[OOPP Name]
               Opioid Overdose Prevention Program
                      Policies and Procedures
                          [Month] [Year]
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       I. Roles and Responsibilities within the Opioid Overdose Prevention Program (OOPP)
       1. Program Director
       The Program Director has the following responsibilities, many of which can be delegated:
          •     Select naloxone Dispensers, in consultation with the Clinical Director, and ensure that all Dispensers
             attend a Training of Dispensers (TOD) with the NYC Health Department;
          •     Oversee Dispensers to ensure they are competent in delivering trainings and giving out naloxone;
          •     Maintain appropriate records for complying with reporting requirements;
          •     Order opioid overdose supplies, or review orders submitted by other authorized program 
             personnel;
          •     Maintain an inventory of opioid overdose supplies;
          •     Submit monthly reports to the NYC Health Department and quarterly reports to NYSDOH;
          •     Submit Community Naloxone Usage Forms to NYSDOH when naloxone use is reported to 
             the OOPP; 
          •  Ensure that the program’s registration with NYSDOH remains up to date; and
          •     Have a validated account on www.nyoverdose.org.
       If the Program Director is also providing overdose response education and dispensing naloxone, the 
       Program Director is also responsible for carrying out the duties of a Dispenser (see Section I, Item 4).
       As of [date] the Program Director of [OOPP name] is [Program Director name, title]. 
       2. Clinical Director
       The Clinical Director, who must be a New York State-licensed physician, nurse practitioner, or 
       physician assistant, has the following responsibilities:
          •  Provide clinical consultation, expertise, and oversight of medical issues related to the OOPP; 
          •  Issue standing orders to Dispensers after they have attended a Training of Dispensers (see Section II);
          •  Provide ongoing supervision of Dispensers; 
          •  Approve and sign Naloxone Supplies Order Forms;
          •  Have a validated account on www.nyoverdose.org;
          •  Review Community Naloxone Usage Forms with the Program Director.
       If the Clinical Director is also providing overdose response education and dispensing naloxone, the Clinical 
       Director is also responsible for carrying out the duties of a Dispenser (see Section I, Item 4).
       As of [date] the Clinical Director of [OOPP name] is [Clinical Director name, title]. 
       3. Naloxone Dispensers
       Naloxone Dispensers are individuals approved by the Clinical Director and Program Director to teach others 
       how to use naloxone and to give out naloxone under a non-patient specific prescription (standing order) issued
       by the Clinical Director. Dispensers may be program staff, peers, or volunteers, and must have completed an 
       approved Training of Dispensers (TOD) course with the NYC Health Department and be authorized to dispense 
       under a Clinical Director’s standing order (see Section II).
       Naloxone Dispensers have the following responsibilities:
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              Teach individuals to respond to overdose by providing the required overdose response education;
              Tailor each training session to the setting and the audience;
              Demonstrate naloxone administration;
              Handle the logistics of dispensing a naloxone kit, including the following:
                   o Issue a blue Certificate of Completion Card with each naloxone kit indicating: 
                          1. The date of dispensing; 
                          2. The name of the prescriber issuing the prescription; 
                          3. The naloxone formulation being provided; and
                          4. The name of the OOPP, including contact information for reporting use of naloxone;
                   o Complete a Naloxone Recipient Form (NRF) for each kit recipient and submit it to the 
                       designated person at the OOPP; and
                   o Dispense naloxone and related equipment to kit recipients;
              Inform kit recipients of the importance of returning to the OOPP to replace naloxone before it expires;
              Inform kit recipients of the importance of reporting naloxone administration, either by returning to the 
               OOPP where they received naloxone or by using the Stop OD NYC mobile app; and
              Submit reports of activities to the designated person at the OOPP, including number of individuals 
               trained, number of doses of naloxone dispensed, and completed NRFs. 
        There should be a record of Dispensers signed by the Clinical Director with the date on which the Dispenser 
        was approved; the Standing Order Template provided by the NYC Health Department is sufficient. 
        As of [date], [OOPP name] does/does not use Dispensers to furnish naloxone to trained individuals.
        Briefly describe who dispenses naloxone, their role within the OOPP, and how they are trained and supervised. 
        Also include who within your agency determines which staff should become Dispensers:
        4. Naloxone Kit Recipients, aka Opioid Overdose Responders 
        Opioid Overdose Responders are the individuals taught to recognize and respond to opioid overdose. In other 
        words, these are the individuals receiving naloxone kits from the OOPP. After receiving training from a 
        Dispenser, Responders should have the knowledge and skills to 1) know what naloxone does, 2) recognize an 
        opioid overdose; 3) respond by checking for responsiveness, calling 911, and administering naloxone; 4) 
        provide post-naloxone aftercare; 5) report their naloxone administration and seek replacement naloxone. All 
        individuals who are interested in becoming Responders are eligible and there is no age minimum.
        Briefly describe who is offered naloxone (e.g. all clients, subset of clients (describe), friends and family of 
        clients, select staff, members of the general public, other). If relevant, describe how you identify who is offered 
        naloxone:
        II. Standing Orders
        The Clinical Director issues standing orders, authorizing persons who have attended a Training of Dispensers 
        with the NYC Health Department to dispense naloxone on the Clinical Director’s behalf. 
        The NYC Health Department provides OOPPs with a standing order template. The Clinical Director completes a 
        standing order for each person that will be dispensing naloxone kits through the OOPP. The Clinical Director 
        and each authorized Dispenser keep a signed copy of this form. Each standing order includes the following:
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              Conditions of dispensing;
              Formulation(s) being dispensed;
              Protocols for naloxone administration;
              Identification of the Dispenser;
              Dated signature of the Clinical Director;
              Address of the Clinical Director; and
              Clinical Director’s NYS license number.
        For all naloxone kits dispensed under the Clinical Director’s standing order, the Clinical Director’s name is 
        written on the Certificate of Completion card in the section marked “Prescribed by” (see Section IV, Item 2).
        As of [date], [OOPP name] does/does not use standing orders to allow persons who have attended an 
        approved Training of Dispensers course to dispense naloxone under the Clinical Director’s license.
        Briefly describe who is responsible for managing standing orders and where copies of signed standing orders 
        are kept:
        III. Ordering Naloxone Supplies and Assembling Kits
        1. Ordering Supplies
        Naloxone, blue bags, and Certificate of Completion cards are ordered from the NYC Health Department via 
        email by following these steps: 
            1. Program Director completes a Naloxone Supplies Order Form, specifying how many doses of naloxone, 
               blue bags, and blue Certificate of Completion cards are needed. When determining order size, Program 
               Director estimates how many naloxone kits will be dispensed over the next 3 months.
            2. Clinical Director signs the order form.
            3. Program Director sends completed and signed order form to reports@health.nyc.gov.
        Briefly describe who is responsible for ordering naloxone supplies:
        2. Assembling Naloxone Kits 
        The following materials are included in each naloxone kit:
            1. Two blister packages of Narcan Nasal Spray
            2. Narcan instruction sheet (from the Narcan box)
            3. Naloxone Educational Insert
            4. Rescue breathing face shield
            5. Two non-latex gloves
        To assemble naloxone kits, OOPP personnel remove the two doses of naloxone and the accompanying 
        instruction sheet from the box they arrive in and pack them into the blue bags (which come pre-packed with 
        the other supplies). 
        Briefly describe who is responsible for assembling naloxone kits:
        3. Naloxone Storage
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