A Mixed-Methods Evaluation of a Statewide Naloxone Distribution Project: Considerations for Future Implementation of Opioid Overdose Prevention Initiatives

A Mixed-Methods Evaluation of a Statewide Naloxone Distribution Project: Considerations for Future Implementation of Opioid Overdose Prevention Initiatives | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Mixed-Methods Evaluation of a Statewide Naloxone Distribution Project: Considerations for Future Implementation of Opioid Overdose Prevention Initiatives Sara Beeler, Olivia Golan, Adrienne Call, Nora Marino, Alina Ghobadi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7142082/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Despite over a 25% national decline in opioid overdose deaths in 2024, overdose remains a leading cause of mortality in the U.S., with persistent regional disparities. Illinois, for example, reported nearly 4,000 overdose deaths in 2022. Evidence-based interventions—such as naloxone distribution—have been integral in reducing fatalities. While naloxone programs vary, research supports broader community access as an effective strategy. In 2021, Illinois launched the Access program, a statewide initiative providing free nasal naloxone through an online portal to community organizations, hospitals, and clinics. This study evaluates the implementation and impact of the statewide program to inform future overdose prevention efforts. Methods: A mixed-methods approach was used to evaluate implementation (qualitative) and outcomes (quantitative). Qualitative data included semi-structured interviews (n = 15) with state policymakers, implementation partners, and participating organizations. Quantitative data focused on naloxone orders and administrations from two program-level tracking systems. Data were analyzed separately and then compared to interpret findings among the researchers. The evaluation covers three years of data, from July 2021 to June 2024. Results: Quantitative analysis revealed a statistically significant relationship between naloxone orders and administrations, suggesting that increased community saturation is associated with more overdose reversals. Demographic trends showed a rise in administrations on Black individuals and a decline among Hispanic populations. Naloxone use increasingly occurred in residential settings, with a decline in 911 calls and hospitalizations post-administration. Qualitative findings emphasized the importance of no-cost access and a simple ordering process, which allowed organizations to redirect resources to other critical programming needs. Conclusions: The Access program successfully expanded naloxone availability across Illinois, particularly among underserved populations. Key facilitators included free ordering and streamlined ordering. However, disparities in institutional participation and response behaviors highlight the need for continued stigma reduction and harm reduction education. Future efforts should focus on expanding uptake in low-barrier settings and conducting longitudinal evaluations to assess the sustained impact of naloxone distribution on overdose mortality. naloxone distribution harm reduction public health opioid overdose prevention access to care mixed-methods evaluation Figures Figure 1 Background The number of national opioid overdose deaths reached an all-time low in 2024, with a 27% decrease from 2023 (110,037 versus 80,391; CDCa, 2025). While this decline is promising, overdose remains among the top three causes of death in the United States (Ahmad et al., 2024). Additionally, regional disparities persist, with several midwestern states ranking among the top ten in terms of overdose deaths. For example, Illinois reported nearly 4,000 overdose deaths in 2022, with a 30% fatality rate (CDCb, 2025). The progress in reducing overdose deaths is largely attributed to the adoption of evidence-based strategies, including public messaging campaigns, prescriber education and tracking systems, medication for opioid use disorders, and naloxone, a medication that reverses opioid overdoses (Massachusetts Health Officers Association [MHOA], 2025). Given the proven effectiveness of naloxone (CDCa, 2025), distribution programs have expanded nationwide. These programs vary in scope (Larweh, 2025), with some targeting broad community access (e.g., bystanders, businesses) and others focusing only on high-need groups (e.g., people who use drugs, emergency responders) (Bohler et al., 2023). Given this variation and the critical role of naloxone in reducing overdose deaths, evaluating the implementation and impact of different distribution models is essential (Bohler et al., 2023). A growing body of research has examined the impact of widespread naloxone distribution programs, aiming to understand whether broader community access to bystanders, families, and businesses can save more lives than distribution limited to emergency responders or high-risk groups (Bohler et al., 2023; Fischer et al., 2025). Fischer and colleagues’ (2025) systematic review and meta-analysis revealed that 44 studies on naloxone distribution programs are effective and that survival is sustained after naloxone administration. Additionally, a study designed to inform agent-based models on community-based naloxone distribution methods reported that distributing naloxone directly to persons using drugs and other persons in the community (bystanders) reduces the risk of opioid deaths (Keane et al., 2018). Despite this evidence, implementation varies widely across states, and more research is needed to understand how different models perform in diverse contexts. In 2021, Illinois launched a community access naloxone distribution program (herein referred to as ‘ Access’ ), offering free nasal naloxone to community organizations, hospitals, and clinics via an online portal (Illinois.gov, 2021). The Access program removes cost barriers to naloxone and mandates the reporting of naloxone distribution and use (IDHS/SUPR, 2023). Building on 2010 legislation allowing nonmedical administration of naloxone, Illinois created the Drug Overdose Prevention Program (DOPP), which encourages organizations to implement Opioid Education and Naloxone Distribution (OEND) services. DOPP enrollment is required to participate in the Access program (Illinois Saves Overdose, n.d.). While Illinois has multiple opioid-related initiatives, this study focuses on Access , examining its implementation, impact, and lessons learned to inform future efforts. Purpose The State partnered with a university to evaluate the Access program. The study aimed to (1) characterize the organizations and individuals who received naloxone, (2) examine the relationship between naloxone distribution and administration, and (3) explore program implementation successes and challenges. Methods The paper utilized mixed methodologies to report on implementation and process outcome data (the quantity of naloxone orders and administrations) and semistructured qualitative interview data (from interviews with state policymakers, implementation partners, and participating organizations). The quantitative and qualitative data were analyzed separately, with the researchers later comparing the results to interpret the findings. The evaluation spanned from the start of the Access project (July 2021) to the end of the third year (June 2024). Sample and eligibility . To participate in Access , organizations must register as a DOPP, which automatically qualifies these organizations forparticipation in the project. A select number of DOPPs are also official OEND programs, which receive additional funding from the State to provide naloxone education, training, and distribution in their region and to help individuals obtain naloxone Data collection . Quantitative data collection. There were two sources of quantitative data for this study. The first source came from the distributor of naloxone, and the second came from the Illinois Saves Overdose (naloxone administration) website. The distributor data offered descriptive findings on who (organizational description), how much (amount and cost of the number of boxes containing two 4 mg doses of naloxone ordered), and where (zip code) the naloxone was requested. The naloxone administration data included information on what naloxone dosage was administered, where and when administration occurred, and individual-level characteristic data of those who received naloxone for attempted opioid reversal. The quantitative portion of this study was approved by the Institutional Review Board at the University of Illinois Chicago. Qualitative data collection. Fifteen 60-minute Zoom interviews were conducted between June 24, 2024, and August 9, 2024, including 5 interviews with policymakers and implementation partners, 5 interviews with OEND program representatives, and 6 interviews with DOPP enrollee representatives (note: one participant was both a policymaker/implementation partner and DOPP enrollee representative). The research team produced a list of 26 outreach candidates, drawing from programs with the highest number of orders from the Access site since July 2021 and incorporating recommendations from State Program Leadership, with the goal of recruiting a diverse sample of organizations. Beginning in June 2024, the research interview team-initiated email outreach to the candidates, and the participants selected a time using a calendar link. If an interview was not scheduled within seven days of the initial email, the research team sent a reminder email to all nonrespondents. State program leadership prompted unresponsive candidates to participate in an interview. The participants did not receive compensation for participating. T The research team developed semi-structured interview guides tailored to the three key informant roles (see supplemental file). The interviews examined what worked well during implementation, challenges in ordering and distributing naloxone in communities, potential outcomes of the program, and the sustainability of naloxone distribution efforts. Two research team members attended each interview, with one conducting the interview and the second taking detailed notes. At the beginning of each interview, the interviewer obtained consent to participate and recorded the call from the participant. The qualitative portion of the study was approved by the Institutional Review Board at NORC at the University of Chicago. Data analyses. Quantitative Data Analysis. Univariate statistics were conducted to describe variables related to the ordering and administration of naloxone. These results are presented as counts and percentages. A basic correlation was conducted to understand the strength and significance of the relationship between naloxone order and administration. A linear regression was