Pharmacists’ Authority to Initiate Harm Reduction Services

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists have the authority to dispense naloxone (effective since 9/28/22). A pharmacist may independently dispense naloxone if all three of the following criteria are satisfied: 1) the pharmacist has completed a one-hour training session on opioid overdose drugs; 2) the pharmacist questions the individual seeking naloxone about the potential users of the naloxone for the purpose of identifying any known contradictions to naloxone usage; and 3) the pharmacist informs the individual seeking naloxone of opioid overdose prevention, recognition, and response to naloxone. The pharmacist may (but is not required to) provide information on and/or referrals to resources on addiction treatment, recovery services, or medication disposal resources. However, the pharmacist may only provide this information if the individual seeking the opioid antagonist drug expresses interest in receiving such information. The pharmacist is required to provide on the drug’s label both instructions on the drug’s administration and directions to call 911 or other emergency services. Alaska Stat. Ann. § 17.20.085; Alaska Stat. Ann. § 08.80.168; Alaska Admin. Code tit. 12 § 52.994.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Alaska.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense naloxone pursuant to a statewide standing order (effective since 9/2/21). The naloxone recipient must sign a form that can be found within the standing order, which serves as the recipient's prescription. The standing order requires pharmacists to inform the naloxone recipient of the following: 1) how to recognize and respond to a possible opioid overdose; 2) how to administer naloxone; and 3) risk factors for opioid overdose, risk and recognition of addiction, and resources for mental health and addiction treatment services. The standing order permits unlimited refills. Ala. Code § 20-2-280; Ala. Code § 20-2-283; Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Alabama. Alabama Board of Pharmacy.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide standing order (effective since 9/6/17). Authorization is automatic, meaning the recipient need not bring/fill out additional paperwork. Pharmacists are authorized to order, dispense, and administer naloxone as well as any supplies needed for administration. A health insurer, including Medicaid, may not: 1) require prior authorization for the patient to obtain coverage for naloxone; or 2) impose any other requirement other than a valid prescription and compliance with the medication-assisted treatment guidelines issued by SAMSHA for a patient to obtain coverage for naloxone. A health insurer that utilizes a tiered drug formulary must place at least one naloxone product on the lowest-cost benefit tier. Ark. Code Ann. § 23-99-1119; Arkansas State Board of Pharmacy.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Arkansas.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense naloxone pursuant to a statewide standing order (effective since 8/23/22; expires and must be renewed by 8/22/23). Authorization is automatic, meaning the recipient need not bring/fill out additional paperwork. The authorized forms of naloxone are intranasal naloxone, intramuscular naloxone, and auto-injector naloxone. The pharmacist must complete an opioid prevention and treatment program that instructs pharmacists on each of the following: 1) how to recognize symptoms of an opioid-related overdose; 2) how to respond to a suspected opioid-related overdose; 3) how to administer all preparations of an opioid antagonist; and 4) the information needed by an individual to whom an opioid antagonist is dispensed. A pharmacist who dispenses an opioid antagonist is required to educate the person seeking the opioid antagonist on each of the following: 1) how to prevent an opioid-related overdose; 2) how to recognize the symptoms of an opioid-related overdose; 3) how to administer all preparations of an opioid antagonist; 4) potential side effects of/adverse events associated with administration of the opioid antagonist; and 5) the importance of contacting emergency services either before or after administering the opioid antagonist. Ariz. Rev. Stat. Ann. § 32-1968; Ariz. Admin. Code R4-23-407.1; Arizona Department of Health Services Standing Order for Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Arizona.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists have the authority to prescribe naloxone (effective since 1/1/23). Pharmacists must complete a one-hour training program on the use of opioid antagonists. The furnishing of naloxone is a covered pharmacist service that may be provided to a Medi-Cal beneficiary. Cal. Welf. & Inst. Code § 14132.968; Cal. Bus. & Prof. Code § 4052.01 (pharmacist furnishing); CDPH Statewide Naloxone Standing Order FAQs.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. The pharmacist must verify that the person seeking hypodermic syringes and needles is 18 or older. Cal. Bus. & Prof. Code § 4145.5.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 9/1/21). The pharmacist is strongly encouraged to educate the naloxone recipient on the use of an opiate antagonist for overdose, including instruction concerning risk factors for overdose, recognizing an overdose, calling emergency medical services, rescue breathing, and administering an opiate antagonist. Colo. Rev. Stat. Ann. § 12-280-123 (pharmacist requirements); Colo. Rev. Stat. Ann. § 12-30-110 (third-party prescriptions and standing orders).

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Colo. Rev. Stat. Ann. § 12-280-123(4).

