Innovative naloxone distribution program shows promise to prevent opioid overdoses
- 3 min. read ▪ Published
Although recent years have seen some reductions, accidental drug overdose is still a leading cause of death in the United States, with opioids such as fentanyl the most common cause.
Naloxone (sold under the brand name Narcan, among other names) is a safe and highly effective drug that can be administered via muscular injection or sprayed up the nose to reverse opioid overdoses; community-based distribution of the drug has been a key overdose prevention strategy. However, some people still die from overdoses due to lack of naloxone access.
A new study led by Shelley Facente, assistant adjunct professor of Community Health Sciences at UC Berkeley School of Public Health and principal of Facente Consulting, and the nonprofit Harm Reduction Michigan (HRMI) evaluated a novel method of making naloxone more accessible to people who need it throughout the state of Michigan.
In 2021, HRMI launched a program that offered free naloxone across the state of Michigan through publicly accessible, unlocked, outdoor naloxone boxes. By 2024, the program had placed 184 naloxone boxes across Michigan—each holding between three and six dozen doses of naloxone when fully stocked—resulting in 24,428 doses of naloxone distributed from 2023 to 2024 alone.
In 2025, Facente’s team conducted stakeholder interviews and analyzed the available data about naloxone box stocking and placement.
“These days most people readily agree that distributing naloxone is an important strategy for addressing the fatal overdose epidemic,” said Facente.”However, many of the strategies used and evaluated to date have been through pharmacies or programs that are not available 24/7; programs to distribute naloxone to first responders, librarians, or teachers; or expensive naloxone vending machines, which provide ready access to people but are very expensive to open and maintain.”
“To our knowledge this is the first evaluation of a program that provides naloxone through publicly accessible, unlocked boxes (sort of like newspaper boxes, but with no change required) placed throughout communities—and we showed it was very feasible and many doses of naloxone were shared through this strategy,” she said.
The stakeholders Facente’s team interviewed universally perceived the naloxone box model as impactful and crucial to saving lives, noting that naloxone boxes democratize naloxone distribution through their low-barrier, 24/7 availability and relative anonymity.
They also noted that, amid persistent drug-related stigma, naloxone boxes create opportunities for productive conversations about overdose, drug use, and harm reduction in communities.
Though no causality could be determined, overdose death rates in Michigan declined nearly five times faster than the U.S. average between 2021 and 2023, beginning the year the boxes were first installed.
The analysis did find, however, that the box distribution didn’t always match the need (i.e., some counties with high overdose death rates had no boxes), and some counties with very high overdose death counts but few-to-no boxes had a very high percentage of Black residents.
“One of our conclusions was that a more data-driven approach to box placement would increase naloxone access in areas of highest need, and improve racial equity for this intervention,” said Facente. “HRMI is working steadily toward making that shift.”
