Naloxone education & distribution programs
Community in Action
Naloxone is a prescription medication that reverses overdoses caused by opioids such as heroin, Vicodin, and OxyContin; it not a controlled substance and does not have potential for abuse1, 2. As of January 2017, 47 states and Washington, D.C. have expanded access to naloxone through legislation that permits prescriptions to people who are likely to encounter someone who might overdose (i.e., third party prescription) or standing orders by health care providers3. States and communities can further expand access to naloxone through education, training, and distribution programs that reach drug users and their families and friends1, 4 and efforts to ensure that all first responders, including EMTs, firefighters, and law enforcement officers, are trained and authorized to administer naloxone5, 6.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased knowledge of appropriate overdose response
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced overdose deaths
Increased self-confidence
What does the research say about effectiveness?
There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation7, 8, 9, 10, 11. Naloxone distribution through such programs is associated with reduced overdose deaths8, 12 and appears to increase participants’ confidence in their ability to respond effectively to overdose situations10, 13, 14. However, additional evidence is needed to confirm effects.
Communities that implement programs to train potential bystanders (e.g., social service staff, opioid users and their family and friends) to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs12.
Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via an information booklet15. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts16. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose17, 18.
Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death19. Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion13.
Implementation Examples
In 2014, 644 local opioid overdose prevention programs in 30 states and Washington, D.C. provided community members with naloxone kits and training in proper use20. Many states provide civil and criminal immunity for both prescribers and administrators21, 22.
In November 2015, a nasal spray method of administering naloxone was approved by the U.S. Food and Drug Administration (FDA) along with the previously-approved injection method23.
Implementation Resources
SAMHSA-Overdose - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid overdose prevention toolkit. 2018.
Project DAWN - Project Dawn (Deaths Avoided With Naloxone). Ohio Department of Health. 2017.
US DOJ BJA-Naloxone - U.S. Department of Justice (U.S. DOJ), Bureau of Justice Assistance (BJA). National Training and Technical Assistance Center. Law Enforcement Naloxone Toolkit.
NSC-Overdose - National Safety Council (NSC). Can you recognize the signs of an opioid overdose?
NIDA-Naloxone - National Institute on Drug Abuse (NIDA). Naloxone.
HRC-Overdose - Harm Reduction Coalition (HRC). Overdose prevention.
RHIhub-Rural naloxone - Rural Health Information Hub (RHIhub). Rural prevention and treatment of substance use disorders toolkit: Naloxone expansion programs.
Footnotes
* Journal subscription may be required for access.
1 NPHL 2016 - Legal interventions to reduce overdose mortality: Naloxone access and overdose Good Samaritan laws. Network for Public Health Law (NPHL). 2016.
2 SAMHSA-Overdose - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid overdose prevention toolkit. 2018.
3 NCSL-Drug overdose - National Conference of State Legislatures (NCSL). Drug overdose immunity and Good Samaritan laws.
4 TFAH-Levi 2013 - Levi J, Segal LM, Miller AF. Prescription drug abuse: strategies to stop the epidemic. Trust for America’s Health (TFAH). 2013.
5 Davis 2014b - Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW. Emergency medical services naloxone access: A national systematic legal review. Academic Emergency Medicine. 2014;21(10):1173-1177.
6 NPHL 2021 - Network for Public Health Law Research (NPHL). Legal interventions to reduce overdose mortality: Naloxone access laws. 2021.
7 Clark 2014 - Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. Journal of Addiction Medicine. 2014;8(3):153-163.
8 Giglio 2015 - Giglio RE, Li G, DiMaggio CJ. Effectiveness of bystander naloxone administration and overdose education programs: A meta-analysis. Injury Epidemiology. 2015;2(10):1-9.
9 Lewis 2016 - Lewis DA, Park JN, Vail L, et al. Evaluation of the overdose education and naloxone distribution program of the Baltimore Student Harm Reduction Coalition. American Journal of Public Health. 2016;106(7):1243-1246.
10 Ashrafioun 2016 - Ashrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods. Substance Abuse. 2016;37(1):76-81.
11 Lott 2016 - Lott DC, Rhodes J. Opioid overdose and naloxone education in a substance use disorder treatment program. The American Journal on Addictions. 2016;25(3):221-226.
12 Walley 2013 - Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ. 2013;346:f174.
13 Wagner 2016 - Wagner KD, Bovet LJ, Haynes B, Joshua A, Davidson PJ. Training law enforcement to respond to opioid overdose with naloxone: Impact on knowledge, attitudes, and interactions with community members. Drug and Alcohol Dependence. 2016;165:22-28.
14 Strang 2008 - Strang J, Manning V, Mayet S, et al. Overdose training and take-home naloxone for opiate users: Prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction. 2008;103(10):1648-57.
15 Williams 2014 - Williams AV, Marsden J, Strang J. Training family members to manage heroin overdose and administer naloxone: Randomized trial of effects on knowledge and attitudes. Addiction. 2014;109(2):250-259.
16 Green 2008 - Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: An evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. 2008;103(6):979-89.
17 Doe-Simkins 2014 - Doe-Simkins M, Quinn E, Xuan Z, et al. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: A retrospective cohort study. BMC Public Health. 2014;14:297.
18 Behar 2014 - Behar E, Santos GM, Wheeler E, Rowe C, Coffin PO. Brief overdose education is sufficient for naloxone distribution to opioid users. Drug and Alcohol Dependence. 2014;148:209-212.
19 Davis 2014c - Davis CS, Ruiz S, Glynn P, Picariello G, Walley AY. Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts. American Journal of Public Health. 2014;104(8):e7-e9.
20 CDC MMWR-Naloxone 2015 - Centers for Disease Control and Prevention (CDC). Opioid overdose prevention programs providing naloxone to laypersons: United States, 2014. Morbidity and Mortality Weekly Report (MMWR). 2015;64:631-635.
21 PDAPS-Naloxone - Prescription Drug Abuse Policy System (PDAPS). Naloxone overdose prevention laws.
22 Davis 2015 - Davis CS, Carr D. Legal changes to increase access to naloxone for opioid overdose reversal in the United States. Drug and Alcohol Dependence. 2015;157:112-120.
23 US FDA-Naloxone 2015 - U.S. Food and Drug Administration (U.S. FDA). FDA moves quickly to approve easy-to-use nasal spray (Naloxone) to treat opioid overdose. 2015.
Related What Works for Health Strategies
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