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 6/30/15). The pharmacist must be trained and certified as part of a program approved by the Commissioner of Consumer Protection, must inform naloxone recipient on how to administer naloxone, and must keep a record of naloxone distribution. Conn. Gen. Stat. Ann. § 20-633c.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes, but may only sell up to 10 to a single person without a prescription. Conn. Gen. Stat. Ann. § 21a-65.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, Pharmacists may dispense through a standing order that they must request from the DC Department of Health. This standing order is not a blanket authorization; individual pharmacists must request and be approved by the Department (effective since 12/4/18). The pharmacist must complete proper training, which covers naloxone and opioid-related overdoses. The DC Health physician and pharmacist must fill out the form that can be found within the standing order, which the pharmacist must keep a copy of on file. District of Columbia Naloxone Standing Order; DC Health Policy Statement (2018).

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Washington, D.C.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Neither statewide standing order nor statute gives pharmacists authority to prescribe or independently dispense naloxone. Either a direct prescription or a standing order within a CPA with a primary care provider would be needed. The PCP is only meant to prescribe naloxone to individuals who have completed an approved training program (this responsibility prior to prescribing is on the PCP – a pharmacist need only be acting in good faith when dispensing). If group health insurance coverage provides prescription medication benefits for the treatment of mental illness and drug and alcohol dependencies, the health insurer must place at least one formulation of naloxone on the lowest tier of the drug formulary developed and maintained by the carrier. The health insurer may not impose either of the following: 1) a prior authorization requirement for naloxone and 2) step therapy requirement for naloxone. Del. Code Ann. tit. 16 § 138, 3001G; Del. Code Ann. Tit. 18 § 3571X.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes, but the pharmacist must verify that the person seeking hypodermic syringes or needles is 18 or older. Del. Code Ann. tit. 16 § 4762.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, a statewide standing order gives pharmacists the authority to independently prescribe and dispense naloxone to emergency responders for administration to persons exhibiting signs of an opioid-related overdose. Either a direct prescription or a standing order as within a CPA with a PCP would be needed for all other individuals seeking naloxone (effective since 9/30/22). Florida Department of Health Statewide Standing Order for Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Florida.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide standing order (effective since 6/29/18). Pharmacists must keep a copy of the SHO-issued standing order on file. Pharmacists can initiate a discussion about naloxone with a patient (i.e., they need not wait for the patient to express potential interest). Insurance is to be billed as any other "medication dispensed to an individual for their use." Pharmacists should also instruct the naloxone recipient on the following: 1) risk factors of an opioid-related overdose; 2) signs and symptoms of an opioid-related overdose; 3) how to respond to an opioid-related overdose; and 4) naloxone administration. Georgia Department of Health Standing Order for Prescription of Naloxone; Georgia Pharmacy Foundation Naloxone Standing Order FAQs.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. However, a pharmacist may not sell a syringe if they have reasonable cause to believe that it will be used for an unlawful purpose. Ga. Comp. R. & Regs. 480-10-.13.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 7/5/19). Pharmacists must complete an approved training program, which covers prescribing opioid antagonists and must provide the naloxone recipient with information and written educational material that covers the following: 1) risk factors of opioid overdose; 2) signs of an opioid overdose; 3) opioid overdose response steps; and 4) uses of the naloxone/opioid antagonist. The Department of Human Services must ensure that opioid antagonists for outpatient use are covered by the Medicaid prescription drug program on the same basis as other covered drugs. Haw. Rev. Stat. Ann. § 461-11.8; Haw. Rev. Stat. Ann. § 329E-4.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must provide the person purchasing syringes with educational material about preventing blood-borne diseases, drug treatment, and safe disposal of used syringes. Haw. Rev. Stat. Ann. § 325-21

