CurrentASAMPolicy 26.85.000

Harm reduction: Dispensing safer use supplies and naloxone at discharge

Policy governing provision of harm reduction supplies (naloxone, safer smoking/snorting/injection kits, fentanyl test strips, etc.) to eligible adult patients with substance use disorder at discharge from Boston Medical Center; applies to nursing and licensed independent practitioners involved in ED, inpatient, observation, L&D triage and outpatient discharges.

Policy Summary

PayerASAM

PolicyHarm reduction: Dispensing safer use supplies and naloxone at discharge

Policy CodePolicy 26.85.000

Change TypeNo material change

Effective Date2023-02

Next Review Date2025-01

Key ActionNurses may use standing orders to assemble and provide naloxone and safer use supply kits at patient discharge.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

18+Minimum age

Naloxone + kitsSupplies included

AuthorizedStanding orders

A & BAppendices

MultipleSupply types listed

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Coverage Criteria for Harm Reduction Supplies and Naloxone

Patient eligibility for harm reduction supplies and naloxone

Covered when ALL of the following are met

Eligibility criteria: Patient is 18 years or older AND has an active substance use disorder AND has capacity to make medical decisions AND is medically and psychiatrically safe for discharge within the next 1-2 hours.

From Patient Eligibility and Application sections.

How supplies are provided

Dispensing pathway logic

Dispensing methods: RN initiates standing order to assemble and provide a supply kit and naloxone at discharge OR LIP/nurse obtains naloxone from the designated secure location and documents in the naloxone dispense log (shared with Outpatient Pharmacy) OR Addiction Consult service delivers naloxone to the patient at discharge if on-site supply is unavailable OR LIP e-prescribes naloxone to the patient's preferred pharmacy when 'Medication in Hand' criteria are not met.

Describes ED, inpatient, observation, L&D triage, and outpatient workflows.

The policy excludes certain individuals from receiving harm reduction supplies and naloxone. Specifically, patients under 18 years of age, patients judged by the attending physician to be at risk for intentional overdose, and patients with a known allergy to naloxone are not eligible to receive these supplies. These exceptions must be verified and documented by the treating team prior to dispensing.

When providing safer injection education and guidance materials, the policy explicitly instructs to avoid the groin, neck, and wrist as injection sites. Patient education should emphasize selecting safer sites (for example, arms or back of hand) and include alternate vein-finding techniques and a back-up site rather than using the listed avoid sites.

Discharge Processes by Level of Care

Provider Actions, Workflow and Documentation

Denial Risk

Eligibility Exceptions

Exceptions: Patients under 18 years of age; patients at risk for intentional overdose as determined by the attending physician; patients with a documented allergy to naloxone.

Documentation Required

Record Keeping and Storage

For record keeping and storage: place the patient's completed supply checklist in the designated secure location. LIP or nurse will obtain naloxone from the designated secure location and maintain the naloxone dispense log, which is shared on a regular basis with the Outpatient Pharmacy. Addiction Medicine service also maintains a naloxone dispense log shared regularly with the Outpatient Pharmacy. Supplies and supply checklists must be stored in a secure area.

Note

Safer Use Supply Menu (Appendix A)

Coding and Billing

No codes listedmixed

No codes listed

Coding notesNone

RationaleNo procedure, diagnosis, or billing codes are listed in the policy or appendices.

Related fieldSee 'CODING' section: No codes listed (neutral).

Treatment Modalities and Linkage

Medication for opioid use disorder (MOUD) linkage

MOUD linkage: Assess and discuss readiness for methadone, buprenorphine, detox, or START clinic; provide referrals to local programs (Project TRUST, AHOPE, Faster Paths) and document linkage/referral as part of discharge planning.

Referrals and linkage included in patient education/workflow.

Definitions and Terminology

Standing order / protocol

DefinitionWritten authorization from a duly authorized prescriber that indicates evidence-based practice standards for a specific medication or activity to be implemented by the nurse.

