Medications for Addiction Treatment (MAT)

The following is provided by the Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Naloxone Administration Links

Below are links to several instructional videos/trainings on how to administer Naloxone in the event of a suspected opioid overdose.

Prescribe to Prevent

• Nasal spray (assembly required)
• Injectable
• Auto-Injector (ready to use)

Oregon Health Authority – Multnomah County (Multco) Health Department

• Nasal spray (assembly required)
• Nasal spray (ready to use)
• Injectable

Pennsylvania Emergency Health Services Council

• Auto-Injector (ready to use)

Veterans Administration

• Injectable

• DO support the person’s breathing by administering oxygen or performing rescue breathing.
• DO administer naloxone.
• DO put the person in the "recovery position" on the side, if he or she is breathing independently.
• DO stay with the person and keep him/ her warm.
• DON'T slap or try to forcefully stimulate the person — it will only cause further injury. If you are unable to wake the person by shouting, rubbing your knuckles on the sternum (center of the chest or rib cage), or light pinching, he or she may be unconscious.
• DON'T put the person into a cold bath or shower. This increases the risk of falling, drowning or going into shock.
• DON'T inject the person with any substance (salt water, milk, "speed," heroin, etc.). The only safe and appropriate treatment is naloxone.
• DON'T try to make the person vomit drugs that he or she may have swallowed. Choking or inhaling vomit into the lungs can cause a fatal injury.

NOTE: All naloxone products have an expiration date, so it is important to check the expiration date and obtain replacement naloxone as needed.

STEP 1: CALL FOR HELP (DIAL 911)

AN OPIOID OVERDOSE NEEDS IMMEDIATE MEDICAL ATTENTION.

An essential step is to get someone with medical expertise to see the patient as soon as possible, so if no EMS or other trained personnel are on the scene, dial 911 immediately. All you have to say is: "Someone is not breathing." Be sure to give a clear address and/or description of your location.

STEP 2: CHECK FOR SIGNS OF OPIOID OVERDOSE

Signs of OVERDOSE, which often results in death if not treated, include [11]: Face is extremely pale and/or clammy to the touch Body is limp Fingernails or lips have a blue or purple cast The patient is vomiting or making gurgling noises He or she cannot be awakened from sleep or is unable to speak Breathing is very slow or stopped Heartbeat is very slow or stopped.

Signs of OVERMEDICATION, which may progress to overdose, include [11]: Unusual sleepiness or drowsiness Mental confusion, slurred speech, intoxicated behavior Slow or shallow breathing Pinpoint pupils Slow heartbeat, low blood pressure Difficulty waking the person from sleep.

Because opioids depress respiratory function and breathing, one telltale sign of a person in a critical medical state is the "death rattle." If a person emits a "death rattle" — an exhaled breath with a very distinct, labored sound coming from the throat — emergency resuscitation will be necessary immediately, as it almost always is a sign that the individual is near death [13].

STEP 3: SUPPORT THE PERSON’S BREATHING

Ideally, individuals who are experiencing opioid overdose should be ventilated with 100% oxygen before naloxone is administered so as to reduce the risk of acute lung injury [2, 4]. In situations where 100% oxygen is not available, rescue breathing can be very effective in supporting respiration [2]. Rescue breathing involves the following steps:

• Be sure the person's airway is clear (check that nothing inside the person’s mouth or throat is blocking the airway).
• Place one hand on the person's chin, tilt the head back and pinch the nose closed.
• Place your mouth over the person's mouth to make a seal and give 2 slow breaths.
• The person's chest should rise (but not the stomach).
• Follow up with one breath every 5 seconds.

STEP 4: ADMINISTER NALOXONE

Naloxone (Narcan) should be administered to any person who shows signs of opioid overdose, or when overdose is suspected [4]. Naloxone injection is approved by the FDA and has been used for decades by emergency medical services (EMS) personnel to reverse opioid overdose and resuscitate individuals who have overdosed on opioids.

Naloxone can be given by intramuscular or intravenous injection every 2 to 3 minutes [4, 13-14]. The most rapid onset of action is achieved by intravenous administration, which is recommended in emergency situations [13]. The dose should be titrated to the smallest effective dose that maintains spontaneous normal respiratory drive.

Opioid-naive patients may be given starting doses of up to 2 mg without concern for triggering withdrawal symptoms [2, 4, 7, 14].

The intramuscular route of administration may be more suitable for patients with a history of opioid dependence because it provides a slower onset of action and a prolonged duration of effect, which may minimize rapid onset of withdrawal symptoms [2, 4, 7].

STEP 5: MONITOR THE PERSON’S RESPONSE

All patients should be monitored for recurrence of signs and symptoms of opioid toxicity for at least 4 hours from the last dose of naloxone or discontinuation of the naloxone infusion. Patients who have overdosed on long-acting opioids should have more prolonged monitoring [2, 4, 7].

Most patients respond by returning to spontaneous breathing, with minimal withdrawal symptoms [4]. The response generally occurs within 3 to 5 minutes of naloxone administration. (Rescue breathing should continue while waiting for the naloxone to take effect. [2, 4, 7])

Naloxone will continue to work for 30 to 90 minutes, but after that time, overdose symptoms may return [13, 14]. Therefore, it is essential to get the person to an emergency department or other source of medical care as quickly as possible, even if he or she revives after the initial dose of naloxone and seems to feel better.

