Naloxone education & distribution programs

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 abuse (NPHL 2016, SAMHSA-Overdose). As of January 2017, 47 states and Washington, DC 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 providers (NCSL-Drug overdose). States and communities can further expand access to naloxone through education, training, and distribution programs that reach drug users and their families and friends (TFAH-Levi 2013, NPHL 2016) and efforts to ensure that all first responders, including EMTs, firefighters, and law enforcement officers, are trained and authorized to administer naloxone (Davis 2014b*, NPHL 2014b).

Expected Beneficial Outcomes (Rated)

  • Increased knowledge of appropriate overdose response

Other Potential Beneficial Outcomes

  • Reduced overdose deaths

  • Increased self-confidence

Evidence of 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 situation (Clark 2014, Giglio 2015, Lewis 2016*, Ashrafioun 2016*, Lott 2016). Naloxone distribution through such programs is associated with reduced overdose deaths (Giglio 2015, Walley 2013*) and appears to increase participants’ confidence in their ability to respond effectively to overdose situations (Ashrafioun 2016*, Wagner 2016*, Strang 2008*). 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 programs (Walley 2013*).

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 booklet (Williams 2014*). 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 experts (Green 2008*). 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 overdose (Doe-Simkins 2014, Behar 2014*).

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death (Davis 2014c*). Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion (Wagner 2016*).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

In 2014, 644 local opioid overdose prevention programs in 30 states and Washington, DC provided community members with naloxone kits and training in proper use (CDC MMWR-Naloxone 2015). Many states provide civil and criminal immunity for both prescribers and administrators (LawAtlas-Naloxone, Davis 2015*).

In November 2015, a nasal spray method of administering naloxone was approved by the US Food and Drug Administration (FDA) along with the previously-approved injection method (US FDA-Naloxone 2015). As of January 2017, Kaléo, a pharmaceutical company, provides naloxone auto-injectors free of charge to qualifying non-profit organizations through their Product Donation Grants Program (Kaleo-Naloxone).

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 - US Department of Justice (US 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.

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

Lewis 2016* - Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG. 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

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.

LawAtlas-Naloxone - Law Atlas. Naloxone overdose prevention laws map.

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.

US FDA-Naloxone 2015 - US Food and Drug Administration (US FDA). FDA moves quickly to approve easy-to-use nasal spray (Naloxone) to treat opioid overdose. 2015.

Kaleo-Naloxone - Kaléo. Kaléo cares: Product donation grants, Evzio (Naloxone HCl injection) Auto-injector.

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