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide protocol (effective since 6/28/22). Pharmacists must complete a one-hour training course approved by the Accreditation Council for Pharmacy Education that relates to utilizing naloxone. Pharmacists are required to determine the potential naloxone recipient's eligibility, based on the risk of overdose or proximity to another at risk of potential overdose, and keep an eligibility form on file for each person seeking naloxone. Naloxone recipients must complete training provided by the pharmacist. The exact requirements of the training are not specified but should include information on overdose signs and symptoms, administration of naloxone, and substance abuse or behavioral health treatment programs, if applicable. The pharmacist is limited to dispensing five naloxone kits to any one person at a time. Iowa Code Ann. § 155A.46; Iowa Board of Pharmacy, Naloxone Statewide Protocol.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Iowa.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 7/1/22). Pharmacists need only be licensed to practice in Idaho and prescribe naloxone in good faith and with reasonable care. Idaho Code Ann. § 54-1733B.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Idaho.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through a standing order that they must request from the Illinois Department of Public Health. This standing order is not a blanket authorization; individual pharmacists must request and be approved by the Department (effective since 9/15). Pharmacists must fill out a standing order request form, which can be found on the IDPH's website. Pharmacists must complete proper training, which covers naloxone and opioid-related overdoses. Pharmacists should inform the naloxone recipient of the following: 1) naloxone dosage and administration; 2) the importance of calling emergency services; and 3) how to care for an overdose victim after administering naloxone. An individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed in Illinois after 1/1/23 that provides coverage for prescription drugs must provide coverage for at least one opioid antagonist, including the medication product, administration devices, and any pharmacy administration fees related to the dispensing of the opioid antagonist. This coverage must include refills for expired or utilized opioid antagonists. Starting 1/1/24, an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in Illinois after 1/1/23 that provides coverage for naloxone hydrochloride is prohibited from imposing a copayment on the coverage provided. 215 Ill. Comp. Stat. Ann. 5/356z.23; IDPH Naloxone Standing Order Form; Illinois Department of Public Health, Naloxone Standardized Procedure.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must verify that the person seeking syringes and needles is 18 or older and may only sell 20 or less to a single person without a prescription 720 Ill. Comp. Stat. Ann. 635/2.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through a standing order if they annually register as a "naloxone entity" with either the state or local health department. Registered naloxone entities must comply with the following requirements: 1) provide naloxone recipients on drug overdose response and treatment, including the administration of naloxone; 2) provide drug addiction treatment information and referrals to drug treatment programs; and 3) submit an annual report to the state department that contains the number and date of naloxone sales. This standing order is not a blanket authorization; individual pharmacists/pharmacies must register annually and follow certain protocols (effective 1/1/23 – 12/31/23; a new standing order is to be issued for 2024). Ind. Code Ann. § 16-42-27-2; Indiana Department of Public Health, Statewide Standing Order for Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists are required to record the name and address of the person purchasing syringes. Persons under the age of 18 are explicitly permitted to purchase syringes. 856 Ind. Admin. Code 2-6-18.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide protocol that they must sign and submit a copy of to the Board of Pharmacy (effective since 3/17/22). Pharmacists must educate the patient seeking naloxone on the following: (1) opioid overdose prevention, recognition, and response; (2) safe administration of an emergency opioid antagonist; (3) potential side effects or adverse events that may occur as a result of administering an emergency opioid antagonist; (4) a requirement that the administering person immediately contact emergency medical services for a patient; and (5) the availability of drug treatment programs. Kan. Stat. Ann. § 65-16, 217; Kan. Admin. Regs. 68-7-23; Kansas State Board of Pharmacy Protocol for Dispensing Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Kansas.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Neither statewide standing order nor statute gives pharmacists the authority to prescribe or independently dispense naloxone. Either a direct prescription or a standing order within a CPA with a PCP would be needed. The pharmacist must be certified to dispense naloxone. To become certified, the pharmacist must complete and submit an Application for Pharmacist Certification for Naloxone Dispensing to the state Board of Pharmacy. The pharmacist must provide verbal counseling and written education materials regarding naloxone administration to the patient seeking naloxone. Protocol to Initiate Dispensing of Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. A pharmacy that offers nonprescription syringes must also offer to provide a naloxone prescription. Ky. Rev. Stat. Ann. § 217.177.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 1/1/23). The standing order recommends that the prescription be written for the patient seeking naloxone, even if they are not the potential recipient, for insurance reimbursement purposes. Pharmacists must provide verbal counseling to the patient seeking naloxone regarding the following: (1) techniques on how to recognize signs of an opioid-related drug overdose; (2) standards and procedures for the storage and administration of naloxone or another opioid antagonist; and (3) emergency follow-up procedures including the requirement to summon emergency services either immediately before or immediately after administering the naloxone or other opioid antagonist to an individual apparently experiencing an opioid-related drug overdose. La. Stat. Ann. § 40:978.2; 46 La. Admin. Code Pt LIII, 2541; Standing Order for the Distribution or Dispensing of Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. 46 La. Admin. Code Pt. LIII, 2509.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 1/1/23). The standing order recommends that the prescription be written for the patient seeking naloxone, even if they are not the potential recipient, for insurance reimbursement purposes. Pharmacists must provide verbal counseling to the patient seeking naloxone regarding the following: (1) techniques on how to recognize signs of an opioid-related drug overdose; (2) standards and procedures for the storage and administration of naloxone or another opioid antagonist; and (3) emergency follow-up procedures including the requirement to summon emergency services either immediately before or immediately after administering the naloxone or other opioid antagonist to an individual apparently experiencing an opioid-related drug overdose. La. Stat. Ann. § 40:978.2; 46 La. Admin. Code Pt LIII, 2541; Standing Order for the Distribution or Dispensing of Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. 46 La. Admin. Code Pt. LIII, 2509.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through a statewide standing order (effective since 10/4/18). All retail pharmacies are required to maintain a continuous supply of naloxone in stock. There is no limit to the amount of naloxone that may be dispensed to a single individual. Pharmacists are not required to undergo additional training or education. Mass. Gen. Laws Ann. ch. 94C, §§ 19B, 19C; Board of Registration in Pharmacy, Policy Statement No. 2018-04: Naloxone Dispensing via Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Mass. Gen. Laws Ann. ch. 94C, § 27.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide standing order (effective since 3/3/23; must be renewed by 6/30/24). Pharmacists are not required to undergo additional training or education. Pharmacists must inform the patient seeking naloxone on the proper administration of the opioid antagonist and of the necessity to seek out emergency services immediately after administering the opioid antagonist. The standing order permits pharmacists to dispense two doses of naloxone to a single individual. Maryland Medicaid covers naloxone (NARCAN® nasal spray, prefilled syringe, and single-dose vials) and the atomizer used to administer the medication in combination with the 2mg/2mL single-dose Luer-Jet prefilled syringe. Health insurers may apply a prior authorization requirement for an opioid antagonist only if the entity provides coverage for at least one formulation of the opioid antagonist without a prior authorization requirement. Md. Code Ann. Health – Gen § 13-3106; Md. Code Ann., Ins. § 15-850; Maryland Statewide Standing Order for Opioid Overdose Reversal Drugs (2023).

