Naloxone education & distribution programs
Naloxone, or Narcan, is a medication that reverses overdoses caused by opioids such as heroin, Vicodin, and OxyContin; it is not a controlled substance and does not have potential for abuse1, 2, 3. Two naloxone products, an intranasal spray and an autoinjector for intramuscular or subcutaneous administration, have been approved by the U.S. Federal Drug Administration (FDA) for community use4. As of 2020, all states and Washington, D.C. have naloxone access laws that increase naloxone dispensing from pharmacies to people at risk of an opioid overdose, to people who are likely to encounter someone who might overdose, or to distribution centers5. States and communities can further expand access to naloxone through education, training, and distribution programs that reach people who misuse opioids and their families and friends1, 6 and efforts to ensure that all first responders are trained and authorized to administer naloxone7, 8.
Opioids refer to all natural, semisynthetic, and synthetic opioids available, while opiates refer to naturally occurring opioids like heroin, morphine, and codeine.
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 strong evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participants with substance use disorders and other participants who are likely to encounter an overdose situation9, 10, 11, 12, 13, 14, 15, 16, 17. Naloxone distribution through such programs is associated with reduced opioid overdose deaths11, 14, 18, 19, increased opioid overdose reversal10, and increased self-confidence in participants’ ability to respond effectively to overdoses11, 16, 20, 21. Education for pharmacists and primary care providers appears to have positive effects on Naloxone prescribing and dispensing rates, while also decreasing opioid drug prescribing over time22.
Communities that implement programs to train potential bystanders (e.g., social service staff, individuals with a substance use disorder, 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 programs19. In New York, community members attending Opioid Overdose Education and Naloxone Distribution (OEND) training programs improved their knowledge and attitudes about opioid overdose23. Family and friends of individuals with a substance use disorder 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 booklet24. Some studies suggest individuals with a substance use disorder who participate in a brief 5-10 minute training or learn naloxone administration through social networks can respond appropriately to an overdose25, 26.
Opioid overdose education delivered via computer or written pamphlets can increase knowledge and reduce behavioral risk factors4, 27, 28. Personalized computer-based OEND programs have been shown to decrease perceived treatment barriers and self-reported opioid use among individuals with a substance use disorder12. OEND program participation may increase adherence to medications that treat opioid use disorder29. Participants in extended training programs are more likely to use naloxone in the short term; however, no difference in naloxone use remains one year after participation in either type of training9.
Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death30. Law enforcement officers and pharmacy students who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion20, 31, 32, 33, 34, 35. Implementing naloxone distribution programs within emergency department settings may increase access to naloxone among high-risk populations36; however, allocating training time within already overloaded schedules for emergency department staff can be challenging36. Prescribing of naloxone by primary care providers may be a way to expand access to individuals who are not part of a community-based approach37. Take home naloxone programs do not seem to increase opioid or substance use18, 38, 39.
Naloxone services provided by pharmacists are beneficial beyond community pharmacy settings and should be considered to create more targeted future programs (e.g., for veterans affairs and academic medical centers)10. Many pharmacists are knowledgeable and confident dispensing naloxone; however, one Ohio-based survey suggests barriers remain in understanding local and state laws40. Additional barriers among pharmacists include education and training, workflow, and management support41, 42. Among medical students, both online and in-person overdose trainings have been shown to be effective28, 43. Trainings on overdose response and naloxone administration can be incorporated broadly in current medical school curriculum44 or specifically for pharmacy students31. Input and perspectives from people who use drugs should be included when designing overdose education and naloxone distribution programs to improve program reach and effectiveness45.
Community-based naloxone distribution programs are cost-effective46, 47. U.S.-based and international analyses estimate that naloxone programs have large positive benefits for society, ranging from hundreds to tens of thousands of dollars47. Overdose education and naloxone distribution operating costs vary by program type and number of sites48.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by intervention design.
