Short Report
Identifying gaps in the implementation of naloxone programs for laypersons in the United States

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Background

The opioid epidemic in the United States (US) continues to generate significant increases in morbidity and mortality with no sign of decline. In 2014, the drug overdose mortality rate was 14.7 per 100,000 (Rudd, Aleshire, Zibbell, & Gladden, 2016), and the age-adjusted opioid overdose mortality rate rose nearly 200% from 2000 to 2014 (Rudd, Aleshire et al., 2016). Opioid-involved overdose deaths increased another 16% from 2014 to 2015, fueled by an increase in deaths involving heroin and

Study population

Our study population includes all 3142 counties in the 50 United States and District of Columbia in 2014.

Data sources

We combined two different data sources: (a) drug overdose mortality, as captured in the National Vital Statistics System from the National Center for Health Statistics (NCHS) (Rossen, Bastian, Warner, Khan, & Chong, 2017); and (b) existing OEND programs from a database that was developed to determine the location and effective dates of all programs that distribute naloxone to laypersons in

Results

In total, 8% (254) of counties in the US had established OEND programs by the time of the HRC survey in 2014, and counties with the highest overdose mortality rates had very low implementation of OEND programs – 12% of counties with >18–≤24 deaths per 100,000, and 13% of counties with >24 deaths per 100,000 had established OEND programs [Fig. 1]. The counties with the lowest overdose mortality rates were least likely to have OEND programs established – <1% of counties with ≤6 deaths per

Discussion

Given the scope of the opioid epidemic in the United States, we observed strikingly low levels of OEND programs established throughout the country. While counties experiencing the highest rate of drug overdose mortality (>24/100,000) did have the highest percentage of OEND programs in our analysis, these programs were operating in only 13% of these high burden counties. The relatively low volume of OEND coverage throughout the United States highlights a critical implementation gap in the

Conflict of interest statement

We declare that we have no conflicts of interest.

Acknowledgement

This research was conducted with funding from the National Institute of Drug Abuse (R34DA039101).

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