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. The person seeking to purchase syringes must show the pharmacist identification and state intended purpose of syringes. Md. Code Regs. 10.13.08.01.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 6/24/17). Pharmacists seeking to prescribe naloxone must first complete a two-hour, ACPE-approved training program, which covers the safe dispensing of an opioid antagonist, counseling, providing instructions to the person receiving the opioid antagonist, and its use as rescue therapy for an opioid overdose. Pharmacists must provide the naloxone recipient with information and written educational material that covers the following: 1) risk factors of opioid overdose; 2) signs of an opioid overdose; 3) opioid overdose response steps (which includes seeking immediate medical attention); and 4) uses of the naloxone/opioid antagonist. The pharmacist must notify the patient’s PCP if the patient has one. Me. Rev. Stat. tit. 22, § 2353; Code Me. R. tit. 02-392 Ch. 40, § 3, 4, 8, and 10.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must verify that the person seeking syringes and needles is 18 or older. Me. Rev. Stat. tit. 32, § 13787-A.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide standing order that they must request from the Michigan Department of Health & Human Services. This standing order is not a blanket authorization; individual pharmacists must request and be approved by the Department (effective since 7/21/22). Pharmacists must first undergo training in the proper use and administration of opioid antagonists and in opioid overdose response. To dispense naloxone under the standing order, a pharmacy must first register with the Department. Pharmacists must provide the patient seeking naloxone with educational material that outlines how to respond to an opioid overdose, including proper naloxone administration. A pharmacist must also provide the patient seeking naloxone with resource information regarding referral for treatment services. Mich. Comp. Laws Ann. § 333.17744e; Mich. Admin. Code R 338.202 – 204; Michigan Health & Human Services, Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Michigan.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide protocol (effective since 12/30/20). Pharmacists who use the statewide protocol must keep a written copy on file. Pharmacists must complete a board-approved training program specifically developed for prescribing opioid antagonists for the treatment of an acute opioid overdose. Pharmacists must provide the patient seeking naloxone with written education material that outlines how to respond to an opioid overdose, which includes proper naloxone administration and the importance of seeking emergency medical services. Pharmacists may, but are not required to, provide information on and/or referrals to resources on substance addiction treatment and recovery services. However, pharmacists may only provide this information if the individual seeking the opioid antagonist expresses interest in receiving such information. Pharmacists shall provide the patient seeking naloxone with information and appropriate resources concerning the proper disposal of medications and needles/syringes. A health plan that provides prescription coverage must provide coverage for opiate antagonists prescribed and dispensed by a pharmacist under the same terms of coverage that would apply had the prescription drug been prescribed by a primary care provider. Minn. Stat. Ann. § 151.37(Subd. 16); Minn. Stat. Ann. § 62Q.529; Minnesota Board of Pharmacy, Pharmacist Prescribing Protocol Opioid Antagonists.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists may only sell up to 10 syringes to a single person without a prescription. Minn. Stat. Ann. § 151.40.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 1/25/23). Pharmacists are not required to undergo additional training or education. Pharmacists must inform the patient seeking naloxone of the following: 1) risk factors and signs of an overdose; 2) overdose response steps; 3) proper use of naloxone; and 4) the need for comprehensive substance abuse medical treatment. Health insurers are prohibited from requiring step therapy or prior authorization for naloxone. Naloxone must be placed on the lowest cost-sharing tier of a health insurer's formulary. Health insurers' formularies must include naloxone. Mo. Ann. Stat. § 195.206; Naloxone HCL Dispensing Protocol (2023).