Naloxone education and distribution programs have the potential to decrease disparities in naloxone distribution and access to reduce overdose deaths. Inequalities by race, geographic location, and economic status persist in overdose deaths57, 58. Most people who overdose are non-Hispanic whites, about 10% are non-Hispanic Blacks, and 8% are Hispanic59. Experts attribute this demographic breakdown to the unconscious bias and prejudices of health care providers, who are more cautious prescribing opioids to non-white patients based on the prejudiced assumption that non-white patients are more likely to abuse or sell opioid prescription drugs59. Individuals who exhibit mental health conditions are also more likely to use opioids59. Providing naloxone and related education to family members of individuals with opioid use disorders is a cost-effective approach to increase access to naloxone for high-risk individuals. There is a need to reach family members of minoritized racial groups as attitudes among this group are more negative toward overdose response compared to their white counterparts46.
In the United States, opioid-related overdose death rates are much higher in rural areas compared to urban areas58. Administration of naloxone by life support personnel is low, even in areas with high overdose death rates. Policies that expand naloxone administration by EMTs and increase access for those at risk of overdose may reduce opioid-related overdose deaths in rural areas58. A study conducted in Massachusetts and Rhode Island found that areas encompassing large cities have higher naloxone kit distribution rates per opioid overdose deaths compared to non-urban areas that don’t encompass large cities60.
Adults who experience homelessness are disproportionately impacted by opioid overdoses and can benefit from naloxone education and distribution programs. An opioid overdose training and routine naloxone prescribing program at a homeless clinic in Pennsylvania, found that patients significantly increased their knowledge of opiate overdose after participating in the 15-minute education program. More research is needed to understand the barriers around naloxone fill rates, including housing, insurance, and other prescription use status61. Opioid overdose rates are highest among individuals with less education and fewer employment opportunities62.
What is the relevant historical background?
Opioid overdose deaths have been increasing since 199963. The rise in opioid overdose deaths began in the 1990s with a substantial increase in the prescription of both natural and semi-synthetic opioids because they were effective at managing chronic pain and falsely marketed to health care providers as non-addictive49, 64, 65. Prescription opioid sales increased fourfold between 1999 and 200862. Many patients who became addicted to prescribed opioids turned to non-prescribed forms of opioids, such as heroin, which lead to a second wave of opioid overdoses in 2010. In 2013, a third wave began when synthetic opioids, such as fentanyl, that are much more potent than other forms of opioids were combined with other drugs or counterfeit prescription pills, often unknown to the purchaser64. In 2013, the U.S. Department of Health and Human Services declared the misuse of prescription opioids an epidemic. Four years later, in 2017 the opioid epidemic was declared a national public health emergency59. Between 2020 and 2021, the opioid overdose death rate increased by over 15% and the synthetic opioid overdose death rate increased by over 22%64.
The dramatic increase in opioid sales was the result of pharmaceutical companies that overproduced and oversupplied opioid drugs for huge profits, pharmacies that filled the prescriptions, and health care providers who overprescribed the medications62. In rural areas many physicians overprescribed opioids to patients who travel long distances for treatment, do not have the ability to attend frequent appointments, and do not have alternative pain management interventions in their area62.
Naloxone was first approved by the FDA in 1971; however, its use was primarily limited to hospitals or ambulances and was controlled by those in the health care and criminal justice systems. Despite the rise in medical prescription opioids often targeted at vulnerable populations, stigmatization of people who misuse opioids increased opposition to naloxone access and increased political, legal, financial, and logistical struggles faced by advocates for naloxone expansion65. For decades advocates worked to overcome barriers to naloxone access and to reframe society’s response to drug use from a criminal justice-oriented approach to a public health approach. This narrative shift initially began to take effect as U.S. veterans struggled with opioid addiction while trying to manage chronic pain and as opioid use impacted many predominantly white, middle-class communities65. The narrative shift has benefitted many white communities; however, predominantly Black and Hispanic communities are largely still treated with criminal justice-oriented policies and mindsets. By 2017, all 50 states in the U.S. have adopted some variation of naloxone access laws; however, more work needs to be done to address disparities in access and to continue to overcome stigma65.
