Increasing naloxone availability and use in high-risk settings: public libraries as partners for reducing opioid overdose mortality

PROJECT SUMMARY/ABSTRACT Opioid overdose mortality has increased substantially since the start of the COVID-19 pandemic. Opioid overdose deaths are preventable and can be reversed with the timely receipt of naloxone. To date, naloxone distribution and implementation programs have targeted traditional first responders (e.g., EMS) as well as people with opioid use disorder and their social networks. While these initiatives have resulted in measurable reductions in opioid overdose mortality, major gaps in naloxone availability and use persist. The overarching goal of this work is to save lives by advancing evidence regarding place-based naloxone implementation and overdose reversal readiness in high-risk settings, using public libraries as a test case. More than one in ten public libraries experienced an on-site overdose in 2022. In addition, public libraries—which host 1.2 billion in-person visits annually and are within 2 miles of most Americans’ homes—are an important safety net for vulnerable populations, including those with substance use disorders. For these reasons, libraries represent a novel setting to promote naloxone uptake. There have been nascent efforts to equip libraries with naloxone, however, uptake remains low. Thus, we aim to understand institutional barriers to and facilitators of naloxone uptake (Aim 1). Then, we will establish a Public Libraries Cohort (PLC) to monitor and identify drivers of naloxone uptake and incidence and outcomes of overdose among public libraries (Aim 2). Aim 3 will compare the efficacy of two web-based interventions (facilitator-guided and self-guided training), each vs. the other and vs. usual care, on increasing both overdose reversal readiness and naloxone uptake in libraries. This work will advance the evidence for place-based naloxone implementation and overdose prevention.