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Missouri.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 5/11/22; must be renewed by 5/10/23). Pharmacists who use the statewide standing order must keep a written copy on file. Pharmacists must complete a training program approved by the Mississippi Board of Pharmacy and must counsel the patient seeking naloxone on its proper administration. Miss. Code. Ann. § 41-29-319; Mississippi State Department of Health, Statewide Naloxone Standing Order; Mississippi Board of Pharmacy, Naloxone Statewide Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Mississippi.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 1/1/23; must be renewed by 12/31/23). Pharmacists who use the statewide standing order must keep a written copy on file. Pharmacists are not required to undergo additional training or education. Pharmacists must provide the naloxone recipient with basic instructions, which include the following: 1) signs of an opioid overdose; 2) opioid overdose response steps (which includes seeking immediate medical attention); and 3) uses of the naloxone/opioid antagonist. Mont. Code Ann. § 50-32-604; Montana Statewide Standing Order for Naloxone Opioid Antagonist (2023).

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Montana.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through statewide standing order (effective since 3/24/22). Pharmacists are not required to undergo additional training/education or take any additional steps. Pharmacists are required to provide the patient seeking naloxone with information regarding the risk factors of overdose, signs of an overdose, overdose response steps, and the use of naloxone. C. Gen. Stat. Ann. § 90-12.7. NC Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in North Carolina.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through the Board of Pharmacy’s statewide protocol (effective since 8/31/22). Pharmacists who use the statewide protocol must keep a written copy on file. Pharmacists must first complete a one-hour training course covering the use of naloxone. Pharmacists must generate a written or electronic prescription for each unit of naloxone distributed, which cites the pharmacist as the prescriber. Pharmacists must notify the primary care provider of the patient seeking naloxone. If the patient does not have a primary care provider, the pharmacist must advise the patient to consult one (pharmacists are not required to list local primary care providers). Pharmacists may, but are not required to, provide information on and/or referrals to resources on substance addiction treatment and recovery services. However, the pharmacist may only provide this information if the individual seeking the opioid antagonist expresses interest in receiving such information. Pharmacists must counsel the patient seeking naloxone on opioid overdose prevention, recognition, response, and administration of the naloxone. D. Cent. Code Ann. § 23-01-42; D. Cent. Code Ann. § 43-15-10; D. Admin. Code 61-04-12-02.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in North Dakota.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 8/11/22; must be renewed by 8/10/23). For purposes of prescribing naloxone, pharmacists acting under the standing order are considered "health professionals" (same as PCP – likely key for insurance). The standing order permits refills (no specified restriction on the number of refills). Pharmacists are not required to undergo additional training or education or take any additional steps. Neb. Rev. Stat. Ann. § 28-470(5)(d); Neb. Rev. Stat. Ann. § 28-470; Nebraska Naloxone Standing Order Information.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Neb. Rev. Stat. Ann. § 28-442.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Neither statewide standing order nor statute gives pharmacists the authority to prescribe or independently dispense naloxone. Either a direct prescription or a standing order within a CPA with a PCP would be needed. N.H. Rev. Stat. Ann. § 318-B:15.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. The pharmacist must verify that the person seeking hypodermic syringes and needles is 18 or older, and must provide the person purchasing syringes with information regarding drug addiction treatment and the safe disposal of hypodermic syringes. N.H. Rev. Stat. Ann. § 318:52-c.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense pursuant to a statewide standing order (effective since 9/7/22). The standing order authorizes unlimited refills. Pharmacists may dispense any other items necessary for the administration of opioid antagonists as determined by the pharmacist's professional judgment, including, but not limited to, syringes. Pharmacists are not required to undergo additional training or education or take any additional steps. Pharmacists must provide the patient seeking naloxone information on the following: 1) opioid overdose prevention and recognition; 2) how to perform rescue breathing and resuscitation; 3) opioid antidote dosage and administration; 4) the importance of calling 911 emergency telephone service for assistance with an opioid overdose; and 5) appropriate care of an overdose victim after opioid overdose administration. Health insurers, including Medicaid, that provide prescription drug benefits are prohibited from requiring prior authorization for naloxone prescriptions obtained under the statewide standing order. Medicaid must also ensure benefits for naloxone to eligible recipients. N.J. Stat. Ann. § 45:14-67.2; N.J. Stat. Ann. § 26:2S-38; N.J. Stat. Ann. § 30:4D-6m; 2nd Revised Standing Order for Pharmacists to Dispense Opioid Antidote for Overdose Prevention (2021).