SIGNS OF OPIOID WITHDRAWAL. The signs and symptoms of opioid withdrawal in an individual who is physically dependent on opioids may include, but are not limited to, the following: body aches, diarrhea, tachycardia, fever, runny nose, sneezing, piloerection, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure. In the neonate, opioid withdrawal may also include convulsions, excessive crying, and hyperactive reflexes [13].

NALOXONE-RESISTANT PATIENTS. If a patient does not respond to naloxone, an alternative explanation for the clinical symptoms should be considered. The most likely explanation is that the person is not overdosing on an opioid but rather some other substance or may even be experiencing a non-overdose medical emergency. A possible explanation to consider is that the individual has overdosed on buprenorphine, a long-acting opioid partial agonist. Because buprenorphine has a higher affinity for the opioid receptors than do other opioids, naloxone may not be effective at reversing the effects of buprenorphine-induced opioid overdose [14].

In all cases, support of ventilation, oxygenation, and blood pressure should be sufficient to prevent the complications of opioid overdose and should be given priority if the response to naloxone is not prompt.

Opioid use disorder treatment is available in a variety of forms. Recovery is possible, and research shows that a combination of medication and treatment counseling offer much more effective results.

The term "Opioid Treatment Programs (OTPs)" refers to highly regulated methadone clinics, most of which also provide access to other medication assisted treatment options. OTPs are still the only places with permission to dispense methadone for opioid use disorder treatment. 

With the expansion of FDA approved options for Medication Assisted Treatment (MAT), there came a related expansion in the types of clinics that can provide those medications. It is important to note that there are currently 3 FDA approved medicines for treatment of opioid use disorder which come in a variety of formulas and brands.

The generic names of these medications are: methadone, buprenorphine, and naltrexone. Buprenorphine and naltrexone can be prescribed, and in some cases, dispensed in (non-OTP) medical clinics by qualified prescribers.

Central Iowa

• United Community Services*
• Center for Behavioral Health
• Covert Action

Eastern Iowa

• Center for Alcohol and Drug Services*
• Center for Behavioral Health

East Central Iowa

• Cedar Rapids Comprehensive Treatment Center

Western Iowa

• Heartland Family Service/ BAART*

North Western Iowa

• Center for Behavioral Health

Additional Providers

• SAMHSA Physician Locator for Buprenorphine

*those marked offer financial assistance

Service providers from outside the currently funded IPN network can apply for SOR funding by filling out this non-competitive application and submitting to Iowa HHS via the instructions.

• YourLifeIowa.org has an interactive map to search for services anywhere in Iowa.
• SAMHSA Physician Locator for Buprenorphine

• Public Safety Alert: Xylazine (May 2023)
• SOR1 Summary
• SOR2 First Year Summary

• Opioid Overdose in Iowa Flyer
• Naloxone Request Form (Organizations, Businesses & Schools)
• Naloxone Request Form (Law Enforcement)
• Distributor Registration

• Cedar Rapids
• Decorah
• Des Moines
• Dubuque
• Sioux City
• Spirit Lake

• Client Brochure (Updated January 2022)
• Buprenorphine Quick Start Guide
• Exception Request Template (Updated October 2022)
• Provider Manual (Updated October 2022)
• SOR3 Intake Form
• Release of Information
• Collateral Contacts Form

• Rapid Testing Technology Video
• Rapid Testing Implementation Checklist
• Rapid Testing Implementation Resources
• Testing Consent Procedures
• Testing Iowa PCA Training Video
• STD Testing Implementation Video
• STD Third Party Billing Video
• STD Testing Implementation Screening Guidelines Reference
• STD Testing Implementation: Virtual Training Supplement

• Grant Management Training PowerPoint
• Grant Management Training Video

All prevention materials are available through Iowa State University Partnerships in Prevention Science Institute. Email the SOR email to get connected.

SOR3-IPN Providers

• FY24 Quarterly Report Survey

SOR3 Corrections Liaison Provider Reports

• CL FY24 Semi-Annual Report Survey

SOR3 SOR-A Provider Reports

• FY24 Semi-Annual Report Survey

Opioid Topics Survey Reports

• Buprenorphine-Waivered Providers Survey: Summary
• Naloxone among Iowa Law Enforcement Agencies Survey Results

• For nurses:
  • Click here for the recorded webinar (please note that the recording begins a few minutes into the presentation),
• For doctors:
  • Click here for the online module through the University of Iowa
• For dentists:
  • Click here for the recorded webinar
• For pharmacists: 
  • Click here for the recorded webinar

Naloxone use in the event of a suspected opioid overdose (see below). Please note that Naloxone may be available at pharmacies in different formats. The Iowa standing order includes the ready-to-use nasal spray.

• Iowa HHS Overdose and Naloxone Training (2022)
• Naloxone Nasal spray (ready to use) training from the manufacturer
• Nasal spray (ready to use) from Oregon Health Authority
• Prescribe to Prevent 
  • Nasal spray (assembly required)
  • Injectable
• Veterans Administration: Providers' Clinical Support System (PCSS)