Statewide Protocols (SWPs) for Colorado Pharmacists

0008-0000-26-116-H08-P
9/30/2026-9/30/2029

Objectives:

1. Describe the epidemiology and public health impact of opioid use disorder (OUD) nationally and in Colorado, including current overdose trends and barriers to treatment access.
2. Define key terminology related to substance use disorders, including addiction, opioid use disorder, tolerance, physical dependence, medications for opioid use disorder (MOUD), and harm reduction.
3. Apply DSM-5 diagnostic criteria to identify and classify the severity of opioid use disorder and recognize common signs and symptoms of opioid withdrawal.
4. Explain the neurobiological basis of substance use disorder, including the effects of opioids on reward pathways, brain function, withdrawal, and recovery.
5. Discuss opioid use disorder as a chronic, biopsychosocial medical condition and describe the role of medications, psychosocial interventions, and harm-reduction strategies in treatment and recovery.
6. Recognize the impact of stigma on patients with OUD and apply recovery-focused, person-centered language to support patient engagement and improve healthcare interactions.

0008-0000-26-120-H08-P
9/30/2026-9/30/2029

Objectives:

1. Define trauma (acute, chronic, and complex) and describe the two-way relationship between trauma and opioid use disorder, including how adverse experiences can fuel substance use.
2. Reinterpret common “difficult” patient behaviors at the pharmacy as adaptive responses to trauma rather than non-adherence or manipulation.
3. Apply the core principles of trauma-informed care (SAMHSA’s four R’s and six principles) within routine pharmacy workflows—without adding visit time.
4. Use recognition-based, identity-affirming strategies attachment-informed engagement, de-shaming, and non-abandonment that go beyond person-first language in MOUD delivery.
5. Connect trauma-informed recognition to MOUD retention and survival through the identity-driven adherence pathway.

0008-0000-26-118-H08-P
9/30/2026-9/30/2029

Objectives:

1. Describe the role of medications for opioid use disorder (MOUD) as the standard of care for OUD and compare the mechanisms of action of opioid agonists, partial agonists, and antagonists.
2. Compare the benefits, limitations, and relative effectiveness of buprenorphine and extended-release naltrexone for the treatment of OUD.
   
3. Identify the indications, pharmacology, contraindications, warnings, and monitoring parameters associated with buprenorphine-containing products used for OUD treatment.
4. Evaluate appropriate use of transmucosal and long-acting injectable buprenorphine formulations, including dosing considerations, administration requirements, and patient selection.
5. Discuss the appropriate use of long-acting injectable naltrexone, including opioid abstinence requirements, administration procedures, safety considerations, and monitoring recommendations.
6.  Provide essential patient counseling and education regarding MOUD therapy, including medication administration, adverse effects, overdose risk, adherence, and safe medication use.
   

0008-0000-26-117-H08-P
9/30/2026-9/30/2029

Objectives:

1. Describe the purpose and scope of the Colorado Statewide Protocol for Medications for Opioid Use Disorder (MOUD), including the pharmacist’s role in collaborative practice.
2. Identify the requirements necessary for pharmacists to participate in the MOUD protocol, including credentialing, DEA registration, training, and collaboration requirements.
3. Explain patient eligibility, consent, and screening requirements for initiating treatment under the MOUD statewide protocol.
4. Discuss the medications and services authorized under the protocol, including MOUD, withdrawal management, overdose prevention, and treatment of opioid-induced side effects.
5. Apply protocol requirements related to patient counseling, monitoring, follow-up, and referral to collaborating practitioners when appropriate.
6. Summarize documentation, recordkeeping, and record-retention requirements associated with providing care under the MOUD statewide protocol.
   

0008-0000-26-113-H08-P
9/30/2026-9/30/2029

Objectives:

1. Identify patients who are appropriate candidates for MOUD by applying the diagnostic criteria for opioid use disorder and evaluating clinical eligibility.
2. Conduct a comprehensive pre-treatment assessment, including substance use history, withdrawal severity, medical and psychiatric comorbidities, concurrent medications, pregnancy status, and social determinants that may influence treatment.
3. Differentiate between buprenorphine and naltrexone treatment and standard, high-dose, and low-dose (micro-induction) buprenorphine initiation strategies and select an appropriate induction approach based on patient presentation and opioid use patterns.
4. Develop an evidence-based induction and early stabilization plan that includes withdrawal management, dose titration, patient education, follow-up, and ongoing monitoring.
5. Apply trauma-informed and harm reduction principles throughout the assessment and induction process to promote patient engagement, reduce barriers to care, and support treatment retention.

0008-0000-26-119-H08-P
9/30/2026-9/30/2029

Objectives:

1. Identify key considerations for establishing collaborative relationships with practitioners or entities to support pharmacist-provided medications for opioid use disorder (MOUD) services.
2. Design pharmacy workflows that maintain patient privacy, confidentiality, and continuity of care during MOUD service delivery.
3. Develop processes for patient intake, documentation, provider communication, and referral management to support pharmacist-led MOUD services.
4. Describe the roles of pharmacy technicians and other support personnel in facilitating efficient MOUD service implementation.
5. Determine situations that require referral to a collaborating practitioner in accordance with the Colorado Statewide Protocol for Medications for Opioid Use Disorder.
6. Develop a community resource and referral network to support comprehensive, patient-centered care for individuals with opioid use disorder.

0008-0000-26-114-H08-P
9/30/2026-9/30/2029

Objectives:

1. Perform a comprehensive patient assessment to determine appropriateness for buprenorphine or naltrexone treatment using simulated patient cases. 
2. Develop and justify individualized buprenorphine and naltrexone induction and stabilization plans based on patient-specific clinical scenarios, including selection of an appropriate induction strategy. 
3. Demonstrate effective patient-centered communication techniques, including shared decision-making, motivational interviewing, trauma-informed care, and harm reduction principles during simulated clinical encounters. 
4. Respond appropriately to common clinical challenges encountered during buprenorphine initiation and early stabilization, including precipitated withdrawal, ongoing opioid use, missed doses, and patient concerns. 
5. Demonstrate competency in documenting clinical assessments, treatment plans, patient counseling, and follow-up recommendations in accordance with evidence-based practice and applicable state regulations.
   

0008-0000-26-115-H04-P
9/30/2026-9/30/2029

Objectives:

1. Identify the Colorado law that authorizes pharmacists to prescribe MOUD and requires payers to reimburse them.
2. Describe the requirements a pharmacist must meet before billing for MOUD services.
3. Explain how to bill an MOUD encounter, including both the visit and the medication administered.