run, along with a Durbin‒Watson statistic, to assess the residuals for the presence of an autocorrelation (Dodge, 2008). The presence of autocorrelation suggests accounting for a time series, or lagged function, between the variables (Nicolau et al., 2024; orders in one month may be used during administration in a later month), and a time series regression was performed to assess the relationship between monthly naloxone orders and monthly naloxone administrations over the study period (July 2021--June 2024). Analyses were conducted via Stata 15 SE. Qualitative Data Analysis. To analyze the qualitative interview data, we used an applied thematic analysis approach. First, the interviews were transcribed and uploaded to Dedoose qualitative software. The team developed a codebook concurrently with conducting the interviews. Three team members participated in the coding.To ensure reliability, one team member developed an interrater reliability (IRR) test through Dedoose to ensure alignment in coding as a team. The three coders completed this test and discussed the results. The IRR from this test ranged from .78 - .85, with 1.0 being a perfect alignment. After sufficient interrater reliability was achieved, each interview transcript was then coded by one research team member. After the interview transcripts were coded, the codes were organized and grouped under higher-order headings (i.e., themes), formulating potential subcategories (i.e., subthemes). We also identified representative quotations for themes and subthemes. Results Naloxone orders. Over three years, naloxone orders increased from 57,588 cartons in July 2022 to 382,104 in June 2024 (see Table 1 ). Among the 711,120 total 4 mg cartons ordered during the first three years of the project, the majority were ordered by community and/or social service organizations (N = 406,896, 57%). Public health departments and other government agencies accounted for approximately one quarter of the total (N = 184,560, 26%), followed by substance use or mental health service agencies (N = 66,252, 9%). The remaining orders came from correctional facilities (N = 20,244, 3%), law enforcement or emergency medical services (EMS)/fire departments (N = 14,244, 2%), school or educational institutions (N = 12,912, 2%), and hospitals or Federally Qualified Health Centers (FQHCs; N = 3,612, 1%). Table 1 Naloxone Cartons Ordered by Organizational Type, Overall and by Fiscal Year (FY), 2022–2024 Organizational Type Overall FY 2022 FY 2023 FY 2024 N % N % N % N % Total 711,120 100% 57,588 100% 271,428 100% 382,104 100% Community and/or social service organizations 406,896 57% 36,876 64% 144,060 53% 225,960 59% Public health departments and other government agencies 184,560 26% 10,896 19% 80,736 30% 92,928 24% Substance use or mental health services 66,252 9% 6,888 12% 17,784 7% 41,580 11% Correctional facilities 20,244 3% 420 1% 11,592 4% 8,232 2% Law enforcement or emergency medical services (EMS)/fire 14,244 2% 432 1% 10,272 4% 3,540 1% Schools or educational institutions 12,912 2% 2,076 4% 6,480 2% 4,356 1% Hospitals or Federally Qualified Health Centers (FQHCs) 3,612 1% 0 0% 420 < 1% 3,192 1% Other 2,400 < 1% 0 0% 84 < 1% 2,316 1% Note: Cartons included 2 doses of 4 mg/1 ml naloxone nasal sprays. Illinois’ fiscal year is July 1 through June 30. Qualitative interviews reinforced and contextualized these patterns, highlighting how the program expanded naloxone access across a wide range of organizations—from small, budget-constrained nonprofits to larger entities such as police departments and colleges. The interviewees emphasized that the program also enabled organizations not previously involved in naloxone distribution to obtain and distribute the medication. Many community-based organizations, particularly OEND programs, use the program’s website to place orders on behalf of other groups. As a result, entities such as religious institutions, small businesses (e.g., grocery stores, clothing stores, restaurants, bars, gas stations, funeral homes), libraries, public transportation systems, and mutual aid groups were also able to distribute naloxone within their communities. “The free access to [naloxone] is provided at such a high level, like such a state level to so many different organizations. The ability to access it does trickle down to other smaller groups and smaller organizations .” – Policymaker/implementation partner The interviews also revealed that fewer than ten percent of naloxone orders were collectively placed by correctional facilities, law enforcement or EMS/fire departments, school or educational institutions, and hospitals or FQHCs. The interviewees identified several barriers to naloxone distribution in these settings. In schools, nurses and administrators are often hesitant to receive, carry, and distribute naloxone due to uncertainty about how it aligns with existing school policies. In correctional settings, such as jails and prisons, staff were frequently reluctant to provide naloxone to current inmates and returning citizens (people leaving correctional facilities), citing stigma, a lack of awareness, and logistical challenges. In hospital settings, particularly emergency departments, interviewees noted that the program’s reporting requirements created an additional burden for already overstretched staff, as the process was separate from standard medical charting and workflows. “Our sheriff is very resistant. We've had a little committee working with them in the jail to try and inform them and help them understand why it was important to… give [inmates] [naloxone] on their way out. The pushback was, “Oh, that's too much work. We don't have enough staff.” – OEND program representative Naloxone administration. Reports of naloxone administrations nearly tripled, from 255 overdose reversals in July 2021 to 909 administrations in June 2024. Appendix Table A shows the monthly number of administrations over the project period. In FYs 2022 and 2023, the number of administrations was greater from March through June. In contrast, in FY 2024, the number of administrations was greater from August through October. Overall, administrations most often occurred in a house (N = 1,075; 64.1%), followed by a public space outdoors (N = 273; 16.3%) (see Table 2 ). The average person receiving naloxone during the project period was reported as a white male between the ages of 25 and 44 years. However, naloxone administrations among Black or African American individuals made up a larger percentage of administrations as years progressed, from 14.1% (N = 36) in FY 2022 to 35% (N = 318) in FY 2024. Additionally, from FY 2023 to FY 2024, the percentage of males receiving an administration decreased (FY 2023: N = 353, 68.7%; FY 2024: N = 485, 53.4%), whereas the percentage of administrations to females increased (FY 2023: N = 139, 27.0%; FY 2024: N = 384, 42.2%). Most people were found unconscious at the time of administration (N = 1,409; 84%). The number of calls to 911 during administration decreased from 53% in FY 2022 (N = 135) to 28% in FY 2024 (N = 253). In FY 2024, the majority of administrations (N = 609; 67%) did not result in a call to 911. Similarly, hospitalizations after administration decreased across the project years. In FY 2022, 39% (N = 99) of administrations resulted in hospitalizations, compared with 29% (N = 263) by FY 2024. Table 2 Characteristics of Reported Naloxone Administrations, Overall and by Fiscal Year (FY), 2022–2024 Overall FY 2022 FY 2023 FY 2024 N % N % N % N % Total 1,678 100% 255 100% 514 100% 909 100% Gender Male 996 59.4% 158 62.0% 353 68.7% 485 53.4% Female 602 35.9% 79 31.0% 139 27.0% 384 42.2% Transgender 25 1.5% 1 0.4% 8 1.6% 16 1.8% Unknown 55 3.3% 17 6.7% 14 2.7% 24 2.6% Age Under 18 8 0.1% 0 0.0% 1 0.1% 7 0.8% 18–24 179 10.7% 22 8.6% 46 8.9% 111 12.2% 25–44 913 54.4% 147 57.6% 275 53.5% 491 54.0% 45–64 397 23.7% 51 20.0% 127 24.7% 219 24.1% 65+ 42 2.5% 1 0.4% 23 4.5% 18 2.0% Unknown 139 8.3% 34 13.3% 42 8.2% 63 7.0% Race and Ethnicity Black or African American 509 30.3% 36 14.1% 155 30.2% 318 35.0% Hispanic/Latinx 200 11.9% 46 18.0% 57 11.1% 97 10.7% White 829 49.4% 126 49.4% 261 50.8% 442 48.6% Other* 35 2.1% 7 2.7% 15 2.9% 13 1.4% Unknown 105 6.3% 40 15.7% 26 5.1% 39 4.3% Location of Administration House 1075 64.1% 132 51.8% 296 57.6% 647 71.2% Other Residence 66 3.9% 7 2.7% 31 6.0% 28 3.1% Public Building 68 4.1% 7 2.7% 38 7.4% 23 2.5% Business Site 93 5.5% 12 4.7% 38 7.4% 43 4.7% Public Outdoor Site 273 16.3% 56 22.0% 82 16.0% 135 14.9% Unknown 38 2.3% 19 7.5% 10 1.9% 9 1.0% Other 65 3.9% 22 8.6% 19 3.7% 24 2.6% Hospitalization Yes 554 33.0% 99 38.8% 192 37.4% 263 28.9% No 921 54.9% 91 35.7% 237 46.1% 593 65.2% Unknown 203 12.1% 65 25.5% 85 16.5% 53 5.8% 911 Call Yes 609 36.3% 135 52.9% 221 43.0% 253 27.8% No 890 53.0% 71 27.8% 210 40.9% 609 67.0% Unknown 179 10.7% 49 19.2% 83 16.1% 47 5% Consciousness Yes 111 6.6% 20 7.8% 50 9.7% 41 5.2% No 1409 84.0% 190 74.5% 411 80.0% 808 88.9% Unknown 158 9.4% 45 17.6% 53 10.3% 60 6.6% *Other races/ethnicities include American Indian, Asian, Native Hawaiian or Pacific Islander, and Multi Racial and Ethnic. Qualitative interviews illustrated the significance behind these naloxone administration statistics. Many interviewees shared first- and second-hand stories of reversing overdoses for friends and family members, often in home settings, aligning with the data showing that most administrations occurred in private residences. The interviewees consistently described the positive impact of naloxone administration not only for overdose survivors but also for families and communities, who avoided the emotional and financial toll of losing loved ones owing to timely naloxone use. “Speaking as a family member, I think that the people who are going to benefit the most are the people that love someone who uses drugs, because they still have them. They didn't have to bury them”. – DOPP enrollee representative The interviewees also emphasized that the actual number of naloxone administrations was likely greater than reported. They highlighted significant challenges in collecting data during overdose events. During an overdose emergency, the immediate focus was on saving the individual’s life, not on collecting or reporting the incident, often resulting in incomplete or missing data. Bystanders who were administered naloxone were also often unaware of the reporting process. Privacy concerns and emotional distress also contributed to reluctance among both overdose survivors and responders to share details after the event. While the quantitative data revealed increased administration over time, the qualitative findings suggest that these data likely underestimate the true extent of naloxone administration. “I can probably count on one hand the number of times that a participant