Community Based Naloxone Program
Formerly the "Take Home Naloxone" Program.
NEW - Overdose Kit Use Reporting Form
For any patients returning to your pharmacy to obtain a replacement overdose kit, please provide a copy of the Overdose Kit Use Reporting form to the individual and ask them to complete it and drop it off at the pharmacy. The form is available in 2 formats:
- Online Survey - https://survey.albertahealthservices.ca/naloxone
- PDF (Paper Version) - https://www.albertahealthservices.ca/assets/healthinfo/mh/hi-amh-thn-usage-form.pdf
Completed forms can be scanned/emailed to email@example.com or Faxed to (780) 638-3844, Attn: Take Home Naloxone Kit Program.
Pharmacies participating in the Community Based Naloxone program should ensure their staff are knowledgeable about the program by completing one of the following 3 options for education.
RxA members can access it easily in GoPharmacist.
Pharmacy Staff Members
Click here to access the NON-ACCREDITED PROGRAM HERE
Click here to REGISTER your pharmacy to participate in the program. Whenever possible this form should be completed by the Pharmacy Manager. Please allow 2-3 business days for your registration to be completed. If you are not able to order kits after that time please send an e-mail to Naloxone.Kit@albertahealthservices.ca
This program is only open to pharmacists, pharmacy technicians and pharmacy staff practicing in Alberta.