Review Article| Volume 234, P43-57, August 2021

Naloxone's role in the national opioid crisis—past struggles, current efforts, and future opportunities

  • Alex S. Bennett
    Reprint requests: Alex S. Bennett, Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY
    Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York

    Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
    Search for articles by this author
  • Luther Elliott
    Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York

    Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
    Search for articles by this author
Published:March 05, 2021DOI:
      Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opioid-related mortality. The establishment of naloxone distribution programs under the umbrella of syringe exchange programs faces the same practical, ideological and financial barriers to expansion similar to those faced by syringe exchange programs themselves. The expansion of naloxone from the confines of a few syringe exchange programs to what we see today represents an enormous triumph for the grass-roots activists, service providers, and public health professionals who have fought to guarantee lay access to naloxone. Despite the extensive efforts to expand access to naloxone, naloxone continues to remains a scarce resource in many US localities. Considerable naloxone “deserts” remain and even where there is naloxone access, it does not always reach those at risk. Promising areas for expansion include the development of more robust telehealth methods for naloxone distribution, including subsidized mail delivery programs; lowering barriers to pharmacy access; working with hospitals, ambulances, and law enforcement to expand naloxone “leave behind” programs; providing naloxone co-prescription with medications for opioid use disorder; and working with prisons, shelters, and networks of people who use drugs to increase access to the lifesaving medication. Efforts to ensure over-the-counter and low- or no-cost naloxone are ongoing and stand alongside medication-assisted treatments as efficacious, readily-actionable, and cost-efficient population-level interventions available for combatting opioid-related overdose in the United States.


      CDC (Centers for Disease Control and Prevention), DEA (Drug Enforcement Agency), EMS (Emergency Medical Services), FDA (Food and Drug Administration), MOUD (Medications for Opioid Use Disorder), NIMBY (Not in My Back Yard), OD (Overdose), OEND (Overdose Education and Naloxone Distribution), OUD (Opioid Use Disorder), PO (Prescription Opioids), PWID (People Who Inject Drugs), PWUD (People Who Use Drugs), PWUO (People Who Use Opioids), SCF (Safe Consumption Facilities), SEP (Syringe Exchange Program), SSP (Syringe Service Program), THN (Take Home Naloxone), US (United States), VA (Veterans Administration)
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