that I've worked directly with has called me saying that they used [naloxone]… Since a lot of that [overdose reversal data] is either secondhand or delayed, the accuracy of… reversal entries is lacking at times”. – DOPP enrollee representative The relationship between naloxone order and naloxone administration. Add in other details regarding regression v. time lagged. Regression analysis revealed a positive association between the monthly number of naloxone orders and the monthly number of administrations (B = .001, SE = .00, t(23) = 2.75, p = .012). In other words, the more naloxone orders that are distributed, the greater the number of naloxone administrations/attempted reversals that are observed. The number of naloxone orders explained 23% of the variance in administrations (R-squared = .2293). Figure 1 shows more variability in the number of administrations at the higher levels of naloxone orders. Qualitative interviews helped explain why increased distribution may have led to more administrations. The interviewees commonly described how the program’s no-cost, easy-to-order naloxone improved access and saturation across communities, making it more likely that naloxone would be available and used during an overdose event. The user-friendly online portal was critical, allowing organizations to quickly place orders and respond to emerging local overdose trends. “With [naloxone] saturation, one of the other things is the speed to which you can do it. [The program] gives us the speed to be able to quickly respond when we see a spike. I think the speed is one of the biggest things.” – OEND program representative Additionally, because the program covered the cost of naloxone, organizations could allocate more resources to staffing and outreach-related expenses (e.g., gas, mileage, harm reduction supplies). This enabled organizations to expand their outreach efforts, particularly in high-risk settings and among populations most likely to witness and respond to overdoses. With greater naloxone supply and increased staff capacity, organizations conducted door-to-door distributions and placed naloxone in accessible community locations such as vending machines, repurposed newspaper boxes (e.g., barneys), front desks, and bathrooms in neighborhoods with high overdose rates. They also distributed more naloxone directly to unhoused individuals living on the street or in homeless encampments. Some organizations have established helplines or websites to help individuals locate naloxone and many paired naloxone distributions with additional harm reduction supplies (e.g., fentanyl test strips) to better engage people who use drugs. “If we were paying for nasal [naloxone] out of our own pocket, just last month, was the cost of two full-time headcounts for an outreach coordinator. That's incredible. If we had to pay for our [naloxone], we'd still be small. There'd be like four of us… [The program allowed us] not only to expand our staff but to expand our footprint in general. The amount of people that we can reach now because we have more [staff] is tremendous… The state picking up the bill on [naloxone] has allowed us to do some really cool stuff and be able to reach people that historically we've been unable to.” – DOPP enrollee representative In addition to naloxone administration, analyzing quantitative overdose data was outside the scope of this study. However, several interviewees reported decreases in overdose fatalities and increases in nonfatal overdoses in their program or county-level data—trends attributed to the widespread availability of naloxone. For example, one OEND program representative stated that they “reduced overdose fatalities by 30%” by saturating their county with naloxone. While nonfatal overdoses had increased, “fatal overdoses are dropping, which means we are doing our job.” Although the interviewees acknowledged the lack of concrete, causal data linking the program directly to reduced deaths, many pointed to anecdotal evidence and local overdose trends as strong indicators that the program was contributing to lives being saved. “Just having this amount of Narcan available, it has a direct correlation with more people surviving. At the end of the day, that's what this is all about. Because people do recover. People can recover. They just need to be given the chance to do it. Part of that chance is living long enough to be able to do something different. To me, in a nutshell, that is what this program is doing.” – DOPP enrollee representative Discussion Qualitative and quantitative data identified key variables contributing to the successful implementation of the statewide Access program. Quantitative analyses revealed a positive and statistically significant relationship between naloxone order and administration, suggesting that increased community saturation is correlated with increased overdose reversals. The qualitative data further emphasized the importance of the program’s free access to naloxone and simple ordering process. The interviewees consistently highlighted how these features enabled them to obtain life-saving medication for their communities while also freeing them from resources for other critical needs, such as staffing and harm reduction supplies. The findings also indicated shifts in the demographics of naloxone recipients over the three program years. While white individuals consistently made up the majority of reported recipients, administrations among black individuals increased over time, whereas the proportion of Hispanic individuals and those classified as ‘unknown’ decreased. These trends likely reflect improved and more consistent data tracking by Access program participants. Importantly, these demographic data also underscore ongoing efforts to address racial health disparities in Illinois, where the overdose fatality rate among black residents remains the highest across all racial groups (Illinois Department of Public Health [IDPH], 2025; see Table 3). Additionally, the data revealed an increase in naloxone administrations occurring in residential settings over the program’s duration. Recent qualitative work from Kahn and colleagues (2022) emphasized the importance of “take-home naloxone” initiatives. The participants noted that naloxone availability in the home was often critical for enabling a bystander or loved one to respond effectively during an overdose. However, having naloxone does not benefit individuals who use drugs in isolation, which highlights the ongoing need for harm reduction education to address the risks of using it alone (Kahn et al., 2022). A decline in hospitalizations and 911 calls following naloxone administration was also observed over the program years. The reasons for this decrease may be explained by Kahn et al.’s findings, where 88% of participants who were treated in a hospital after naloxone administration reported experiencing stigma and shame from healthcare staff and/or emergency responders. In another study, law enforcement officers reported that overdose calls typically result in transportation to either a hospital or jail (Smiley-McDonald et al., 2022). As a result, individuals may choose not to seek emergency assistance during an overdose to avoid stigma or potential legal consequences. These patterns may contribute to the observed decrease in emergency responses and underscore the need for more compassionate, coordinated responses that align with Good Samaritan laws. Relatedly, we found that fewer than ten percent of naloxone orders were placed by correctional facilities, law enforcement or EMS/fire departments, schools, hospitals or FQHCs. Our qualitative data suggest that institutional stigma remains a significant barrier to naloxone distribution in criminal justice, educational, and hospital settings. Moving forward, identifying and leveraging trusted messengers may be an effective strategy to increase naloxone uptake in environments that may be less familiar with or comfortable with the medication (Showalter et al., 2021). For example, engaging respected team members such as supportive school nurses, sheriffs, or emergency room physicians to advocate for naloxone use with administrators could help reduce stigma and encourage broader adoption across these settings (Garcia & Mejia, 2024). Limitations There are limitations to consider for these data and reporting. The information is representative of the data associated with the Access project and likely mis/underreports the number of naloxone administrations that occurred. The data and figures reported are reflective of orders made by organizations throughout the State and do not necessarily reflect where the orders are then distributed or to whom. Throughout the State, there are other avenues to receive naloxone that are not captured here. For example, naloxone can be purchased over the counter. The growing avenues to receive low/no-cost naloxone, coupled with the nationwide problem of mis/underreporting of the administration/overdose reversal counts, create a challenge to specify and pinpoint the direct impact of the Access program on state-wide overdose rates and naloxone distribution. Additionally, it is important to consider the generalizability of the results. The Access program is unique to State-level variables and representative of one Midwest State. The qualitative component of this study was limited by a small sample size of 15 interviews, which included only a few participants from each stakeholder group and did not include individuals who used drugs or those who had received naloxone through the Access project. Implications for Practice and Policy The findings indicate that an increase in administrations occurring in homes and residences reinforces the importance of harm reduction policies. Agencies could distribute naloxone to staff and encourage keeping the medication on their person during outreach and field work. Continued education on the dangers of using drugs alone will be vital, especially with the rise of fentanyl, which is now found in most drugs being sold (Kahn et al., 2022). Safe consumption sites (SCSs) provide safe places where individuals feel safe and have access to testing strips, naloxone, and other psychosocial support (Yoon et al. 2022). A recent systematic review and thematic analysis of SCS research revealed that SCSs foster a sense of inclusion versus stigma while also increasing the public’s sense of safety, as it reduces the visibility of drug use in public (Yoon et al., 2022). Additionally, Yoon et al. (2022) reported that persons using drugs will utilize SCSs due to the inclusion of peer workers, which creates a sense of community. With these SCS findings in mind, local legislation and community-based services could promote or support safe consumption sites, decreasing the likelihood of their use alone. Given