Naloxone policy for treatment programs: a Texas guide for IOP, PHP and outpatient

The short answer

A Texas treatment program can keep naloxone on site, have any trained staff member give it, and hand it to clients. Texas Health and Safety Code chapter 483 lets anyone possess naloxone without a prescription, lets an organization store and distribute it under a prescriber's standing order (as long as it doesn't charge for it), and protects a person who gives it in good faith. Since 2023 the 4 mg and 3 mg nasal sprays have been sold over the counter, and the state's Naloxone Texas program gives it away free. What a good program adds is the system: kits in marked, unlocked places reachable in under a minute, a monthly expiration check, training at hire and every year with quarterly practice, a posted response, an incident report after every use, and a kit in every client's hand before they leave care.

Texas law: Health and Safety Code chapter 483

Subchapter E of Texas Health and Safety Code chapter 483, "Opioid Antagonists," was added in 2015 by Senate Bill 1462. Naloxone is the opioid antagonist most programs stock. What each section means for an outpatient program:

Section	What it says (in short)	What it means for your program
§483.102 Prescription	A prescriber may prescribe an opioid antagonist, directly or by standing order, to a person at risk of an opioid overdose or to a family member, friend or "other person in a position to assist" that person. The prescription counts as issued for a legitimate medical purpose, and a prescriber acting in good faith with reasonable care is protected from criminal, civil and disciplinary liability.	Your medical director can write a standing order that isn't tied to a named patient, covering clients and the family and friends around them. Programs commonly rely on the "position to assist" language for their own stock; confirm your setup with counsel.
§483.103 Pharmacists	A pharmacist may dispense an opioid antagonist under a valid prescription to the same groups, with the same good-faith protection.	A pharmacy can fill a client's prescription or dispense under a standing order, so clients can get naloxone at the counter without seeing a prescriber.
§483.104 Distribution under a standing order	A person or organization acting under a prescriber's standing order may store and distribute an opioid antagonist, provided it doesn't request or receive payment for storing or dispensing it.	This is the section that lets a program hand naloxone to clients and families. Don't charge clients for naloxone you give out this way.
§483.105 Possession	Any person may possess an opioid antagonist, whether or not they have a prescription for it.	Staff, clients, families and volunteers can carry it. Clients can keep their own kit at home or in a bag.
§483.106 Administration	A person who, acting in good faith and with reasonable care, gives an opioid antagonist to someone they believe is having an opioid overdose is protected from criminal prosecution, professional licensing sanctions and civil liability.	Counselors, techs, peers and front-desk staff can give it; it isn't limited to nurses. Training is what shows "reasonable care," so document it.

Read the current text before you write your policy: the sections above are our summary of the enrolled bill and the codified chapter, and the legislature can amend them. Texas licensing rules for chemical dependency treatment facilities, 26 TAC chapter 564, didn't name naloxone in the text we reviewed (current through March 2025 on Cornell LII), so treat stocking it as the standard of care and what an accreditor or payer auditor expects, not as a box in the state rule. Our 26 TAC 564 walk-through covers what the chapter does require.

The Texas Good Samaritan law

Texas's overdose Good Samaritan law came from House Bill 1694 (2021), took effect September 1, 2021, and added a defense to prosecution to Health and Safety Code chapter 481 for low-level drug possession. As the Hogg Foundation's summary explains it:

• Who it covers: the first person to call 911 for someone who may be overdosing, and the person overdosing.
• The conditions: the caller asked for help during the emergency, stayed on scene until help arrived, and cooperated with medical and law enforcement personnel.
• Who it doesn't cover: people with certain previous drug convictions, people who have used the defense before, and people who called 911 for an overdose in the previous 18 months.
• Its limits: it's a defense, not immunity, so a person can still be arrested and must raise it; and evidence found because of the call can still be used for offenses the defense doesn't cover.

Why it belongs in your program: teach it to clients in overdose education, because fear of arrest is a reason people don't call. Staff who give naloxone at work rely on §483.106, not this law. Never tell a client the law "makes them immune"; it doesn't.

