Impact of a community-based naloxone distribution program on opioid overdose death rates
Open accessAbstract
Background In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. Methods One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. Results The rate of OOD in counties with 1-100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95% CI: $1,237, $4882). Conclusions Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers.
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A North Carolina study estimated that naloxone distribution averted 352 overdose deaths over a three-year period, at a cost of $1,605 per life saved.
“The sixth study estimated that naloxone distribution in North Carolina averted 352 overdose deaths over a three-year period, at a cost of $1,605 per life saved [34].”
From Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: a systematic review and meta-analysis (2025) · cites this paper as [34]
The Results > Cost-benefit analysis estimates approximately 352 deaths avoided from August 2013 through December 2016. It reports $1,605 per death avoided only for 2015–2016, when an estimated 255 deaths were avoided; the claim incorrectly pairs that cost with the longer period and its 352-death estimate. (LLM, conf=0.93)
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- Authors
- Naumann, R. B., Durrance, C. P., Ranapurwala, S. I., Austin, A. E., Proescholdbell, S., Childs, R., Marshall, S. W., Kansagra, S., & Shanahan, M. E.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- NC Department of Health and Human Services (US)
- JBS International (United States) (US)
- Corresponding author
- Naumann, Rebecca B.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 204
- Pages
- 107536
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC8107918
- OpenAlex
- W2970055270
- Cited by
- 112
- References
- 24
- Citations by year
- 2026: 16 · 2025: 29 · 2024: 24 · 2023: 11 · 2022: 10 · 2021: 16 · 2020: 6
- FWCI
- 7.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (5NU17CE002728)
- University of North Carolina at Chapel Hill (R49‐CE001495)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- naloxone distribution, opioid overdose deaths, harm reduction, cost-benefit analysis, North Carolina, value of a statistical life
- MeSH terms
- Adolescent, Adult, Cost-Benefit Analysis, Delivery of Health Care, Female, Humans, Male, Middle Aged, Naloxone, Narcotic Antagonists, Opioid-Related Disorders, North Carolina, Program Evaluation, Young Adult, Drug Overdose
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