that help-seeking behavior is lower among populations using drugs, we must also support creative, albeit controversial, methods to increase the utilization of helping services along the continuum of care. These methods might include implementing “street medicine” and mobile treatment units that deliver medical care out of mobile vans as they meet people where they are by entering neighborhoods with drug use and overdose hotspots (Kaufman et al., 2024). A recent study implementing a mobile treatment unit alongside their harm reduction outreach efforts offered low-barrier access to needed medical services, including medication for opioid use disorders, and increased follow-up visits from existing clients (Messmer et al., 2023). Our results also indicate a decrease in hospitalizations and 911 calls. This aligns with extant research highlighting that even though Good Samaritan laws are designed to protect against bystander intervention, fear of prosecution, arrest, and hesitancy in seeking harm reduction care still exists (Durieux et al., 2022; Kahn et al., 2022). To reduce the stigma associated with drug use, continued harm reduction literacy is important for policymakers, law enforcement officials, and providers. Future policy should focus on incorporating health literacy education on the importance of harm reduction integration into micro, mezzo-, and macrolevel systems of care, which are inclusive of enhancing knowledge among providers, systems, clients, and the general public (Beeler et al., 2025). Importantly, best practices for OEND programming include focusing education efforts via outreach in the community, in line with culturally appropriate services; other best practice categories include staff training and support; naloxone saturation and supply; and harm reduction (Wenger et al., 2022). Additionally, to better understand the dispersal and saturation of naloxone into different communities, investing in wastewater analysis could be a promising strategy. Wastewater analysis is currently being used in emerging research in high-overdose areas across diverse counties in the country. The results from longitudinal wastewater data across 40 weeks substantiate the impact this novel methodology has in anticipating new adulterants, such as xylazine, in drug supplies that allow providers and emergency departments to respond better to public health responses (Centazzo et al., 2019). The wastewater data also inform analytics and algorithms to successfully predict drug overdoses up to 11 days in advance (Mathematica, 2024). While wastewater analysis has been utilized in major metropolitan areas in the past to understand drug use across the calendar year (Centazzo et al., 2019), recent evidence shows that wastewater methods can offer evidence to shape more humane and just drug-related policies. For example, wastewater analysis allowed two counties in Kentucky that decriminalized the use of fentanyl drug testing strips to observe a decrease in fentanyl in their water supply (Mathematica, 2024). This method is difficult to study, and often anonymous, owing to the nature of naloxone distribution and administration effort, waste water analysis allows us to understand and track where naloxone goes after leaving the hands of outreach workers and providers, as well as the location of where naloxone is administered, which is currently a gap in knowledge (Sugarman et al., 2023). Future policy implications also include introducing legislation that requires insurance companies to reimburse hospitals for take-home naloxone prescriptions. Hospitals are key providers of emergency medical services, with up to one-third of persons dying of overdoses having accessed emergency services within the year before their death (Barefoot et al., 2020). Additional changes to policies on insurance and access laws could be modeled from some that already exist. For example, Naloxone Access Laws (NALs) were created to decrease barriers to access to and availability of naloxone, thereby allowing over-the-counter purchases in pharmacies and distribution through community-based efforts (Bohler et al., 2022). Although NALs are vital to naloxone availability, there is variability in NALs across the U.S. (Bohler et al., 2022). Medicaid is a major insurer for substance use services, often being a key reimbursement entity for naloxone distribution and prescription. One study reviewed NALs and their relationship with Medicaid reimbursement and reported consistent associations with increases in naloxone dispensing (Gertner et al., 2018). These findings highlight an important opportunity for streamlined policy to ensure consistent reimbursement of life-saving medications that can be prescribed over the counter and at hospital discharge, not just during the provision of emergency services (see The Naloxone Project in Colorado; naloxoneproject.com). In summary, this project was an investment from the State in response to the growing number of opioid overdoses prior to the start of the Access program. Since the implementation of the program, orders for naloxone have increased, as have opioid overdose reversals/naloxone administration. The Access project reduced one barrier to ensuring that lifesaving naloxone could be ordered, received, distributed, and administered at no cost to community organizations, healthcare organizations, and clinics working with historically underserved, marginalized, and less visible populations (including persons using opioids). While both naloxone orders and administrations continue, our results suggest that the intended goal of naloxone saturation within at-risk communities is improving, with more naloxone available when overdoses occur. However, more evaluation and outcome research is needed to better understand the longitudinal impact of naloxone distribution versus overdose rates. Abbreviations Drug Overdose Prevention Program (DOPP) Opioid Education and Naloxone Distribution (OEND) Interrater reliability (IRR) Emergency Medical Services (EMS) Federally Qualified Health Center (FQHC) Illinois Department of Public Health (IDPH) Safe consumption sites (SCSs) Naloxone Access Laws (NALs) Declarations Ethics approval and consent to participate. The study protocols were reviewed and approved by the Institutional Review Boards of the University of Illinois Chicago (IRB Protocol #2021-1201) and NORC at the University of Chicago (IRB Protocol #23-06-1382). Informed consent was obtained from all participants who consented to the qualitative interviews. Informed consent did not apply to the quantitative data from this project, as it did not include any identifiable information and was not considered human subject research. All procedures were conducted in accordance with the ethical standards of the institutional research committees and with the Declaration of Helsinki of 1964 and its later amendments. Consent for publication. Not applicable. Availability of data and materials. The data analyzed during the current study are not publicly available, as this was not in the permissions and consent of the research study, and therefore cannot be shared. The semi-structured interview guides can be found in the supplemental files. Competing interests. The authors declare that they have no competing interests. Funding. Funding for this study was made possible through the Illinois Cannabis Regulation and Tax Act (CRTA) grant awarded to the Illinois Department of Human Services, Divisions of Substance Use Prevention and Recovery and Mental Health. Authors' contributions. SB was the co-investigator of this project and oversaw the evaluation and reporting for the project; additionally, SB led the writing of the narrative for the background, the quantitative methodology and results, and the conclusion section. OG led the writing of the qualitative results and outlines for the background and conclusion sections. SB and OG collaborated on figure and table creation. AC, NM, and AG also participated in content development and edits for the entire document. OG, AC, NM, and AG were the interview research team overseeing the qualitative portion of this study. KM oversaw the implementation of the Access project, contributed to discussion topics, and edited/approved the entire document. Acknowledgements This project was made possible through an intergovernmental agreement between the Jane Addams College of Social Work at the University of Illinois Chicago (UIC; PI: James Swartz) and the Illinois Department of Human Services. References Ahmad FB, Cisewski JA, Anderson RN. Leading Causes of Death in the US, 2019–2023. JAMA. 2024;332(12):957–8. https://doi.org/10.1001/jama.2024.15563 . Barefoot EH, Cyr JM, Brice JH, Bachman MW, Williams JG, Cabanas JG, Herbert KM. Opportunities for Emergency Medical Services Intervention to Prevent Opioid Overdose Mortality. Prehospital Emerg Care. 2020;25(2):182–90. https://doi.org/10.1080/10903127.2020.1740363 . Beeler S, Allen-Meares P, Slavic L. Triple Jeopardy: Substance Use, Incarceration, and Low Health Literacy. Health & Social Work; 2025. p. hlaf016. Bohler RM, Freeman PR, Villani J, Hunt T, Linas BS, Walley AY, Chandler R. The policy landscape for naloxone distribution in four states highly impacted by fatal opioid overdoses. Drug alcohol Depend Rep. 2023;6:100126. Centazzo N, Frederick BM, Jacox A, Cheng SY, Concheiro-Guisan M. Wastewater analysis for nicotine, cocaine, amphetamines, opioids and cannabis in New York City. Forensic Sci Res. 2019;4(2):152–67. https://doi.org/10.1080/20961790.2019.1609388 . CDCa. (2025, May 17). U.S. Overdose Deaths Decrease Almost 27% in 2024. Retrieved from National Center for Health Statistics at https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250514.htm CDCb. (2025, January 10, 2025). Drug Overdose Mortality by State. Retrieved May 19, 2025 from National Center for Health Statistics at https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm Dodge Y. (2008). Durbin–Watson test. In The concise encyclopedia of statistics (pp. 173–175). Springer. https://doi.org/10.1007/978-0-387-32833-1_122 Durieux J, Curtis A, Mirka M, Jefferis E, Felix C, Essel B. An Exploration of Narcan as a Harm Reduction Strategy and User’s Attitudes toward Law Enforcement Involvement in Overdose Cases. Int J Environ Res Public Health. 2022;19(6):3149. https://doi.org/10.3390/ijerph19063149 . Fischer LS, Asher A, Stein R, et al. Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: a systematic review and meta-analysis. BMC Public Health. 2025;25:1135. https://doi.org/10.1186/s12889-025-22210-8 . Garcia K, Mejia P. (2024, August 23). Messaging guide for communicating about overdose prevention. Berkeley Media Studies Group. Retrieved from https://www.bmsg.org/resources/publications/message-guide-for-communicating-about-overdose-prevention/#acknowledgments Gertner AK, Domino ME, Davis CS. Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid. Drug Alcohol Depend. 2018;190:37–41. Illinois.gov. (2021, July 27). Pritzker Administration Announces $13 Million Investment to Expand Access to Life Saving Medication in Opioid Crisis Fight. Retrieved from https://www.illinois.gov/news/press-release.23628.html Illinois Department of Human Services/Substance Use Prevention and Recovery (IDHS/SUPR). (2023). About the Drug Overdose Prevention Program (DOPP). Retrieved from https://www.dhs.state.il.us/page.aspx?item=58142 Illinois Department of Public Health (IDPH). (2025, January). Statewide Semiannual report. Retrieved from https://dph.illinois.gov/topics-services/opioids/idph-data-dashboard/semiannual-opioid-reports.html Kahn LS, Wozniak M, Vest BM, Moore C. Narcan Encounters: Overdose and Naloxone Rescue Experiences among People who use Opioids. Substance abuse. 2022;43(1):113–26. 10.1080/08897077.2020.1748165 . Kaufman RA, Mallick M, Louis JT, Williams M, Oriol N. The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review. Int J Environ Res Public Health. 2024;21(6):760. https://doi.org/10.3390/ijerph21060760 . Keane C, Egan JE, Hawk M. Effects of naloxone distribution to likely bystanders: results of an agent-based model. Int J Drug Policy. 2018;55:61–9. https://doi.org/10.1016/j.drugpo.2018.02.008 . Larweh H. (2025). Distribution Models and Strategies to Consider to Expand Access to Naloxone. Retrieved from https://opioidprinciples.jhsph.edu/distribution-models-and-strategies-to-consider-to-expand-access-to-naloxone/ Massachusetts Health Officers Association (MHOA). (2025). Section II: Evidence-based Opioid Prevention Interventions. Retrieved from https://opioid-toolkit.mhoa.com/evidence-based-opioid-prevention-examples/ Mathematica. (2024, April 30). Wastewater Data Offers Powerful Tool in Confronting Opioid Epidemic [News]. Retrieved from https://www.mathematica.org/news/wastewater-data-offers-powerful-tool-in-confronting-opioid-epidemic Nicolau AP, Dyson K, Saah D, Clinton N. Exploring Lagged Effects in Time Series. In: Cardille JA, Crowley MA, Saah D, Clinton NE, editors. Cloud-Based Remote Sensing with Google Earth Engine. Cham: Springer; 2024. https://doi.org/10.1007/978-3-031-26588-4_21 . Showalter D, Wenger LD, Lambdin BH, Wheeler E, Binswanger I, Kral AH. Bridging institutional logics: Implementing naloxone distribution for people exiting jail in three California counties. Soc Sci Med. 2021;285:114293. Smiley-McDonald HM, Attaway PR, Richardson NJ, Davidson PJ, Kral AH. Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone. Health justice. 2022;10(1):9. Substance Abuse and Mental Health Services Administration’s (SAMSHA). (2023, April 24 ). Harm Reduction Framework. Retrieved from https://www.samhsa.gov/substance-use/harm-reduction/framework Sugarman OK, Hulsey EG, Heller D. Achieving the Potential of Naloxone Saturation by Measuring Distribution. JAMA Health Forum. 2023;4(10):e233338. 10.1001/jamahealthforum.2023.3338 . Wenger LD, Doe-Simkins M, Wheeler E, Ongais L, Morris T, Bluthenthal RN, Lambdin BH. Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach. Harm Reduct J. 2022;19(1):55. https://doi.org/10.1186/s12954-022-00639-z . Yoon GH, Levengood TW, Davoust MJ, Ogden SN, Kral AH, Cahill SR, Bazzi AR. Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis. Harm Reduct J. 2022;19(1):73. Additional Declarations No competing interests reported. Supplementary Files NarcanInterviewGuideAccess.docx Appendices.docx Cite Share Download PDF Status: Published Journal Publication published 21 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 15 Nov, 2025 Reviews received at journal 12 Nov, 2025 Reviews received at journal 04 Nov, 2025 Reviews received at journal 27 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers invited by journal 08 Oct, 2025 Editor assigned by journal 11 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":31082,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of Naloxone Cartons Ordered and Naloxone Administered by Fiscal Month, 2022-2024\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7142082/v1/e57c1de1355b0034e76c77dd.png"},{"id":105224505,"identity":"ea771eff-f7b7-4e1f-aa74-5df91371308f","added_by":"auto","created_at":"2026-03-23 16:14:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":782923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7142082/v1/32362f49-5250-4b4f-91e8-498be7f7890a.pdf"},{"id":94105447,"identity":"30883c36-02eb-42e7-92a9-0bd15b4379fc","added_by":"auto","created_at":"2025-10-22 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Initiatives","fulltext":[{"header":"Background","content":"\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The number of national opioid overdose deaths reached an all-time low in 2024, with a 27% decrease from 2023 (110,037 versus 80,391; CDCa, 2025). While this decline is promising, overdose remains among the top three causes of death in the United States (Ahmad et al., 2024). Additionally, regional disparities persist, with several midwestern states ranking among the top ten in terms of overdose deaths. For example, Illinois reported nearly 4,000 overdose deaths in 2022, with a 30% fatality rate (CDCb, 2025).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The progress in reducing overdose deaths is largely attributed to the adoption of evidence-based strategies, including public messaging campaigns, prescriber education and tracking systems, medication for opioid use disorders, and naloxone, a medication that reverses opioid overdoses (Massachusetts Health Officers Association [MHOA], 2025). Given the proven effectiveness of naloxone (CDCa, 2025), distribution programs have expanded nationwide. These programs vary in scope (Larweh, 2025), with some targeting broad community access (e.g., bystanders, businesses) and others focusing only on high-need groups (e.g., people who use drugs, emergency responders) (Bohler et al., 2023). Given this variation and the critical role of naloxone in reducing overdose deaths, evaluating the implementation and impact of different distribution models is essential (Bohler et al., 2023).\u003c/p\u003e\n\u003cp\u003eA growing body of research has examined the impact of widespread naloxone distribution programs, aiming to understand whether broader community access to bystanders, families, and businesses can save more lives than distribution limited to emergency responders or high-risk groups (Bohler et al., 2023; Fischer et al., 2025). Fischer and colleagues’ (2025) systematic review and meta-analysis revealed that 44 studies on naloxone distribution programs are effective and that survival is sustained after naloxone administration. Additionally, a study designed to inform agent-based models on community-based naloxone distribution methods reported that distributing naloxone directly to persons using drugs \u003cem\u003eand\u0026nbsp;\u003c/em\u003eother persons in the community (bystanders) reduces the risk of opioid deaths (Keane et al., 2018). Despite this evidence, implementation varies widely across states, and more research is needed to understand how different models perform in diverse contexts.\u003c/p\u003e\n\u003cp\u003eIn 2021, Illinois launched a community access naloxone distribution program (herein referred to as ‘\u003cem\u003eAccess’\u003c/em\u003e), offering free nasal naloxone to community organizations, hospitals, and clinics via an online portal (Illinois.gov, 2021). The \u003cem\u003eAccess\u0026nbsp;\u003c/em\u003eprogram removes cost barriers to naloxone and mandates the reporting of naloxone distribution and use (IDHS/SUPR, 2023). Building on 2010 legislation allowing nonmedical administration of naloxone, Illinois created the Drug Overdose Prevention Program (DOPP), which encourages organizations to implement Opioid Education and Naloxone Distribution (OEND) services. DOPP enrollment is required to participate in the \u003cem\u003eAccess\u003c/em\u003e program (Illinois Saves Overdose, n.d.). While Illinois has multiple opioid-related initiatives, this study focuses on \u003cem\u003eAccess\u003c/em\u003e, examining its implementation, impact, and lessons learned to inform future efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe State partnered with a university to evaluate the \u003cem\u003eAccess\u003c/em\u003e program. The study aimed to (1) characterize the organizations and individuals who received naloxone, (2) examine the relationship between naloxone distribution and administration, and (3) explore program implementation successes and challenges.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe paper utilized mixed methodologies to report on implementation and process outcome data (the quantity of naloxone orders and administrations) and semistructured qualitative interview data (from interviews with state policymakers, implementation partners, and participating organizations). The quantitative and qualitative data were analyzed separately, with the researchers later comparing the results to interpret the findings. The evaluation spanned from the start of the \u003cem\u003eAccess\u003c/em\u003e project (July 2021) to the end of the third year (June 2024).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample and\u0026nbsp;\u003c/em\u003e\u003cem\u003eeligibility\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo participate in\u0026nbsp;\u003cem\u003eAccess\u003c/em\u003e, organizations must register as a DOPP, which automatically qualifies these organizations forparticipation in the project. A select number of DOPPs are also official OEND programs, which receive additional funding from the State to\u0026nbsp;provide naloxone education, training, and distribution in their region and to\u0026nbsp;help individuals obtain naloxone\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u0026nbsp;\u003c/em\u003e\u003cem\u003ecollection\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuantitative\u0026nbsp;\u003c/em\u003e\u003cem\u003edata collection.\u003c/em\u003eThere were two sources of quantitative data for this study. The first source came from the distributor of naloxone, and the second came from the Illinois Saves Overdose (naloxone administration) website. The distributor data offered descriptive findings on who (organizational description), how much (amount and cost of the number of boxes containing two 4 mg doses of naloxone ordered), and where (zip code) the naloxone was requested. The naloxone administration data included information on what naloxone dosage was administered, where and when administration occurred, and individual-level characteristic data of those who received naloxone for attempted opioid reversal. The quantitative portion of this study was approved by the Institutional Review Board at the University of Illinois Chicago.