Equity Considerations
- How does your community provide naloxone education and support naloxone distribution? Are naloxone take home kits readily available for community members? If not, why is that?
- Who can you partner with to create or expand a naloxone education and distribution program in your community?
- What do opioid related overdose death rates look like in your community? Who has access to naloxone and who still needs access? What changes can your community make to a naloxone education and distribution program to reach community members at high risk of opioid overdose?
Implementation Examples
As of September 2019, there are 17 states that have enacted naloxone co-prescribing laws that allow prescribers to prescribe naloxone to patients who meet overdose risk criteria49. 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 use50. Many states provide civil and criminal immunity for both prescribers and administrators51, 52. The Veterans Health Administration (VHA) has developed and implemented a national Opioid Overdose Education and Naloxone Distribution (OEND) at all VHA medical facilities53.
Since November 2017, all 50 states have passed and implemented enhanced naloxone access laws with only 19 of those states mandating naloxone education training to pharmacists before they engage in independent naloxone dispensing and prescribing activities54.
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 method55.
Take home naloxone (THN) kits are increasingly available through community pharmacy-based THN programs56.
Implementation Resources
‡ Resources with a focus on equity.
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.
Naloxone for All - NEXT Distro. Stay alive, stay safe. Naloxone for all.
CDC-Pharmacist fact sheet 2019 - Centers for Disease Control and Prevention (CDC). Fact sheet: Pharmacists.
CDC-Naloxone training 2023 - Centers for Disease Control and Prevention (CDC). Naloxone training.
CDC-Vital signs 2019 - Centers for Disease Control and Prevention (CDC). Vital signs. Life-saving naloxone from pharmacies.
SAMHSA-Community coalition 2023 - Substance Abuse and Mental Health Services Administration (SAMHSA). Engaging community coalitions to decrease opioid overdose deaths.
Pew-Naloxone access 2020 - The Pew Charitable Trusts (Pew). Expanded access to naloxone can curb opioid overdose deaths. 2020.
PHLR-Platt 2022 - Platt E. Naloxone overdoes prevention laws. Center for Public Health Law Research (PHLR). 2022.
Footnotes
* Journal subscription may be required for access.
1 NPHL-Naloxone access laws - The Network for Public Health Law (NPHL). Legal interventions to reduce overdose mortality: Naloxone access laws.
2 NPHL-Good Samaritan laws - The Network for Public Health Law (NPHL). Legal interventions to reduce overdoes mortality: Overdose Good Samaritan laws.
3 SAMHSA-Overdose - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid overdose prevention toolkit. 2018.
4 Dunn 2017 - Dunn KE, Yepez-Laubach C, Nuzzo PA, et al. Randomized controlled trial of a computerized opioid overdose education intervention. Drug and Alcohol Dependence. 2017;173(Suppl 1):S39-S47.
5 Evoy 2021 - Evoy KE, Hill LG, Davis CS. Considering the potential benefits of over-the-counter naloxone. Integrated Pharmacy Research and Practice. 2021;10:13-21.
6 TFAH-Levi 2013 - Levi J, Segal LM, Miller AF. Prescription drug abuse: strategies to stop the epidemic. Trust for America’s Health (TFAH). 2013.
7 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.
8 NPHL 2021 - Network for Public Health Law Research (NPHL). Legal interventions to reduce overdose mortality: Naloxone access laws. 2021.
9 Jones 2022b - Jones JD, Campbell AN, Brandt L, et al. A randomized clinical trial of the effects of brief versus extended opioid overdose education on naloxone utilization outcomes by individuals with opioid use disorder. Drug and Alcohol Dependence. 2022;237:109505.
10 Rawal 2023 - Rawal S, Osae SP, Cobran EK, Albert A, Young HN. Pharmacists’ naloxone services beyond community pharmacy settings: A systematic review. Research in Social and Administrative Pharmacy. 2023;19(2):243-265.
11 Razaghizad 2021 - Razaghizad A, Windle SB, Filion KB, et al. The effect of overdose education and naloxone distribution: An umbrella review of systematic reviews. American Journal of Public Health. 2021;111(8):e1-e12.
