The DOI matches its Crossref record; 23 of the 24 references it cites were found in a registry or an index.
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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“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]
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Statistical Analysis of Correlated Data Using Generalized Estimating Equations: An Orientation
Hanley, J. A. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwf215 · Cited by 2,185
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013) · BMJ · doi:10.1136/bmj.f174 · Cited by 999
Ecologic Studies in Epidemiology: Concepts, Principles, and Methods
Morgenstern, H. (1995) · Annual Review of Public Health · doi:10.1146/annurev.pu.16.050195.000425 · Cited by 755
McDonald, R., & Strang, J. (2016) · Addiction · doi:10.1111/add.13326 · Cited by 472
Opioid Overdose Prevention Programs Providing Naloxone to Laypersons - United States, 2014.
(2015) · PubMed Central · Cited by 426
Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal
Coffin, P. O., & Sullivan, S. D. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-1-201301010-00003 · Cited by 347
Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opioid overdose
Doe-Simkins, M., Walley, A. Y., Epstein, A., & Moyer, P. (2009) · American Journal of Public Health · doi:10.2105/ajph.2008.146647 · Cited by 250
Strang, J., Manning, V., Mayet, S., Best, D. W., Titherington, E., Santana, L., Offor, E., & Semmler, C. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02314.x · Cited by 197
Wagner, K. D., Valente, T. W., Casanova, M., Partovi, S. M., Mendenhall, B. M., Hundley, J. H., Gonzalez, M., & Unger, J. B. (2009) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2009.01.003 · Cited by 192
Green, T. C., Heimer, R. R., & Grau, L. E. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02182.x · Cited by 192
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Nataraj, N., Chen, Y., Stewart, A., Rikard, S. M., Zhang, K., Rice, K., Jiang, X., Mattson, C. L., Ko, J. Y., Guy, G. P., et al. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5391644
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Lyons, E., & Bernhardt, J. M. (2026) · Journal of Substance Use · doi:10.1080/14659891.2026.2615702
Knudsen, H. K., Goetz, M., Andrews-Higgins, S., Back-Haddix, S., Davis, O. A., Freeman, P. R., Oyler, D. R., & WALSH, S. L. (2026) · Implementation Research and Practice · doi:10.1177/26334895261438500
Plesons, M., Bartholomew, T. S., Tookes, H. E., & Feaster, D. (2026) · Harm Reduction Journal · doi:10.1186/s12954-026-01444-8
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Mandavia, A. D., Coppersmith, D. D. L., Banducci, A. N., Rose, G. A., Bradley, J. C., Marx, B. P., Davenport, M. J., & Livingston, N. A. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117320
Agostini, T., Herrera, A., Paulson, E., Shyne, R., Delgado, C., Oyetunji, S. O., & Campbell, K. (2026) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000002426
Ray, B. R., Gillenwater, L. A., Dir, A. L., Ouyang, F., Monahan, P. O., McGladrey, M., Reda, K., & Aalsma, M. C. (2026) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2026.113287
Harris, A., & Edwards, H. (2026) · North Carolina Medical Journal · doi:10.18043/001c.169243
Johnson, E., Eukel, H. N., Skoy, E. T., & Werremeyer, A. B. (2026) · American Journal of Health Education · doi:10.1080/19325037.2026.2744599
Metadata
- 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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