High-Impact (No-Cost) Naloxone Distribution
Virginia Department of Health (VDH) and the Virginia Department of Behavioral Health and Developmental Services (DBHDS) share the common goal of increasing naloxone access for all Virginians. Due to limited resources, VDH is prioritizing high-risk individuals to receive no-cost naloxone. High-risk individuals include people who use drugs (PWUD), family members, friends or coworkers of PWUD and people who work directly with PWUD.
The following organization types are eligible to obtain naloxone at no-cost from VDH. Eligibility criteria are subject to change.
- Authorized comprehensive harm reduction sites
- Community services boards
- Local health departments
- First responders
- Reentry programs
- K-12 public school divisions
- Public universities (campus recovery programs)
- High-impact community partners
The Division of Pharmacy Services currently ships over-the-counter (OTC) 4mg naloxone nasal spray, prescription 8mg naloxone nasal spray, and prescription intramuscular (IM) naloxone to eligible partners. Prescription naloxone must continue to be dispensed in accordance with the Virginia Board of Pharmacy Naloxone protocol, which includes utilizing the Statewide Standing Order for Naloxone and Other Opioid Reversal Agents.
Additional Resources:
- No-Cost Naloxone Distribution Program One-Pager (January 2025)
- General Naloxone Agreement Requirements for Partners (January 2025)
- Prescription vs. Over-the-Counter Naloxone Requirements (August 2024)
What is Expanded Access?
Expanded Access is an extension of the High-Impact (No-Cost) Naloxone Distribution Program. This program extension provides over-the-counter (OTC) naloxone 4mg nasal spray to organizations whose intended use of naloxone does not qualify for the no-cost naloxone.
VDH provides naloxone to Expanded Access partners at cost, inclusive of the cost of the drug, processing and shipping fees. Eligible partners include:
- Institutions of higher education
- Local government jurisdictions (counties and independent cities)
- Private K-12 schools
- State agencies
While High-Impact Partners are restricted to providing no-cost naloxone solely to high-risk individuals, Expanded Access partners are not limited by these eligibility restrictions when distributing purchased naloxone. High-Impact Partners may also participate in the Expanded Access extension, allowing them to access no-cost naloxone for high-risk individuals and purchase naloxone for individuals who may not be at the highest risk of overdose.
Apply for an Expanded Access agreement: Naloxone Expanded Access Registration and Order Form
Harm Reduction Test Strips
Local Health Departments, Community Service Boards, Authorized Comprehensive Harm Reduction sites, and Community-Based Organizations are eligible for no-cost naloxone, fentanyl test strips, xylazine test strips, benzodiazepine test strips, and nitazene test strips to dispense to high-priority members of the local community.
Notice of Xylazine Test Strip Expiration Date Extension:
VDH recently received notice of an expiration date extension from Premier Biotech, the manufacturer of the Xylazine test strips that VDH provides to partners at no cost. Some Xylazine test strips now have an expiration extended beyond the date printed on the label. Please refer to this notice for details about the impacted lot numbers: Premier Biotech Expiration Date Extension Letter Xylazine Test Strips
Additional Resources:
First responders, including law enforcement, fire service organizations, licensed emergency medical services (EMS) agencies, correctional facilities, Department of Juvenile Justice, state or regional probation and parole, and local and regional jails are eligible for no-cost naloxone from VDH.
Additional Resources:
High-impact community partners include treatment and recovery centers, rehabilitation facilities, homeless service providers, and community-based organizations that serve high-risk populations. High-impact community partners are eligible for no-cost naloxone from VDH to dispense to high-risk individuals. These community partners can apply for a naloxone agreement with VDH using the steps below.
Prior to accessing no-cost naloxone from VDH, high-impact community partners must complete one of the following training requirements:
- Online or in-person training in REVIVE! Opioid Overdose and Naloxone Education program, a course that teaches people how to respond to an opioid overdose and administer naloxone, or
- Online training in harm reduction education and counseling, which provides techniques for providing education in a short, concise manner and to provide one-on-one harm reduction counseling.
Additional Resources:
Local health departments (LHDs), community service boards (CSBs), and authorized comprehensive harm reduction sites (CHRs) are eligible to order Kloxxado (naloxone) 8mg nasal spray in addition to the naloxone 4mg nasal spray.
- Kloxxado 8mg nasal spray is U.S. Food and Drug Administration (FDA) approved as a prescription opioid reversal agent medication. It is the only form of higher-dose naloxone nasal spray. One dose of Kloxxado is equivalent to two doses of naloxone 4 mg nasal spray, which is the primary opioid reversal agent medication that VDH has provided to partners prior to September 2024.
- Kloxxado 8mg is currently a prescription medication. If dispensing to an individual pursuant to the Statewide Standing Order for Naloxone and Other Opioid Reversal Agents, the authorized dispenser must adhere to the Virginia Board of Pharmacy Naloxone Protocol, including appropriately labeling the medication and record keeping of dispensations.