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQualitative data collection.\u0026nbsp;\u003c/em\u003eFifteen 60-minute Zoom interviews were conducted between June 24, 2024, and August 9, 2024, including 5 interviews with policymakers and implementation partners, 5 interviews with OEND program representatives, and 6 interviews with DOPP enrollee representatives (note: one participant was both a policymaker/implementation partner and DOPP enrollee representative). The research team produced a list of 26 outreach candidates, drawing from programs with the highest number of orders from the \u003cem\u003eAccess\u003c/em\u003e site since July 2021 and incorporating recommendations from State Program Leadership, with the goal of recruiting a diverse sample of organizations. Beginning in June 2024, the research interview team-initiated email outreach to the candidates, and the participants selected a time using a calendar link. If an interview was not scheduled within seven days of the initial email, the research team sent a reminder email to all nonrespondents. State program leadership prompted unresponsive candidates to participate in an interview. The participants did not receive compensation for participating. T\u003c/p\u003e\n\u003cp\u003eThe research team developed\u0026nbsp;semi-structured interview guides tailored to the three key informant roles (see supplemental file). The interviews examined what worked well during implementation, challenges\u0026nbsp;in\u0026nbsp;ordering and distributing naloxone in communities, potential outcomes of the program, and\u0026nbsp;the\u0026nbsp;sustainability of naloxone distribution efforts. Two research team members attended each interview, with one conducting the interview and the second taking detailed notes. At the beginning of each interview, the interviewer obtained consent to participate and\u0026nbsp;recorded\u0026nbsp;the call from the participant. The qualitative portion of the study was approved by the Institutional Review Board at NORC at the University of Chicago.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analyses.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuantitative Data Analysis.\u0026nbsp;\u003c/em\u003eUnivariate statistics were conducted to describe variables related to the ordering and administration of naloxone. These results are presented as counts and percentages. A basic correlation was conducted to understand the strength and significance of the relationship between naloxone order and administration. A linear regression was run, along with a Durbin‒Watson statistic, to assess the residuals for the presence of an autocorrelation (Dodge, 2008). The presence of autocorrelation suggests accounting for a time series, or lagged function, between the variables (Nicolau et al., 2024; orders in one month may be used during administration in a later month), and a time series regression was performed to assess the relationship between monthly naloxone orders and monthly naloxone administrations over the study period (July 2021--June 2024). Analyses were conducted via Stata 15 SE.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQualitative Data Analysis.\u0026nbsp;\u003c/em\u003eTo analyze the qualitative interview data, we used an applied thematic analysis approach. First, the interviews were transcribed and uploaded to Dedoose qualitative software. The team developed a codebook concurrently with conducting the interviews.\u0026nbsp;Three team members participated in the coding.To ensure reliability, one team member developed an interrater reliability (IRR) test through Dedoose to ensure alignment in coding as a team. The three coders completed this test and discussed the results. The IRR from this test ranged from .78 - .85, with 1.0 being a perfect alignment. After sufficient interrater reliability was achieved, each interview transcript was then coded by one research team member. After the interview transcripts were coded, the codes were organized and grouped under higher-order headings (i.e., themes), formulating potential subcategories (i.e., subthemes). We also identified representative quotations for themes and subthemes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eNaloxone orders.\u003c/em\u003e Over three years, naloxone orders increased from 57,588 cartons in July 2022 to 382,104 in June 2024 (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the 711,120 total 4 mg cartons ordered during the first three years of the project, the majority were ordered by community and/or social service organizations (N\u0026thinsp;=\u0026thinsp;406,896, 57%). Public health departments and other government agencies accounted for approximately one quarter of the total (N\u0026thinsp;=\u0026thinsp;184,560, 26%), followed by substance use or mental health service agencies (N\u0026thinsp;=\u0026thinsp;66,252, 9%). The remaining orders came from correctional facilities (N\u0026thinsp;=\u0026thinsp;20,244, 3%), law enforcement or emergency medical services (EMS)/fire departments (N\u0026thinsp;=\u0026thinsp;14,244, 2%), school or educational institutions (N\u0026thinsp;=\u0026thinsp;12,912, 2%), and hospitals or Federally Qualified Health Centers (FQHCs; N\u0026thinsp;=\u0026thinsp;3,612, 1%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNaloxone Cartons Ordered by Organizational Type, Overall and by Fiscal Year (FY), 2022\u0026ndash;2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"20\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOrganizational Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c12\" namest=\"c7\"\u003e\u003cp\u003eFY 2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c16\" namest=\"c13\"\u003e\u003cp\u003eFY 2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c20\" namest=\"c17\"\u003e\u003cp\u003eFY 2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e711,120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e\u003cp\u003e57,588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c15\" namest=\"c13\"\u003e\u003cp\u003e271,428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c19\" namest=\"c17\"\u003e\u003cp\u003e382,104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity and/or social service organizations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e406,896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e57%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003e36,876\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e64%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003e144,060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u003cp\u003e225,960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u003cp\u003e59%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic health departments and other government agencies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e184,560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e10,896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u003cp\u003e19%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e80,736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e92,928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstance use or mental health services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66,252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e6,888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e17,784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e41,580\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e11%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorrectional facilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20,244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e11,592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e8,232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaw enforcement or emergency medical services (EMS)/fire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14,244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e10,272\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e3,540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchools or educational institutions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12,912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e2,076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e6,480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e4,356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospitals or Federally Qualified Health Centers (FQHCs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e3,192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c16\" namest=\"c14\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e2,316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e\u003cp\u003e1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"20\"\u003eNote: Cartons included 2 doses of 4 mg/1 ml naloxone nasal sprays. Illinois\u0026rsquo; fiscal year is July 1 through June 30.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eQualitative interviews reinforced and contextualized these patterns, highlighting how the program expanded naloxone access across a wide range of organizations\u0026mdash;from small, budget-constrained nonprofits to larger entities such as police departments and colleges. The interviewees emphasized that the program also enabled organizations not previously involved in naloxone distribution to obtain and distribute the medication. Many community-based organizations, particularly OEND programs, use the program\u0026rsquo;s website to place orders on behalf of other groups. As a result, entities such as religious institutions, small businesses (e.g., grocery stores, clothing stores, restaurants, bars, gas stations, funeral homes), libraries, public transportation systems, and mutual aid groups were also able to distribute naloxone within their communities.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The free access to [naloxone] is provided at such a high level, like such a state level to so many different organizations. The ability to access it does trickle down to other smaller groups and smaller organizations\u003c/em\u003e.\u0026rdquo; \u0026ndash; Policymaker/implementation partner\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe interviews also revealed that fewer than ten percent of naloxone orders were collectively placed by correctional facilities, law enforcement or EMS/fire departments, school or educational institutions, and hospitals or FQHCs. The interviewees identified several barriers to naloxone distribution in these settings. In schools, nurses and administrators are often hesitant to receive, carry, and distribute naloxone due to uncertainty about how it aligns with existing school policies. In correctional settings, such as jails and prisons, staff were frequently reluctant to provide naloxone to current inmates and returning citizens (people leaving correctional facilities), citing stigma, a lack of awareness, and logistical challenges. In hospital settings, particularly emergency departments, interviewees noted that the program\u0026rsquo;s reporting requirements created an additional burden for already overstretched staff, as the process was separate from standard medical charting and workflows.