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) has compiled webinars, trainings, data,
and marketing materials from ROOR recipients that may help other rural communities implement their
own naloxone expansion programs. NOSORH also 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.
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
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
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
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
Samaritan Drug Overdose Laws
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
Good Samaritan Overdose
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
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
Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan
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
Opioid Overdose Prevention
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
Prescription Drug Overdose
(PDO) Prevention for States
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
Organization(s): Centers for Disease Control and Prevention
Lazarus Community Toolkit
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
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