- LHDs, CSBs, and Authorized CHRs can order Kloxxado 8mg through the same ordering platform that you currently use to order naloxone and test strips.
The Statewide Standing Order for Naloxone and Other Opioid Reversal Agents is available for public and private schools. Public K-12 schools are eligible for no-cost naloxone through VDH. Private schools may purchase OTC naloxone or email opioidreversal@vdh.virginia.gov for assistance.
Statewide Standing Order for Naloxone and Other Opioid Reversal Agents
Are K-12 schools allowed to possess and administer naloxone to students?
The emergency response and procedures for opioid overdose in the school setting are part of the school division’s School Crisis, Emergency Management and Medical Response Plan. The Code of Virginia § 54.1-3408 (X) provides the framework for schools to develop policy around naloxone possession and administration in the school setting. This legislation pertains to school nurses, health department personnel assigned to schools, and school board employees that provide health services. They may possess and administer naloxone as long as they have completed a training program pursuant to an oral, written, or standing order.
It is important to note that the Code of Virginia § 54.1-3408 (X) does not mandate that schools possess and administer naloxone. School divisions are encouraged to decide whether they want to adopt a naloxone-in-schools policy based on multiple factors including access or location of Emergency Medical Services (EMS) relative to school setting; local data on opioid use/misuse; School Resource Officers (SROs) possession of naloxone; community and school board feedback; and local resources for sustainability.
How do K-12 schools prepare to possess and administer naloxone?
The decision to adopt a naloxone policy in schools is made by the local educational agency (LEA). If an LEA approves naloxone administration by school employees, the Best Practices on Naloxone and Other Opioid Antagonists Possession and Administration in Response to a Suspected Opioid Overdose in the School Setting may be used by school divisions to assist in developing local school policies in response to suspected opioid overdose.
In order to possess or administer naloxone in the school setting, local school boards must develop and implement policies and procedures for the administration of naloxone in schools and ensure the training of relevant school personnel, pursuant to § 54.1-3408.X. The Virginia Department of Behavioral Health and Developmental Services (DBHDS) provides training to school personnel on how to recognize and respond to an opioid overdose emergency with the administration of naloxone.
REVIVE! is the name of the DBHDS’ Opioid Overdose and Naloxone Education (OONE) program for the Commonwealth of Virginia. Schools should document training of school personnel on an annual basis and provide the information upon request to VDH. For further information, schools should refer to the Virginia Department of Education School Health webpage or contact opioidreversal@vdh.virginia.gov.
Do I Need to Report on the Use of Naloxone in the School Setting?
As outlined in the Virginia Department of Education's Best Practices on Naloxone and Other Opioid Antagonists (HB 732), beginning school year 2025-2026, school divisions will report on the administration of opioid antagonists via the School Health Services Data Survey. This mandated data is collected annually and is due via the Single Sign-On Web Systems (SSWS) every June 30th.
Additional Resources:
Public universities are eligible to receive naloxone from VDH to provide to targeted groups, e.g., organizations of students in recovery from drug use/substance use disorder.
Additional Resources:
Virginia Campus Forum: Navigation Opioid Antagonist Training Requirements for RAs
House Bill 342 was passed in the 2024 General Assembly session and is effective July 1, 2024. HB342 requires state agencies to possess naloxone or other opioid antagonists used for overdose reversal to a person who is believed to be experiencing or about to experience a life-threatening opioid overdose and permits employees of any state agency to possess and administer naloxone or other opioid antagonists. See the statewide procurement and distribution plan below:
- Plan-for-the-Procurement-and-Distribution-of-Opioid-Reversal-Agents-to-State-Agencies (Revised September 26, 2024)
Naloxone and Test Strips Request Process for Eligible Community Partners
Additional Resources:
- Pharmacy Partner Hub User Guide - Revised August 2025
- Pharmacy Partner Hub FAQ - Revised May 2025
- Registration and Order Instructions for Pharmacy Partner Hub - Revised July 2024
Step 1: Apply
Use this form to APPLY if it is the first time your organization is requesting naloxone, if your organization’s agreement with VDH has expired, OR if you have an active agreement with VDH and have not yet registered your organization in the Pharmacy Partner Hub. Once all signatures are obtained and the agreement is executed, the organization is responsible for ensuring the agreement is updated before expiration date.
To renew an existing agreement, please contact opioidreversal@vdh.virginia.gov.
Step 2: Order
If you have an active agreement and have registered in the Pharmacy Partner Hub, log in to your Pharmacy Partner Hub account to order naloxone and test strips:
If you are a Local Health District, please use WebVision to order naloxone and test strips.
If you are unsure whether your organization has an executed agreement or if an agreement is still active, please contact opioidreversal@vdh.virginia.gov.
Step 3: Return
Please use this form to RETURN expired, unused, or damaged naloxone to the Virginia Department of Health. Partner organizations are required to return expired, unused, or damaged naloxone kits and may not distribute them to other organizations.
Contact Us: OpioidReversal@vdh.virginia.gov