12 Winhusen 2020 - Winhusen T, Wilder C, Lyons MS, et al. Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids. Drug and Alcohol Dependence. 2020;216:108265.
13 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.
14 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.
15 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.
16 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.
17 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.
18 Chimbar 2018 - Chimbar L, Moleta Y. Naloxone effectiveness: A systematic review. Journal of Addictions Nursing. 2018;29(3):167-171.
19 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.
20 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.
21 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.
22 Kulbokas 2021 - Kulbokas V, Hanson KA, Smart MH, et al. Academic detailing interventions for opioid-related outcomes: A scoping review. Drugs Context. 2021;10:1-20.
23 Heavey 2018 - Heavey SC, Burstein G, Moore C, Homish GG. Overdose education and naloxone distribution program attendees: Who attends, what do they know, and how do they feel? Journal of Public Health Management and Practice. 2018;24(1):63-68.
24 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.
25 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.
26 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.
27 Sisson 2023 - Sisson ML, Azuero A, Chichester KR, et al. Preliminary effectiveness of online opioid overdose and naloxone administration training and impact of naloxone possession on opioid use. Drug and Alcohol Dependence. 2023;249:110815.
28 Berland 2019 - Berland N, Lugassy D, Fox A, et al. Use of online opioid overdose prevention training for first-year medical students: A comparative analysis of online vs in-person training. Substance Abuse. 2019;40(2):240-246.
29 Jones 2021a - Jones JD, Campbell AN, Brandt L, et al. Intervention in an opioid overdose event increases interest in treatment among individuals with opioid use disorder. Substance Abuse. 2021;42(4):407-411.
30 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.
31 Kwon 2020 - Kwon M, Moody AE, Thigpen J, Gauld A. Implementation of an opioid overdose and naloxone distribution training in a pharmacist laboratory course. American Journal of Pharmaceutical Education. 2020;84(2):231-238.
32 Dahlem 2023 - Dahlem CH, Patil R, Khadr L, et al. Effectiveness of take ACTION online naloxone training for law enforcement officers. Health and Justice. 2023;11(1):47.
33 White 2021 - White MD, Perrone D, Malm A, Watts S. Narcan cops: Officer perceptions of opioid use and willingness to carry naloxone. Journal of Criminal Justice. 2021;72:101778.
34 Dahlem 2017 - Dahlem CHG, King L, Anderson G, et al. Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers. Public Health Nursing. 2017;34(6):516-521.
35 Purviance 2017 - Purviance D, Ray B, Tracy A, Southard E. Law enforcement attitudes towards naloxone following opioid overdose training. Substance Abuse. 2017;38(2):177-182.
36 Gunn 2018 - Gunn AH, Smothers ZPW, Schramm-Sapyta N, et al. The emergency department as an opportunity for naloxone distribution. Western Journal of Emergency Medicine. 2018;19(6):1036-1042.
37 Behar 2018 - Behar E, Bagnulo R, Coffin PO. Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review. Preventive Medicine. 2018;114:79-87.
38 Tse 2022 - Tse WC, Djordjevic F, Borja V, et al. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply. International Journal of Drug Policy. 2022;100:103513.
39 Katzman 2020 - Katzman JG, Takeda MY, Greenberg N, et al. Association of take-home naloxone and opioid overdose reversals performed by patients in an opioid treatment program. JAMA Network Open. 2020;3(2):e200117.
40 Thompson 2019 - Thompson EL, Rao PSS, Hayes C, Purtill C. Dispensing naloxone without a prescription: Survey evaluation of Ohio pharmacists. Journal of Pharmacy Practice. 2019;32(4):412-421.
41 Thakur 2019 - Thakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. Journal of the American Pharmacists Association. 2019;60(1):178-194.
42 Muzyk 2019 - Muzyk A, Smothers ZPW, Collins K, MacEachern M, Wu LT. Pharmacists’ attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature. Substance Abuse. 2019;40(4):476-483.