Over-the-counter naloxone since 2023

• March 29, 2023: the FDA approved Narcan 4 mg nasal spray for nonprescription use, the first naloxone product sold without a prescription (FDA announcement).
• July 28, 2023: RiVive 3 mg nasal spray became the second over-the-counter naloxone nasal spray (FDA timeline).
• June 16, 2026: the FDA approved another over-the-counter 4 mg nasal spray, Rextovy (FDA announcement).
• Still prescription: injectable naloxone, higher-dose sprays and some other forms. If your medical director wants those in the kit, you need a prescriber's order or standing order.
• Shelf life: in January 2024 the FDA announced that newly made Narcan 4 mg nasal spray has a 4-year shelf life, up from 3; product made earlier keeps the date printed on it (FDA). Go by the printed expiration date.

What it changes for a program: you can buy nasal spray at a pharmacy or from a distributor without a prescription, and staff and clients can buy their own. What it doesn't change: OTC doesn't mean easy to get. A 2024 Rice University Baker Institute report found that 71% of Houston pharmacies that carried naloxone kept it behind the counter or in a locked cabinet (Rice News). That's why the policy below puts a kit in the client's hand instead of telling them to buy one.

Getting naloxone and stocking the program

Where it comes from

Source	How it works	Good for
Naloxone Texas (free)	The state program, formerly called More Narcan Please, run by UT Health San Antonio under contract with HHSC. It gives free naloxone to individuals and organizations, including recovery and treatment programs. Request through naloxonetexas.com.	Kits for clients and families, at no cost to you or them
Over-the-counter purchase	Buy 4 mg or 3 mg nasal spray from a pharmacy or medical distributor. Budget it with your clinical supplies.	Your on-site emergency stock, so it never depends on a grant
A standing order	Your medical director writes one, or you request the free standing order the Texas Overdose Training Initiative offers to any pharmacy or organization operating in Texas (TxOTI standing order FAQ).	Prescription forms, and the §483.104 framework behind your distribution
The client's insurance	Texas Medicaid has covered naloxone through the Vendor Drug Program formulary, with preferred products and quantity limits (Superior HealthPlan naloxone guide); check the current formulary at txvendordrug.com. The prescriber can also prescribe it for clients on buprenorphine.	A refill after a client uses their kit

Don't build the whole plan on the free program. It ran out of money in 2022 and stopped taking new requests for a time (KUT), and in 2024 the Texas Tribune reported delays and an unpredictable supply. Buy your emergency stock; use free naloxone for what you hand out.

Where it goes and how it's checked

From the medication policy in the kit we build programs on, and the monthly check in Comply:

• Locations: marked, unlocked places that any staff member can reach in under a minute: typically the front desk, each group room hallway, and next to the AED if you have one. Never in the locked medication cabinet. Add one to each program vehicle.
• The rescue kit: at least two doses (one box of nasal spray), gloves, a CPR face shield, and a card with the steps.
• The monthly check: each kit present, sealed and in its marked place; the earliest expiration date written down; the count of doses on hand (our check flags fewer than 2). An expired or missing kit is fixed the same day. Put the check on your environment of care rounds so it never depends on one person remembering.
• Storage: as the package label directs; don't leave kits in a hot car.
• Client kits: a separate supply, logged in and out, so the emergency stock is never the one you give away.

Training staff

When	Who	What	Proof
Orientation, day 1	Every new hire, contractor, intern and volunteer	Where the kits and AED are; the posted response steps	Signed orientation checklist
Within 30 days of hire, and before working without another trained person present	Everyone	Full overdose response and naloxone training, with CPR and first aid for direct-care staff	Certificate or sign-in sheet in the personnel file
Every year	Everyone	Refresher, policy changes, new products	Training record
Every quarter	Each shift	A practice run with a training device: find the kit, act it out, time it	Drill log with names and time to naloxone

The content: the signs of an opioid overdose (won't wake up, slow or no breathing, choking or snoring sounds, blue or gray lips and fingertips, pinpoint pupils); how to give each product you stock; rescue breathing and the recovery position; why to stay, because naloxone wears off; what §483.106 protects; and how to talk with a client afterward without shame. SAMHSA's free Overdose Prevention and Response Toolkit is a good base for the slides. Put the training dates in each staff credential file; any staff member, on any shift, should be able to say where the nearest kit is without thinking.

