Naloxone dispensing models in the United States: A scoping review of the literature evaluating the outcomes and prevalence of implemented naloxone distribution methods

Abstract

Specific Aims: To identify and evaluate naloxone distribution methods in the United States (U.S.). Methods: PubMed, EMBASE, Cochrane Library, and Scopus databases were searched between January 2013 and June 2023 to identify U.S. based studies that evaluated programs, initiatives, and laws relating to naloxone dispensing or distribution. The four databases were searched using polyglot search queries that included terms such as naloxone, opioid overdose, dispensing, distribution, naloxone use education, and harm reduction. Articles obtained from the search queries were each screened by two independent reviewers for mentions of programs and initiatives in the U.S. that included opioid education and naloxone distribution (OEND) programs, pharmacies dispensing naloxone under standing orders, and take-home naloxone rescue kits. Articles were included if they had outcomes or data on the prevalence of opioid-related deaths post-intervention. Data on where naloxone was distributed, method of naloxone access, naloxone administration route, and cost-effectiveness were extracted by two independent reviewers. Results: Five articles were identified with evaluations of programs, initiatives, and laws that broadened access to naloxone. One study evaluated naloxone access laws across the U.S. Four studies looked at the effectiveness of OEND programs with or without additional training for persons who use opioids (PWUO) or healthcare professionals. One study evaluated the cost-effectiveness of intranasal naloxone distribution. Conclusions: Naloxone is commonly distributed through community OEND programs. However, in areas where an OEND program was not available, naloxone was often provided through take-home kits, standing orders, and individually dispensed in pharmacies.