ScopeApplicable to specific patients or situations with consistent directions during implementation.

Approving authorityStanding orders are approved by BMC Medical-Dental Staff to allow licensed nurses to implement the order.

Safer Use Supply Menu (Appendix A)

DefinitionA list of injection, smoking, and other supplies provided for safer consumption (e.g., syringes, cookers, sterile water, alcohol pads, tourniquet, band-aids, fentanyl test strips, sharps container).

Example items (injection)Syringes (28g 1cc 1/2"; 31g 1cc 5/16"), cooker (sterile cylinder), sterile dental cotton, normal saline vial, tourniquet, alcohol pads, band-aid.

Background and Rationale

Harm reduction supplies and naloxone are framed in this policy as part of the clinical continuum of care for people who use drugs, intended to reduce overdose risk and improve public health outcomes. The program supports nurse-initiated standing orders and workflow options that enable timely provision of naloxone and safer use kits at discharge, linkage to addiction services when needed, and documentation of dispensing. Educational materials include practical, harm-reduction–focused instructions such as how to find a safe vein (use a tourniquet, exercise the limb, apply a warm compress) and emphasize selecting safer injection sites while avoiding higher-risk sites. These components are designed to facilitate rapid linkage to services and safer use education as part of discharge planning.

Policy Summary

PayerASAM

PolicyHarm reduction: Dispensing safer use supplies and naloxone at discharge

Policy CodePolicy 26.85.000

Change TypeNo material change

Effective Date2023-02

Next Review Date2025-01

Key ActionNurses may use standing orders to assemble and provide naloxone and safer use supply kits at patient discharge.

SourceLink

On This Page

Safer use supply menu (see Appendix A) — items that may be offered and documented on the supply checklist include: safer injection supplies (syringes of various sizes, cookers, sterile cotton, sterile water/normal saline vials, tourniquets, alcohol pads, Band‑Aids), safer smoking supplies (glass pipes, bubble pipes, chore boys, rubber tips, push sticks, chapstick), safer snorting supplies (plastic card, straw, plastic razor, scoop), fentanyl test strips, and sharps containers. Use the Appendix checklist to assemble kits based on patient-selected items.

Prior Authorization

Alternate Dispensing Steps

Alternate dispensing steps when on-site naloxone is not available: the LIP or nurse will page the Addiction Consult service to deliver naloxone to the patient at discharge. If naloxone cannot be located and Addiction Consult is not available, the LIP will e-prescribe naloxone to the patient's preferred pharmacy or BMC Yawkey when criteria for 'Medication in Hand' are not met. Nurses may also initiate naloxone per the Nurse-Initiated Protocol for Naloxone Take Home Kits where applicable.

Page Addiction Consult service to deliver naloxone at discharge (if on-site stock unavailable).
E-prescribe naloxone to patient’s preferred pharmacy or BMC Yawkey if 'Medication in Hand' criteria are not met.

Note

Provider Action Notes

Provider actions (miscellaneous): RN initiates standing order for Harm Reduction Supplies per protocol; offer to dispose of used supplies; provide supply checklist and assemble kit per patient's selections; provide supplies to patient at discharge together with naloxone; note that all patients with substance use (including stimulant-only) should be offered naloxone due to fentanyl risk.

Example items (smoking)Glass cylinder pipe, bubble pipe, copper wool (Chore boys), rubber lip protector, push stick, chapstick.

Additional itemsFentanyl test strips; sharps container.

Find a safe vein (Appendix B)

DefinitionBrief safer injection guidance describing techniques to locate and prepare a safer injection site (e.g., use a tourniquet, exercise, warm compress) and to select best vs. avoid sites.

Recommended techniquesUse a tourniquet (remove if you lose feeling below it); exercise (squeeze hands, swing arms); apply a warm compress over the site.

Preferred sitesArms; back of hand.

Sites to avoidGroin; neck; wrist.