Naloxone Expansion Programs

In 2017, drug overdose/drug poisoning was the leading cause of injury-related death in the U.S. Many rural communities are seeking to decrease drug overdose deaths by implementing wide-spread use of naloxone. This emergency medication can reverse the effects of opioid overdoses, leading to decreased overdose-related morbidity and mortality. Naloxone can be administered by anyone who has received training, including healthcare providers, first responders, and laypeople. There is some evidence that naloxone distribution and education programs can reduce opioid overdose death rates in communities, though additional research is needed.

In 2015, the U.S. Department of Health and Human Services developed a pilot program with the Federal Office of Rural Health Policy called the Rural Opioid Overdose Reversal (ROOR) Program. Eighteen grant recipients in 13 states were awarded $100,000 over a one-year period to reduce opioid overdose in rural communities through the purchase and placement of naloxone kits to reverse the effects of opioid overdoses. The National Organization of State Offices of Rural Health (NOSORH) prepared a report that describes lessons learned from ROOR.

Experts recommend using Good Samaritan drug overdose laws as a way to reduce overdose deaths. Good Samaritan drug overdose laws can also help to support naloxone expansion programs by providing immunity from criminal prosecution for prescribing naloxone, requesting emergency services during an overdose, or administering naloxone. As of July 2017, all 50 states and the District of Columbia have passed legislation to improve naloxone access to community members.

Examples of Rural Naloxone Expansion Programs

Project Lazarus is a North Carolina-based organization that provides technical assistance to community groups and clinics on overdose prevention and opioid safety education. In addition to coalition building and community engagement activities, the Project Lazarus program has created toolkits and trainings designed for pharmacies, care managers, primary care providers, emergency department staff, law enforcement, and first responders on opioid overdose prevention.
The Wabanaki Pathway to Hope and Healing initiative, funded by the Rural Opioid Overdose Reversal Program, created a partnership between Diversion Alert, a statewide program for sharing data between law enforcement and healthcare providers, with a coalition of five tribal communities in rural Maine. Naloxone kits were distributed within each tribal community and trainings were provided on the administration of the life-saving drug. Using Project Lazarus as a model, materials were adapted to be culturally appropriate to the tribal communities involved.
Project VIBRANT, based in rural North Carolina at the Granville Vance Health Department and funded through the Rural Opioid Overdose Reversal grant program, conducted community-wide trainings on recognizing the signs of overdose and administering naloxone. Community members at risk of experiencing or witnessing an overdose, as well as first responders, emergency medical providers, and drug treatment counselors received training on and access to naloxone kits.
Project DAWN: Deaths Avoided With Naloxone is a community-based overdose education and naloxone distribution program from Ohio provides participants with education about overdose and training on how to administer naloxone.
The San Luis Valley N.E.E.D. (Naloxone; Education; Empowerment; Distribution) program, organized by the San Luis Valley Area Health Education Center, is a Rural Opioid Overdose Reversal grant program provided naloxone access and education to six rural Colorado counties. Community stakeholders were trained in the administration of naloxone and were provided with naloxone kits free of charge after completing the training.

Considerations for Implementation

Layperson administration of naloxone is most safe when the individual has received training on recognizing signs of opioid overdose and proper administration of naloxone. Many states, but not all, have passed laws that make it easier for laypeople to dispense naloxone in an emergency. In late 2015, the FDA also approved a nasal spray version of naloxone, which had previously only been available in injectable form. While both methods of administering naloxone are effective, one rural program reported greater willingness for non-medical professionals like law enforcement personnel to administer the life-saving drug when it was available as a nasal spray, as they were hesitant to administer an injection.

Rural programs implementing naloxone distribution programs frequently cite the importance of contracts and memoranda of understanding with partnering agencies like pharmacists, primary care providers, law enforcement, hospitals, and other key community stakeholders. Programs also referenced the importance of community buy-in and participation in the development of naloxone distribution programs. By involving the community in the beginning stages, rural programs report being able to better address the attitudes, perceptions, and stigma associated with working on issues related to opioid use disorders.

Program Clearinghouse Examples

Resources to Learn More

Evidence-Based Guidelines for EMS Administration of Naloxone
Document
Describes evidence-based guidelines and a model protocol for emergency medical services (EMS) administration of naloxone to people with a suspected opioid overdose.
Author(s): Williams, K., Lang, E.S., Panchal, A.R., et al.
Citation: Journal of Prehospital Emergency Care, 23(6), 749-763
Date: 2019

Good Samaritan Drug Overdose Laws
Document
Provides links to resources demonstrating evidence of effectiveness for Good Samaritan drug overdose laws and offers examples of implementation.
Organization(s): County Health Rankings & Roadmaps
Date: 3/2016

Good Samaritan Overdose Prevention Laws
Website
An interactive map offering users access to Good Samaritan laws by state.
Organization(s): Prescription Drug Abuse Policy System (PDAPS), Center for Public Health Law Research, Temple University

Law Enforcement Naloxone Toolkit
Website
Provides law enforcement the resources needed to establish a naloxone program that will reduce opioid overdoses and save lives. Topics covered include acquiring and administering naloxone, law enforcement training, liability and risk, and partnerships with other agencies.
Organization(s): Bureau of Justice Assistance (BJA), National Training and Technical Assistance Center (NTTAC)

Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws
Document
Summarizes the characteristics of naloxone access and the Good Samaritan laws in states where they have been enacted to reduce opioid overdose.
Organization(s): The Network for Public Health Law
Date: 7/2017

Opioid Overdose Prevention Toolkit
Document
Provides information about opioid use disorder (OUD) and various strategies to help prevent opioid overdose. Offers resources for first responders, prescribers, and patients and families.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 2018

Prescription Drug Overdose (PDO) Prevention for States
Website
Describes a prevention program designed to help states combat the high rates of prescription drug overdose by providing health departments the resources necessary to strengthen interventions that prevent PDOs.
Organization(s): Centers for Disease Control and Prevention

Project Lazarus Community Toolkit
Document
Provides guidance for communities to create coalitions to address opioid overdose using the Project Lazarus Model. Contains fact sheets designed for specific community sectors and offers information on naloxone prescribing and training in its use.
Organization(s): Project Lazarus

Rural Healthy People 2020, Volume 1
Document
Contains literature reviews related to a broad range of health topics and their importance to rural populations. Includes an overview of substance abuse data in rural communities and an analysis of substance abuse prevalence and disparities.
Author(s): Kash, B., McMaughan, D., Hutchison, L, & Tan, D.
Citation: Rural Healthy People 2020, 1, 73-82
Date: 2015