**Background.** Naloxone distribution is a key intervention to reduce opioid overdose mortality. State laws like standing orders are associated with higher naloxone prescription rates and lower opioid overdose mortality. However, little is known about the characteristics and health service utilization of people filling naloxone under a standing order.
**Objective.** To examine Medicaid claims for naloxone fills and health service contacts under Louisiana’s standing order.
**Methods.** Retrospective cohort study of Louisiana Medicaid members from January 23, 2017 to December 31, 2019. We identified naloxone fills under the standing order as claims filled with the clinician who signed the standing order as the prescriber. We classified health service contacts as any claims associated with a provider visit, and other medication fills that occurred prior to filling naloxone. For provider visits, we classified them as opioid-related or non-opioid related using diagnosis codes.
**Results.** Altogether, 2,053 naloxone prescriptions were filled by 1,912 individuals. The total number of naloxone fills increased from 22 in 2017 to 1,218 in 2019. Most members (n=1,586, 83%) had some type of health service in the 30 days before filling naloxone while 391 members (20.5%) had at least one opioid-related health service. In the 60 days before filling naloxone, 242 members (12.7%) received medication for opioid use disorder, and 815 (42.6%) filled prescription opioid analgesics. Nineteen members (1.0%) had an emergency department visit for overdose within 90 days after filling naloxone.
**Conclusions.** Naloxone uptake under the standing order increased gradually among Louisiana Medicaid members in the two years following the standing order’s implementation. Because most members filling naloxone had health system contact, the standing order appears to function as a “safety net” for individuals who did not receive prescriptions from other providers. Notably, many individuals had opioid-related health care or opioid prescriptions, indicating opportunities to train providers on naloxone prescribing.