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must verify that the person seeking syringes and needles is 18 or older and provide the person purchasing syringes with information regarding drug addiction treatment and the safe disposal of hypodermic syringes. Pharmacists may only sell up to 10 to a single person without a prescription. N.J. Stat. Ann. § 2C:36-6.2.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through the Board of Pharmacy’s statewide protocol (effective since 7/1/20). Pharmacists who use the statewide protocol must keep a written copy on file. Pharmacists must first complete an ACPE-approved course regarding the use of opioid antagonists and the counseling of a recipient of an opioid antagonist. Pharmacists must notify the primary care provider of the naloxone recipient (if the patient has one) within fifteen days following dispensing. Pharmacists must also counsel patients seeking naloxone on the following: 1) the recognition, prevention, and responses to opioid-related drug overdoses; 2) methods for the safe administration of opioid antagonists; and 3) the importance of seeking emergency medical assistance for a person experiencing an opioid-related drug overdose. N.M. Stat. Ann. § 24-23-1; N.M. Admin. Code 16.19.26.12; New Mexico Statewide Standing Order for Registered Pharmacist Naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. N.M. Stat. Ann. § 30-31-25.1.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through the Board of Pharmacy’s statewide protocol (effective since 7/1/17). Pharmacists are explicitly prohibited from delegating the task of dispensing naloxone (e.g., delegating the task to a pharmacy technician). Pharmacists must first complete a one-hour, ACPE-approved course regarding the use of opioid antagonists and the counseling of a recipient of an opioid antagonist. Pharmacists must counsel patients seeking naloxone on the following: 1) the recognition, prevention, and responses to opioid-related drug overdoses; 2) methods for the safe administration of opioid antagonists; 3) potential side effects and adverse events related to the administration of an opioid antagonist; and 4) the importance of seeking emergency medical assistance for a person experiencing an opioid-related drug overdose. Nev. Rev. Stat. Ann. § 453C.120.

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Nev. Rev. Stat. Ann. § 454.480.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

Yes, pharmacists may dispense through statewide standing order (effective since 1/1/23). Pharmacists must provide the patient seeking naloxone information on the following: 1) how to recognize symptoms of an opioid overdose; 2) steps to take prior to and after an opioid antagonist is administered, including calling first responders; 3) how to administer the opioid antagonist; 4) the number for the toll-free office of alcoholism and substance use services HOPE line; and 5) how to access the office of alcoholism and substance use services’ website. N.Y. Pub. Health Law § 3309; Non-Patient Specific Prescription for Naloxone with Pharmacy Dispensing Protocol (2023).

Do pharmacists have the legal authority to sell nonprescription syringes?

Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must verify that the person seeking syringes and needles is 18 or older. Pharmacists must provide the person purchasing syringes with educational material about the prevention of blood-borne diseases, drug treatment, safe use of syringes, and safe disposal of used syringes. The pharmacist must also relay a toll-free phone number for information on HIV. The pharmacist may only sell up to 10 syringes to a single person without a prescription. N.Y. Pub. Health Law § 3381. 

