As the opioid crisis continues to devastate communities across the United States, claiming thousands of lives each year, the HEALing Communities Study (HCS) has highlighted the pivotal role of community-led initiatives in increasing the availability of naloxone, a medication that can reverse opioid overdoses.
A recent study, published in the International Journal of Drug Policy, explores strategies used by four New York State counties participating in the HCS to increase naloxone accessibility and reduce opioid overdose deaths through implementing naloxone boxes, also known as naloxone housing units. Similar to the publicly available automated external defibrillators (AEDs) to reverse cardiac arrest, naloxone boxes allow laypeople the means to respond to an overdose and administer the life-saving medication prior to the arrival of first responders. These boxes are available in public settings and contain individual doses of naloxone as well as instructions for use.
While the four counties utilized coalitions for naloxone distribution planning, each selected distinct implementation approaches. One urban county utilized technology-based strategies to streamline its current naloxone distribution strategy, which led them to increase naloxone boxes by 390 sites over 2 years. The county used the Overdose Detection Mapping Application Program (ODMAP) to identify areas to prioritize naloxone box installment. They then created an opioid dashboard to allow the public to track the locations of naloxone boxes, overdoses, and drug disposal locations; an online application form on the county’s website to request new boxes; and a text/call line to request a naloxone box or replacement equipment. Another county, with a mix of urban and rural landscapes, adopted a grassroots approach led by the County Department of Health and Mental Health in collaboration with community stakeholders to install 76 naloxone boxes in public and high-risk areas (e.g., county government buildings, public libraries, bars, and social service organizations) and utilized innovative methods like QR codes for replacement requests and overdose training videos.
Conversely, two counties opted for contracting with local Overdose Outreach Prevention Programs (OOPP) to support the implementation of naloxone boxes. In a more rural county, where resources were limited, the coalition focused on increasing naloxone availability for veterans, people living in poverty, and rural populations, placing five units in key locations such as at the courthouse, the Department of Social Services, a regional independent living center for individuals with disabilities, and OOPPs. In contrast, the fourth county, a densely populated area, contracted with multiple OOPPs and focused on both active and passive naloxone distribution strategies. This involved co-locating naloxone with AEDs and engaging local businesses to host naloxone boxes, while also offering overdose education training and direct distribution of naloxone kits to establishment employees. This initiative saw the installation of 64 naloxone boxes, along with training 59 business employees in 51 establishments, and distributing 165 naloxone kits directionally to employees.
Through this study of the outcomes of the various county-level approaches, the researchers identified several critical findings and factors for implementing community-wide naloxone boxes, including:
The cost per naloxone unit ranged from $211 to $3,361, which is relatively low compared to the societal cost of fatal opioid overdoses in the United States.
Data-driven decisions, aided by location-based data from health departments and first responders, like ODMAP, along with input from those with lived experience, can help inform and prioritize planning and placement strategies.
Co-locating naloxone units with AEDs can help normalize overdose prevention and encourage community acceptance.
Providing naloxone to all government-owned or local businesses and training employees at establishments can enhance program effectiveness and increase acceptance.
Creating community partnerships and local champions can ensure daily maintenance and refills. In rural areas, multiple champions may be needed for efficient promotion and maintenance.
Busy public spaces such as restaurants, public restrooms, and libraries may reach more individuals, while law enforcement and government buildings may present barriers due to intimidation or fear of legal consequences.
This study demonstrates that community-led approaches to naloxone distribution are crucial for effectively combating the opioid crisis. By involving local stakeholders, adopting flexible and culturally competent strategies, and overcoming legal, financial, and social barriers, communities can significantly improve access to this life-saving medication and enhance their overall public health response. For more information and insights from the study, read the full article.
About the HEALing Communities Study
The HEALing Communities Study is a multi-site research study to test the integration of prevention, overdose treatment, and medication-based treatment in select communities hard hit by the opioid crisis. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®. Learn more at https://hcs.rti.org.