Journal Article

Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: a systematic review and meta-analysis

Becasen, Jeffrey, Stein, Renee, Edlin, Brian R., Meltzer, Martin I., Fischer, Leah S., Asher, Alice, Doreson, Amanda, Mermin, Jonathan

2025

Overview

Background It is estimated that over 111,000 people in the U.S. died from a drug overdose in the twelve-month period ending in July 2023. More than three-quarters of those deaths were attributed to opioids. Naloxone has long been available in healthcare facilities to reverse opioid overdose rapidly and safely but is not universally accessible for use in community settings where overdoses occur. We conducted a systematic literature review and meta-analysis to assess the effectiveness of overdose education and naloxone distribution (OEND) programs in three types of community settings to reduce overdose deaths among people who use opioids nonmedically. Methods We systematically searched electronic databases, including Medline (OVID), Embase (OVID), Psycinfo (OVID), and Global Health (OVID), for peer-reviewed studies of OEND programs published during 2003–2018 (Group 1) that reported overdose outcomes individual level survivals or deaths immediately following naloxone administration. The PRISMA checklist guided screening, quality assessment, and data abstraction. We later identified studies published during 2018–2022 (Group 2), when drug usage and fentanyl-related overdose deaths notably increased, differed from earlier ones. We conducted meta-analyses on both Groups using random effects models to estimate summary survival proportions. Results Among the 44 Group 1 studies published during 2003–2018, survival did not differ by time (year), location, naloxone dose, or route of administration, but studies of OEND programs serving people who use drugs reported 98.3% (95% CI: 97.5–98.8) survival; those serving family of people who use drugs or other community members reported 95.0% (95% CI: 91.4–97.1) survival; and those for police reported 92.4% (95% CI: 88.9–94.8) survival ( p  < 0.01). Five Group 2 studies (2018–2022) yielded similar results. Conclusions Community-based naloxone distribution programs can be effective in preventing opioid overdose deaths. The paper demonstrates that in the face of increasing overdose deaths over time, survival after naloxone administration has been sustained. The very high survival rates provide clear evidence for public health to continue efforts to expand channels for naloxone distribution in community settings.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Biostatistics / Community / Dosage and administration / Drug overdose / Drug Overdose - mortality / Drug Overdose - prevention & control / Drug use / Drugs / Effectiveness / Environmental Health / Epidemiology / Fatalities / Fentanyl / Global health / Health care facilities / Humans / Injection drug use / Intervention / Literature reviews / Medicine / Medicine & Public Health / Meta-analysis / Naloxone / Naloxone - administration & dosage / Naloxone - supply & distribution / Naloxone - therapeutic use / Narcotic Antagonists - administration & dosage / Narcotic Antagonists - supply & distribution / Narcotic Antagonists - therapeutic use / Narcotics / Opiate Overdose - drug therapy / Opiate Overdose - mortality / Opiate Overdose - prevention & control / Opioid / Opioids / Overdose / Prevention / Public Health / Quality assessment / Quality control / Software / Survival / Systematic Review / Vaccine