Identifying gaps in the implementation of naloxone programs for laypersons in the United States

Abstract

Background The opioid epidemic in the United States (US) continues to generate significant increases in morbidity and mortality with no sign of decline. Overdose education and naloxone distribution (OEND) programs are highly effective at preventing opioid overdose mortality. We assessed the geographical distribution of overdose mortality and OEND programs in the US. Methods We conducted a cross-sectional, ecological study of all 3142 counties in the United States. Our variables of interest included 1) county-level drug overdose mortality rates, and 2) whether the county had an established OEND program. We mapped the drug overdose mortality rates and presence of OEND programs and assessed for differences in OEND program implementation by drug overdose mortality rates with Fisher's exact test. Results In total, 8% (254) of counties in the US had established OEND programs by 2014, and only 13% of counties with the highest overdose mortality rates (>24 deaths/100,000) had OEND programs operating within them. Counties with the lowest overdose mortality rates were least likely to have OEND programs established (p < 0.001). Conclusions We identified counties experiencing a high prevalence of drug overdose mortality but lacking OEND programs. Improving access to evidence-based approaches like OEND programs is a critical component to address the country's growing overdose epidemic.