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Our sheriff is very resistant. We've had a little committee working with them in the jail to try and inform them and help them understand why it was important to\u0026hellip; give [inmates] [naloxone] on their way out. The pushback was, \u0026ldquo;Oh, that's too much work. We don't have enough staff.\u0026rdquo;\u003c/em\u003e\u0026ndash; OEND program representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNaloxone administration.\u003c/em\u003e Reports of naloxone administrations nearly tripled, from 255 overdose reversals in July 2021 to 909 administrations in June 2024. Appendix Table A shows the monthly number of administrations over the project period. In FYs 2022 and 2023, the number of administrations was greater from March through June. In contrast, in FY 2024, the number of administrations was greater from August through October.\u003c/p\u003e\u003cp\u003eOverall, administrations most often occurred in a house (N\u0026thinsp;=\u0026thinsp;1,075; 64.1%), followed by a public space outdoors (N\u0026thinsp;=\u0026thinsp;273; 16.3%) (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The average person receiving naloxone during the project period was reported as a white male between the ages of 25 and 44 years. However, naloxone administrations among Black or African American individuals made up a larger percentage of administrations as years progressed, from 14.1% (N\u0026thinsp;=\u0026thinsp;36) in FY 2022 to 35% (N\u0026thinsp;=\u0026thinsp;318) in FY 2024. Additionally, from FY 2023 to FY 2024, the percentage of males receiving an administration decreased (FY 2023: N\u0026thinsp;=\u0026thinsp;353, 68.7%; FY 2024: N\u0026thinsp;=\u0026thinsp;485, 53.4%), whereas the percentage of administrations to females increased (FY 2023: N\u0026thinsp;=\u0026thinsp;139, 27.0%; FY 2024: N\u0026thinsp;=\u0026thinsp;384, 42.2%).\u003c/p\u003e\u003cp\u003eMost people were found unconscious at the time of administration (N\u0026thinsp;=\u0026thinsp;1,409; 84%). The number of calls to 911 during administration decreased from 53% in FY 2022 (N\u0026thinsp;=\u0026thinsp;135) to 28% in FY 2024 (N\u0026thinsp;=\u0026thinsp;253). In FY 2024, the majority of administrations (N\u0026thinsp;=\u0026thinsp;609; 67%) did not result in a call to 911. Similarly, hospitalizations after administration decreased across the project years. In FY 2022, 39% (N\u0026thinsp;=\u0026thinsp;99) of administrations resulted in hospitalizations, compared with 29% (N\u0026thinsp;=\u0026thinsp;263) by FY 2024.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Reported Naloxone Administrations, Overall and by Fiscal Year (FY), 2022\u0026ndash;2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eFY 2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eFY 2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eFY 2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,678\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e514\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e68.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e53.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e27.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e42.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransgender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnder 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e12.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e913\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e54.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e24.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRace and Ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlack or African American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e318\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e35.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHispanic/Latinx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e829\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e48.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLocation of Administration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e51.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther Residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Building\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Outdoor Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e554\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e65.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e911 Call\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e27.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e67.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eConsciousness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e411\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e80.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e88.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e*Other races/ethnicities include American Indian, Asian, Native Hawaiian or Pacific Islander, and Multi Racial and Ethnic.\u003c/p\u003e\u003cp\u003eQualitative interviews illustrated the significance behind these naloxone administration statistics. Many interviewees shared first- and second-hand stories of reversing overdoses for friends and family members, often in home settings, aligning with the data showing that most administrations occurred in private residences. The interviewees consistently described the positive impact of naloxone administration not only for overdose survivors but also for families and communities, who avoided the emotional and financial toll of losing loved ones owing to timely naloxone use.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Speaking as a family member, I think that the people who are going to benefit the most are the people that love someone who uses drugs, because they still have them. They didn't have to bury them\u0026rdquo;.\u003c/em\u003e \u0026ndash; DOPP enrollee representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe interviewees also emphasized that the actual number of naloxone administrations was likely greater than reported. They highlighted significant challenges in collecting data during overdose events. During an overdose emergency, the immediate focus was on saving the individual\u0026rsquo;s life, not on collecting or reporting the incident, often resulting in incomplete or missing data. Bystanders who were administered naloxone were also often unaware of the reporting process. Privacy concerns and emotional distress also contributed to reluctance among both overdose survivors and responders to share details after the event. While the quantitative data revealed increased administration over time, the qualitative findings suggest that these data likely underestimate the true extent of naloxone administration.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I can probably count on one hand the number of times that a participant that I've worked directly with has called me saying that they used [naloxone]\u0026hellip; Since a lot of that [overdose reversal data] is either secondhand or delayed, the accuracy of\u0026hellip; reversal entries is lacking at times\u0026rdquo;. \u0026ndash;\u003c/em\u003e DOPP enrollee representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe relationship between naloxone order and naloxone administration.\u003c/em\u003e Add in other details regarding regression v. time lagged. Regression analysis revealed a positive association between the monthly number of naloxone orders and the monthly number of administrations (B\u0026thinsp;=\u0026thinsp;.001, SE\u0026thinsp;=\u0026thinsp;.00, t(23)\u0026thinsp;=\u0026thinsp;2.75, p\u0026thinsp;=\u0026thinsp;.012). In other words, the more naloxone orders that are distributed, the greater the number of naloxone administrations/attempted reversals that are observed. The number of naloxone orders explained 23% of the variance in administrations (R-squared\u0026thinsp;=\u0026thinsp;.2293). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows more variability in the number of administrations at the higher levels of naloxone orders.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eQualitative interviews helped explain why increased distribution may have led to more administrations. The interviewees commonly described how the program\u0026rsquo;s no-cost, easy-to-order naloxone improved access and saturation across communities, making it more likely that naloxone would be available and used during an overdose event. The user-friendly online portal was critical, allowing organizations to quickly place orders and respond to emerging local overdose trends.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;With [naloxone] saturation, one of the other things is the speed to which you can do it. [The program] gives us the speed to be able to quickly respond when we see a spike. I think the speed is one of the biggest things.\u0026rdquo;\u003c/em\u003e \u0026ndash; OEND program representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, because the program covered the cost of naloxone, organizations could allocate more resources to staffing and outreach-related expenses (e.g., gas, mileage, harm reduction supplies). This enabled organizations to expand their outreach efforts, particularly in high-risk settings and among populations most likely to witness and respond to overdoses. With greater naloxone supply and increased staff capacity, organizations conducted door-to-door distributions and placed naloxone in accessible community locations such as vending machines, repurposed newspaper boxes (e.g., barneys), front desks, and bathrooms in neighborhoods with high overdose rates. They also distributed more naloxone directly to unhoused individuals living on the street or in homeless encampments. Some organizations have established helplines or websites to help individuals locate naloxone and many paired naloxone distributions with additional harm reduction supplies (e.g., fentanyl test strips) to better engage people who use drugs.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If we were paying for nasal [naloxone] out of our own pocket, just last month, was the cost of two full-time headcounts for an outreach coordinator. That's incredible. If we had to pay for our [naloxone], we'd still be small. There'd be like four of us\u0026hellip; [The program allowed us] not only to expand our staff but to expand our footprint in general. The amount of people that we can reach now because we have more [staff] is tremendous\u0026hellip; The state picking up the bill on [naloxone] has allowed us to do some really cool stuff and be able to reach people that historically we've been unable to.