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 No, neither statewide standing order nor statute gives pharmacists the authority to prescribe or independently dispense naloxone. Either a direct prescription or a standing order as within a CPA with a primary care provider would be needed. A pharmacist who “prescribes” naloxone pursuant to a CPA must provide the patient seeking naloxone in-person training and written educational materials on the following: (1) risk factors of opioid overdose; (2) strategies to prevent opioid overdose; (3) signs of opioid overdose; (4) steps in responding to an overdose; (5) information on naloxone; (6) procedures for administering naloxone; (7) proper storage and expiration of naloxone product dispensed; and (8) information on where to obtain a referral for substance use treatment. Ohio Rev. Code Ann. § 4729.44; Ohio Admin. Code 4729:1-3-04.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Ohio Rev. Code Ann. § 3719.172.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, statute gives pharmacists the authority to prescribe naloxone (effective since 11/1/17). Pharmacists are not required to undergo additional training/education or take any additional steps. Pharmacists must provide the patient seeking naloxone with information on the following: 1) how to spot symptoms of an overdose; 2) basic resuscitation techniques; 3) proper naloxone administration; and 4) the importance of calling 911 for help. Stat. Ann. tit. 63 § 2-312.2; Stat. Ann. tit. 63, § 1-2506.2; Admin. Code 535:10-9-15.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Oklahoma.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, statute gives pharmacists authority to prescribe naloxone (effective since 4/4/16). Pharmacists must ensure the patient seeking naloxone demonstrates an understanding of educational materials related to opioid overdose prevention, recognition, response, and the administration of naloxone. Rev. Stat. Ann. § 689.682; Admin. R. 855-019-0460.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Oregon.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 1/17/23). Pharmacists are not required to undergo additional training/education or take any additional steps. 35 Pa. Stat. Ann. § 780-113.8; PA Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Pennsylvania.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 No, neither statewide standing order nor statute gives pharmacists the authority to prescribe or independently dispense naloxone. Either a direct prescription or a standing order as within a CPA with a primary care provider would be needed. A pharmacist who “prescribes” naloxone pursuant to a CPA must provide the patient seeking naloxone information on the following: 1) drug overdose prevention and recognition; 2) how to perform rescue breathing and resuscitation; 3) opioid antidote dosage and administration; 4) the importance of calling 911; and 5) care for the overdose victim after administration of the overdose antidote. Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended, or renewed in the state must provide coverage for at least one generic opioid antagonist and device. Prior authorization may be required for non-generic forms of opioid antagonists and devices. 216 R.I. CODE R. § 20-20-5.4; 27 R.I. Gen. Laws Ann. § 27-18-82.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must provide the person purchasing syringes with information regarding drug addiction treatment and the safe disposal of hypodermic syringes. 21 R.I. Gen. Laws Ann. § 21-28-4.04; 216 R.I. Code R. 20-15-6.3.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through the Board of Pharmacy’s statewide protocol (effective since 2/23/22). Pharmacists who use the statewide protocol must keep a written copy on file. Specific training is not required, but pharmacists must “be sufficiently educated regarding the Naloxone HCl product(s) being dispensed.” Pharmacists must provide patients seeking naloxone information on the following: 1) opioid overdose prevention and recognition; 2) opioid antidote dosage and administration; 3) the importance of calling 911 emergency telephone service for medical assistance with an opioid overdose; and 4) care for an overdose victim after administration of the opioid antidote. S.C. Code Ann. § 44-130-40; S.C. Code Ann. § 44-53-361; South Carolina Naloxone Protocol.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. S.C. Code Ann. § 44-53-930.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 9/19/22; must be renewed by/on 9/18/24). Pharmacists who use the statewide standing order must keep a written copy on file. Pharmacists must complete at least one hour of training related to naloxone dispensing and administration. Pharmacists must provide patients seeking naloxone verbal and written education about signs of an overdose, overdose response steps, and how to use naloxone. Pharmacies must complete a short eligibility assessment form for every individual who receives Naloxone. These forms must be filled out before dispensing, be maintained with pharmacy records for at least two years, and be available for inspection and copying by the SD Board of Pharmacy. Before utilizing the standing order, pharmacists must join the statewide participating pharmacy list. SD Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in South Dakota.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order that they must request from the Tennessee Department of Health. This standing order is not a blanket authorization; individual pharmacists must request and be approved by the Chief Medical Officer for the Tennessee Department of Health (Authorizing Physician) (effective since 2/25/16). Pharmacists must provide documentation that they have completed a training program covering opioid antagonists within the last two years. Pharmacists must provide to the patient seeking naloxone education and counseling that covers the following topics: 1) the online overdose prevention education program offered by the Department of Health; 2) the purpose of naloxone, the correct way to administer naloxone, and precautions regarding medications that may interact with naloxone; 3) high-risk overdose situations, risk reduction strategies, and appropriate response sets in addition to naloxone administration, including rescue breathing and calling 911. Tenn. Code Ann. § 63-1-152; Tenn. Code Ann. § 63-1-157. TN Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. The person seeking to purchase syringes must state the intended purpose of the syringes. Tenn. Comp. R. & Regs. 1140-03-.12.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide protocol that they must request from the Texas Board of Pharmacy. This standing order is not a blanket authorization; individual pharmacists must request and be approved by the Board, (effective since 8/1/16). Pharmacists must complete an ACPE-approved, one-hour course that must cover the following: 1) when to dispense naloxone, 2) how to work with a patient when selecting which opioid antagonist to dispense, and 3) when to administer naloxone. Tex. Health & Safety Code Ann. § 483.102 – 104; Tex. Occ. Code Ann. § 554.005; 22 Tex. Admin. Code § 295.13; TX Naloxone Standing Order Application.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Texas.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order that they are asked to enroll in every two years, (effective since 2/16/21). Pharmacists are not required to undergo additional training/education or take any additional steps. Pharmacists must educate patients seeking naloxone on how to administer naloxone and the importance of seeking emergency medical services after administering naloxone. Utah Code Ann. § 26-55-105; Utah Admin. Code r. R156-17b-625; UT Naloxone Standing Order; UT Naloxone Enrollment.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Utah.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 2/10/23). Pharmacists are not required to undergo additional training/education or take any additional steps. Pharmacists must instruct the patient seeking naloxone on the following: 1) opioid overdose prevention, 2) overdose recognition, 3) proper administration and dosing of naloxone, and 4) effectiveness and response following administration of naloxone. A pharmacist may (but is not required to) provide information on and/or referrals to resources on substance addiction treatment and recovery services. However, the pharmacist may only provide this information if the individual seeking the opioid antagonist expresses interest in receiving such information. Va. Code Ann. § 54.1-3408(X); VA Naloxone Standing Order; VA Naloxone Protocol.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacists must verify that the person seeking to purchase syringes is 16 or older. Pharmacists are required to record the name, address, and stated syringe purpose of the person purchasing syringes. Va. Code Ann. § 54.1-3468; Va. Code Ann. § 54.1-3467.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 8/31/21; must be renewed by/on 8/31/23). Pharmacists must either review instructional material or complete a training course approved by the Vermont Department of Health. Vt. Stat. Ann. tit. 18, § 4240; VT Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

