the archive when you double-click it, you may need to use a separate decompression program such as UnZip.

Read More

Access further information on this document at Drug and Alcohol Dependence

This article was published outside of RAND. The full text of the article can be found at the link above.


The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior.


We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions.


As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1%) or offer a naloxone prescription (2 states, 11.8%); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8%) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness.


A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.

Supplemental Information

Supplementary data created in the course of this research is available for download above.

Research conducted by

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.