The overdose response, step by step

Post this beside every kit. It's the sequence in the medication policy we write, which follows the SAMHSA toolkit:

1. Check for a response: shout the person's name and rub the breastbone.
2. Call 911, or have someone call, and send someone for the naloxone and the AED.
3. Give naloxone as the package directs: one spray in one nostril.
4. Support breathing: rescue breaths or CPR if the person isn't breathing normally. SAMHSA's point: restoring breathing matters more than waking the person up.
5. Give another dose if there's no response in 2 to 3 minutes, in the other nostril, with a new device.
6. Recovery position and stay. Once the person is breathing, turn them on their side and stay until EMS takes over. Naloxone can wear off in 30 to 90 minutes, before the opioid does, so the overdose can come back.
7. Hand off to EMS: what you saw, what time, how many doses. The person should go to the hospital; if they refuse, staff stay with them and follow the medical director's instructions.
8. Afterward: incident report the same day, restock the kit, and a leadership debrief within a week.

Two points staff get wrong. Naloxone doesn't reverse alcohol, benzodiazepine or stimulant overdoses, so 911 and breathing support come first in every emergency. But if opioids might be involved, give it: the CDC notes that naloxone won't harm someone who hasn't taken opioids. Our emergency operations plan guide puts an overdose with naloxone among the medical emergencies you drill.

What to document

Record	What goes in it	Where it lives
Stock log	Each kit's location, product, lot and expiration; date received and source; date used, given away or discarded	Safety binder or Comply
Monthly check	Date, who checked, each location present and sealed, earliest expiration, doses on hand, what was replaced	Environment of care records
Training and drills	Date, trainer, content, sign-in, competency; drill time to naloxone	Personnel files and the training log
Incident report (every use)	Time found, signs, each dose and its time, time 911 was called and EMS arrived, who stayed with the person, where they went, outcome; staff names	Incident log, reviewed under your performance improvement plan
Client's chart	A dated progress note of the event, the follow-up conversation, the treatment plan review, and any kit given; overdose history at intake	The EHR
Kit given to a client	Date, product, who taught them, a teach-back, and the overdose education covered	The progress note and the discharge plan

Two rules about the chart. Telling EMS what's going on is allowed: 42 CFR 2.51 permits disclosure to medical personnel to the extent needed in a bona fide medical emergency, and you note who you told, when and why in the record. And if the note is written the next day, it's a dated late entry, never backdated (see our late entry guide). Whether an overdose has to be reported to HHSC, an accreditor or a payer, and how fast, depends on where it happened and what followed; our Texas incident reporting guide lays out the timelines.

Naloxone for clients, and at discharge

The people most likely to need naloxone are your clients and the people they live with. The discharge policy in our kit says no client leaves care without being offered an aftercare plan, crisis resources and, for SUD clients, overdose prevention information and naloxone. In practice:

• At intake: ask about overdose history and whether anyone at home has naloxone. Offer a kit to the client and, with consent, to a family member in the family program.
• In group: overdose prevention and a naloxone demonstration at least monthly, so no client finishes an episode without it. It's a recurring topic in our IOP group curriculum.
• After a return to use or a positive test: offer naloxone and overdose education the same day, as our drug testing policy sets out.
• At discharge, planned or not: a kit in hand, a teach-back of the steps, and the warning that matters most: after a stretch of not using, tolerance is lower and the same amount can kill. Clients who leave against advice need this the most; keep a kit at the front desk for them.
• Clients on medication: people taking buprenorphine or methadone should have naloxone too; our guide to adding MAT to an IOP covers the rest of the MOUD side.
• No charge. Kits given under a standing order must be free under §483.104, and free is the right answer anyway.

Write it into the discharge summary and aftercare plan ("naloxone kit given, teach-back done") so it's provable. Our guides to discharge planning for an IOP and the SUD discharge summary show where the line goes. Recovery residences need the same thing at house level; see sober living house rules.

Policy outline you can copy

1. Purpose: to be ready for an opioid overdose at any moment and to put naloxone in the hands of clients and families.
2. Authority: Texas Health and Safety Code §§483.102 to 483.106; the medical director's standing order, if you use one.
3. Policy statement: naloxone is always on site, unlocked and in marked places; every staff member is trained; any trained staff member may give it; clients receive it free.
4. Stock and locations: products, number of kits, where each lives, who orders, the separate client supply.
5. Checks: monthly, by the safety officer, with the log; same-day replacement.
6. Training: orientation, within 30 days, yearly, quarterly drills; the content list above.
7. Response procedure: the eight steps, posted.
8. After an overdose: EMS hand-off, emergency contact as the client's consent allows, incident report, debrief, required reports, care for the staff and clients who saw it.
9. Client education and distribution: intake, monthly group, after any return to use, at every discharge; teach-back; no charge.
10. Documentation: the six records above.
11. Responsibilities: the medical director approves the policy and any standing order; the program director owns the supply and checks; supervisors run drills; every staff member knows where naloxone is and how to respond.
12. Review: yearly, and after every overdose.