Retail sale of nonprescription syringes is not regulated in Vermont.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through statewide standing order (effective since 1/12/23). Pharmacists are not required to undergo additional training/education or take any additional steps. Pharmacists must provide written instructions on the proper response to an opioid‐related overdose, including instructions for seeking immediate medical attention. Health insurers must provide coverage without prior authorization of at least one FDA-approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists for the following types of plans: 1) health plan offered to public employees and school employees, 2) Medicaid managed care plan, and 3) private health plans. Wash. Rev. Code Ann. § 69.41.095; Wash. Rev. Code Ann. § 41.05.525; Wash. Rev. Code Ann. § 48.43.760; Wash. Rev. Code Ann. § 74.09.645; WA Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Yes, pharmacists are explicitly permitted to sell nonprescription syringes. Pharmacist must sufficiently satisfy themselves that syringes sold will be used for a legal purpose. Wash. Rev. Code Ann. § 70.115.050

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order that they must register for and receive a signed copy of (effective since 4/7/22). Once registered, the pharmacist will receive a signed copy of the statewide standing order. The pharmacist must keep a written copy on file. Pharmacists must complete a one-hour training course that covers prescribing opioid antagonists. Because the statewide standing order is signed by a physician who is Medicaid certified, Medicaid patients of record may be covered by their insurance. Wis. Stat. Ann. § 448.9727; WI Naloxone Standing Order; WI Naloxone Distribution Registrar.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Wisconsin.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 8/10/21). Pharmacists must educate patients seeking naloxone on the proper administration of the opioid antagonist and the importance of seeking emergency medical services either before or after administering the opioid antagonist. Pharmacists must also provide patients seeking naloxone educational materials on opiate-related overdose prevention and treatment programs. W. Va. Code Ann. § 16-46-3a; W. Va. Code Ann. § 16-46-7; WV Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in West Virginia.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, statute gives pharmacists the authority to prescribe (effective since 6/30/22). Pharmacists must first complete a one-hour training course on the use of naloxone. Pharmacists must educate patients seeking naloxone on the following: 1) signs and symptoms of an opioid overdose; 2) how to administer an opioid antagonist; and 3) the importance of seeking emergency medical services after administering the opioid antagonist. Wyo. Stat. Ann. § 33-24-158; Wyo. Stat. Ann. § 35-4-903; Wyo. Admin. Code 059.0001.18 § 5.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Wyoming.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 Yes, pharmacists may dispense through a statewide standing order (effective since 3/6/19). Pharmacists must ensure that the person seeking naloxone is over the age of 18. A person seeking naloxone is required to present identification. Pharmacists are not required to undergo additional training/education or take any additional steps. 2021 Puerto Rico Laws Act 035 (P. del S. 71); PR Naloxone Standing Order.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in Puerto Rico.

Do pharmacists have the legal authority to dispense naloxone without a prescription from a primary care provider (PCP)?

 No, neither statute nor statewide standing order gives pharmacists the authority to independently prescribe naloxone.

Do pharmacists have the legal authority to sell nonprescription syringes?

 Retail sale of nonprescription syringes is not regulated in the Virgin Islands.