Harm reduction

What are communities doing to make naloxone more accessible?

Discover how communities are increasing access to naloxone to combat the opioid crisis and how this increased availability can help save more lives.

Ophelia team
Naloxone over U.S. map
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Fact checked by
Arthur Robin Williams, MD

According to the National Institute on Drug Abuse, over 16,000 people died from prescription opioid use in 2021 alone — and that doesn’t even account for the number of people affected by opioids in the street drug supply. The severity of the ongoing opioid crisis has prompted states and cities to begin making naloxone more readily available in an effort to save lives. This medication has proven to be effective in reversing the effects of opioids, making it useful for helping someone who has overdosed. While it’s not a treatment for opioid addiction, it can be a helpful tool in an emergency overdose situation. Naloxone access has been a hot topic in recent months, so here’s what you need to know about current community-based responses.

Where is naloxone becoming more widely available?

States expanding access to naloxone

Although the FDA made naloxone available over the counter in March, there hasn’t been any federal follow-up action. This means states and municipalities are charting their own courses to ensure people can get lifesaving care. The good news is that all 50 states have some type of law granting access to naloxone. The downside is that not every state follows the same protocol, and costs can vary widely by location and insurance provider. As with any other medication, prices at the pharmacy can be a significant barrier to access. Plus, there’s still a lot of stigma and stereotyping around drug use and treatment, and the fear of judgment could also deter people from taking advantage of available care resources.

The standing order is the most common protocol, which means healthcare providers other than physicians are authorized to perform certain clinical tasks without going through the physician. In some cases, family, friends, and community groups are also authorized to help at-risk individuals.

These are the states that have standing orders for naloxone, whether by state law or through agreements between licensed physicians and pharmacists:

  • Alabama
  • Alaska
  • Arizona
  • California
  • Colorado
  • Delaware
  • Georgia
  • Illinois
  • Indiana
  • Iowa
  • Louisiana
  • Maine
  • Massachusetts
  • Michigan
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Pennsylvania
  • Rhode Island
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin

Some states, like Massachusetts, grant pharmacies the ability to dispense naloxone without a prescription from a doctor. Pharmacies are also required to keep these rescue kits stocked in their locations.

Others, such as Ohio and Delaware, have programs that allow individuals to order naloxone online and receive it through the mail. In some cases, online training videos or simple online tests are required to complete the order. This helps ensure the person ordering it knows how and when to administer it.

Several states, such as Minnesota and Nebraska, offer informational websites to help you find local medical facilities or pharmacies that carry naloxone for free.

Currently, 37 states participate in NEXTDistro, a program that distributes naloxone by mail. Among the states that don’t participate in NEXTDistro, 5 have their own statewide mail program.

Many states also have harm reduction programs that give out free naloxone kits. The Harm Reduction Coalition maintains a searchable map of programs, and you can find nearby resources by typing in your ZIP code.

Municipalities expanding access to naloxone

Not every program is state-wide. Individual cities, including Chicago and Philadelphia, have begun programs that allow citizens to acquire naloxone kits at local libraries to battle opioid overdoses.

In Washington, D.C., anyone can pick up no-cost naloxone at a pharmacy or community center without ID or a prescription. Additionally, the district operates a hotline that connects people who can’t reach a pickup site with outreach workers who can deliver kits within two business days. For those who have time to wait for mail delivery, the district provides access to a request form for discreet shipping.

What to know about using naloxone

Naloxone comes in different forms, including a nasal spray and an injectable version that can go into the muscle or a vein. The form will determine how the naloxone gets administered. While both are considered user-friendly, the spray is the most common method and easier for anyone to administer, even without medical training. Providing this lifesaving care is the most important step, but in all cases, it’s also important to call for emergency assistance.

Naloxone administration step-by-step guide
Naloxone administration guide

How is nasal spray naloxone administered?

Intranasal naloxone is a prepackaged device filled with one dose. The device fits between your middle and index fingers, using your thumb for support and to deploy the plunger. When administering this spray, tilt the person’s head back and insert the spray nozzle into one nostril until your fingers touch the bottom of their nose. Press the plunger all the way down, then remove the device. If the person remains unresponsive within 3 minutes, administer another dose. 

How is injectable naloxone administered?

The injectable naloxone kit consists of a needle and vial of medicine, and the medication should be injected in the person’s upper arm or outer thigh. Since this method has more specific requirements and steps, it’s more commonly used by harm reduction workers and medical personnel. To administer a dose, carefully insert the needle into the vial and draw up the full amount. Then, inject the needle in the appropriate location and push the plunger until the syringe is empty. It’s okay to inject through a layer of clothing if necessary. Like the spray form, injectable naloxone can be administered if the person remains unresponsive within 3 minutes.


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