43 Berland 2017 - Berland N, Fox A, Tofighi B, Hanley K. Opioid overdose training with naloxone, an adjunct to basic life support for first-year medical students. Substance Abuse. 2017;38(2):123-128.
44 Taylor 2018 - Taylor JL, Rapoport AB, Rowley CF, Mukamal KJ, Stead W. An opioid overdose curriculum for medical residents: Impact on naloxone prescribing knowledge and attitudes. Substance Abuse. 2018;39(3):371-376.
45 Enich 2023 - Enich M, Flumo R, Campos S, et al. Overdose education and naloxone distribution program design informed by people who use drugs and naloxone distributors. Preventive Medicine Reports. 2023;35:102374.
46 Resko 2024 - Resko SM, Pasman E, Hicks DL, et al. Naloxone knowledge and attitudes towards overdose response among family members of people who misuse opioids. Journal of Community Health. 2024;49:70-77.
47 Cherrier 2022 - Cherrier N, Kearon J, Tetreault R, Garasia S, Guindon E. Community distribution of naloxone: A systematic review of economic evaluations. PharmacoEconomics - Open. 2022;6(3):329-342.
48 Behrends 2022 - Behrends CN, Gutkind S, Winkelstein E, et al. Costs of opioid overdose education and naloxone distribution in New York City. Substance Abuse. 2022;43(1):692-698.
49 Haffajee 2020 - Haffajee RL, Cherney S, Smart R. Legal requirements and recommendations to prescribe naloxone. Drug and Alcohol Dependence. 2020;209:107896.
50 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.
51 PDAPS-Naloxone - Prescription Drug Abuse Policy System (PDAPS). Naloxone overdose prevention laws.
52 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.
53 Oliva 2017 - Oliva EM, Christopher MLD, Wells D, et al. Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program. Journal of the American Pharmacists Association. 2017;57(Suppl 2):S168-S179.e4.
54 Roberts 2019 - Roberts AW, Carpenter DM, Smith A, Look KA. Reviewing state-mandated training requirements for naloxone-dispensing pharmacists. Research in Social and Administrative Pharmacy. 2019;15(2):222-225.
55 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.
56 Cid 2021 - Cid A, Daskalakis G, Grindrod K, Beazely MA. What is known about community pharmacy-based take-home naloxone programs and program interventions? A scoping review. Pharmacy. 2021;9(1):30.
57 CDC-Disparities widen - Centers for Disease Control and Prevention (CDC). Vital signs. Drug overdose deaths rise, disparities widen.
58 Zhang 2018c - Zhang X, Marchand C, Sullivan B, Klass EM, Wagner KD. Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities. Addictive Behaviors. 2018;86:79-85.
59 Salmond 2019 - Salmond S, Allread V. A population health approach to America’s opioid epidemic. Orthopaedic Nursing. 2019;38(2):95-108.
60 Zang 2021 - Zang X, Macmadu A, Krieger MS, et al. Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island. International Journal of Drug Policy. 2021;98:103435.
61 Pietrusza 2018 - Pietrusza LM, Puskar KR, Ren D, Mitchell AM. Evaluation of an opiate overdose educational intervention and naloxone prescribing program in homeless adults who use opiates. Journal of Addictions Nursing. 2018;29(3):188-195.
62 Judd 2023 - Judd D, King CR, Galke C. The opioid epidemic: A review of the contributing factors, negative consequences, and best practices. Cureus. 2023;15(7):e41621.
63 Freeman 2018 - Freeman PR, Hankosky ER, Lofwall MR, Talbert JC. The changing landscape of naloxone availability in the United States, 2011 – 2017. Drug and Alcohol Dependence. 2018;191:361-364.
64 CDC-Understanding the epidemic - Centers for Disease Control and Prevention (CDC). Understanding the opioid overdose epidemic.
65 Bennett 2021 - Bennett AS, Elliott L. Naloxone’s role in the national opioid crisis — past struggles, current efforts, and future opportunities. Translational Research. 2021;234:43-57.
Related What Works for Health Strategies
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countyhealthrankings.org/whatworks