This sits inside the medication policy (as section "naloxone and overdose response") in the manuals we write, cross-referenced from the emergency, discharge and drug testing policies. Your medical director should sign it.

Already open? Consulting by the hour is $175 per hour, a mock survey will test whether staff can find the kit, or book a free 30-minute call.

Questions

Can a treatment center give out Narcan in Texas?

Yes. Under Health and Safety Code §483.104, an organization acting under a prescriber's standing order may store and distribute naloxone, as long as it doesn't charge for storing or dispensing it. Over-the-counter nasal sprays can also be bought and handed out. Keep a log and document each kit in the client's chart.

Do you need a prescription for Narcan in Texas?

No. Narcan 4 mg nasal spray has been approved for over-the-counter sale since March 2023, and Texas law (§483.105) lets anyone possess naloxone without a prescription. Injectable and higher-dose forms still need a prescription or standing order.

Is naloxone free in Texas?

Often, yes. Naloxone Texas, the state program formerly called More Narcan Please, gives free naloxone to individuals and organizations through naloxonetexas.com. Supply has been uneven in past years, so buy your own on-site emergency stock.

Can staff who aren't nurses give naloxone?

Yes. Nasal naloxone is made for laypeople, and §483.106 protects anyone who gives it in good faith and with reasonable care to someone they believe is overdosing. Train every staff member and keep the training record, because training is how you show reasonable care.

Can we be sued for using naloxone on a client?

Texas law protects a person who gives naloxone in good faith and with reasonable care from criminal prosecution, licensing sanctions and civil liability. Follow your policy, call 911, stay with the person and document it. Ask your attorney and liability carrier how this applies to your program.

Does the Texas Good Samaritan law protect people who call 911?

Partly. Since September 1, 2021, the first caller who stays and cooperates, and the person overdosing, can raise a defense to prosecution for low-level possession. It isn't immunity, and it doesn't apply to people with certain prior drug convictions, who've used it before, or who called for an overdose in the past 18 months.

Is a Texas outpatient program required to keep naloxone?

We didn't find a 26 TAC chapter 564 rule that names naloxone. Accreditors expect a program to be ready for the medical emergencies its clients are likely to have, and for an SUD program an overdose is the obvious one. Treat naloxone as required and confirm with your accreditor's current standards.

How often should naloxone kits be checked?

Monthly: each kit present, sealed and in place, the earliest expiration date recorded, and enough doses on hand. Replace anything expired or used the same day.

Sources

• Texas Health and Safety Code chapter 483, subchapter E (opioid antagonists); SB 1462, 84th Legislature (2015), enrolled text
• Texas Legislature, HB 1694, 87th Legislature (2021), bill analysis; Hogg Foundation for Mental Health, Overdose bystander law: an overview
• FDA, FDA approves first over-the-counter naloxone nasal spray (March 29, 2023); FDA broadens access to over-the-counter naloxone nasal spray (2026); shelf life extension (2024); timeline of FDA overdose prevention activities; information about naloxone and nalmefene
• Texas HHSC, HHSC highlights resources during Fentanyl Poisoning Awareness Month (October 2026); Naloxone Texas
• KUT, Texas program that gives out lifesaving drugs has been out of money for months (2022); Texas Tribune, Texas revamps Narcan distribution (2024)
• Texas Overdose Training Initiative, Naloxone standing order FAQ
• Rice University, Baker Institute report on naloxone access in Houston pharmacies (2024)
• Superior HealthPlan, naloxone quick reference (Texas Medicaid VDP formulary) (2021); Texas Vendor Drug Program
• SAMHSA, Overdose Prevention and Response Toolkit; CDC, Lifesaving naloxone
• eCFR, 42 CFR 2.51, medical emergencies; 26 TAC chapter 564: Cornell LII