\u0026rdquo;\u003c/em\u003e \u0026ndash; DOPP enrollee representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn addition to naloxone administration, analyzing quantitative overdose data was outside the scope of this study. However, several interviewees reported decreases in overdose fatalities and increases in nonfatal overdoses in their program or county-level data\u0026mdash;trends attributed to the widespread availability of naloxone. For example, one OEND program representative stated that they \u0026ldquo;reduced overdose fatalities by 30%\u0026rdquo; by saturating their county with naloxone. While nonfatal overdoses had increased, \u0026ldquo;fatal overdoses are dropping, which means we are doing our job.\u0026rdquo; Although the interviewees acknowledged the lack of concrete, causal data linking the program directly to reduced deaths, many pointed to anecdotal evidence and local overdose trends as strong indicators that the program was contributing to lives being saved.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Just having this amount of Narcan available, it has a direct correlation with more people surviving. At the end of the day, that's what this is all about. Because people do recover. People can recover. They just need to be given the chance to do it. Part of that chance is living long enough to be able to do something different. To me, in a nutshell, that is what this program is doing.\u0026rdquo;\u003c/em\u003e \u0026ndash; DOPP enrollee representative\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eQualitative and quantitative data identified key variables contributing to the successful implementation of the statewide \u003cem\u003eAccess\u0026nbsp;\u003c/em\u003eprogram. Quantitative analyses revealed a positive and statistically significant relationship between naloxone order and administration, suggesting that increased community saturation is correlated with increased overdose reversals. The qualitative data further emphasized the importance of the program’s free access to naloxone and simple ordering process. The interviewees consistently highlighted how these features enabled them to obtain life-saving medication for their communities while also freeing them from resources for other critical needs, such as staffing and harm reduction supplies.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The findings also indicated shifts in the demographics of naloxone recipients over the three program years. While white individuals consistently made up the majority of reported recipients, administrations among black individuals increased over time, whereas the proportion of Hispanic individuals and those classified as ‘unknown’ decreased. These trends likely reflect improved and more consistent data tracking by \u003cem\u003eAccess\u003c/em\u003e program participants. Importantly, these demographic data also underscore ongoing efforts to address racial health disparities in Illinois, where the overdose fatality rate among black residents remains the highest across all racial groups (Illinois Department of Public Health [IDPH], 2025; see Table 3).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Additionally, the data revealed an increase in naloxone administrations occurring in residential settings over the program’s duration. Recent qualitative work from Kahn and colleagues (2022) emphasized the importance of “take-home naloxone” initiatives. The participants noted that naloxone availability in the home was often critical for enabling a bystander or loved one to respond effectively during an overdose. However, having naloxone does not benefit individuals who use drugs in isolation, which highlights the ongoing need for harm reduction education to address the risks of using it alone (Kahn et al., 2022).\u003c/p\u003e\n\u003cp\u003eA decline in hospitalizations and 911 calls following naloxone administration was also observed over the program years. The reasons for this decrease may be explained by Kahn et al.’s findings, where 88% of participants who were treated in a hospital after naloxone administration reported experiencing stigma and shame from healthcare staff and/or emergency responders. In another study, law enforcement officers reported that overdose calls typically result in transportation to either a hospital or jail (Smiley-McDonald et al., 2022). As a result, individuals may choose not to seek emergency assistance during an overdose to avoid stigma or potential legal consequences. These patterns may contribute to the observed decrease in emergency responses and underscore the need for more compassionate, coordinated responses that align with Good Samaritan laws.\u003c/p\u003e\n\u003cp\u003eRelatedly, we found that fewer than ten percent of naloxone orders were placed by correctional facilities, law enforcement or EMS/fire departments, schools, hospitals or FQHCs. Our qualitative data suggest that institutional stigma remains a significant barrier to naloxone distribution in criminal justice, educational, and hospital settings. Moving forward, identifying and leveraging trusted messengers may be an effective strategy to increase naloxone uptake in environments that may be less familiar with or comfortable with the medication (Showalter et al., 2021). For example, engaging respected team members such as supportive school nurses, sheriffs, or emergency room physicians to advocate for naloxone use with administrators could help reduce stigma and encourage broader adoption across these settings (Garcia \u0026amp; Mejia, 2024).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere are limitations to consider for these data and reporting. The information is representative of the data associated with the \u003cem\u003eAccess\u003c/em\u003e project and likely mis/underreports the number of naloxone administrations that occurred. The data and figures reported are reflective of orders made by organizations throughout the State and do not necessarily reflect where the orders are then distributed or to whom. Throughout the State, there are other avenues to receive naloxone that are not captured here. For example, naloxone can be purchased over the counter. The growing avenues to receive low/no-cost naloxone, coupled with the nationwide problem of mis/underreporting of the administration/overdose reversal counts, create a challenge to specify and pinpoint the direct impact of the \u003cem\u003eAccess\u0026nbsp;\u003c/em\u003eprogram on state-wide overdose rates and naloxone distribution. Additionally, it is important to consider the generalizability of the results. The \u003cem\u003eAccess\u003c/em\u003e program is unique to State-level variables and representative of one Midwest State. The qualitative component of this study was limited by a small sample size of 15 interviews, which included only a few participants from each stakeholder group and did not include individuals who used drugs or those who had received naloxone through the \u003cem\u003eAccess\u003c/em\u003e project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Practice and Policy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings indicate that an increase in administrations occurring in homes and residences reinforces the importance of harm reduction policies. Agencies could distribute naloxone to staff and encourage keeping the medication on their person during outreach and field work. Continued education on the dangers of using drugs alone will be vital, especially with the rise of fentanyl, which is now found in most drugs being sold (Kahn et al., 2022). Safe consumption sites (SCSs) provide safe places where individuals feel safe and have access to testing strips, naloxone, and other psychosocial support (Yoon et al. 2022). A recent systematic review and thematic analysis of SCS research revealed that SCSs foster a sense of inclusion versus stigma while also increasing the public’s sense of safety, as it reduces the visibility of drug use in public (Yoon et al., 2022). Additionally, Yoon et al. (2022) reported that persons using drugs will utilize SCSs due to the inclusion of peer workers, which creates a sense of community. With these SCS findings in mind, local legislation and community-based services could promote or support safe consumption sites, decreasing the likelihood of their use alone.\u003c/p\u003e\n\u003cp\u003eGiven that help-seeking behavior is lower among populations using drugs, we must also support creative, albeit controversial, methods to increase the utilization of helping services along the continuum of care. These methods might include implementing “street medicine” and mobile treatment units that deliver medical care out of mobile vans as they meet people where they are by entering neighborhoods with drug use and overdose hotspots (Kaufman et al., 2024). A recent study implementing a mobile treatment unit alongside their harm reduction outreach efforts offered low-barrier access to needed medical services, including medication for opioid use disorders, and increased follow-up visits from existing clients (Messmer et al., 2023).\u003c/p\u003e\n\u003cp\u003eOur results also indicate a decrease in hospitalizations and 911 calls. This aligns with extant research highlighting that even though Good Samaritan laws are designed to protect against bystander intervention, fear of prosecution, arrest, and hesitancy in seeking harm reduction care still exists (Durieux et al., 2022; Kahn et al., 2022). To reduce the stigma associated with drug use, continued harm reduction literacy is important for policymakers, law enforcement officials, and providers. Future policy should focus on incorporating health literacy education on the importance of harm reduction integration into micro, mezzo-, and macrolevel systems of care, which are inclusive of enhancing knowledge among providers, systems, clients, and the general public (Beeler et al., 2025). Importantly, best practices for OEND programming include focusing education efforts via outreach in the community, in line with culturally appropriate services; other best practice categories include staff training and support; naloxone saturation and supply; and harm reduction (Wenger et al., 2022).\u003c/p\u003e\n\u003cp\u003eAdditionally, to better understand the dispersal and saturation of naloxone into different communities, investing in wastewater analysis could be a promising strategy. Wastewater analysis is currently being used in emerging research in high-overdose areas across diverse counties in the country. The results from longitudinal wastewater data across 40 weeks substantiate the impact this novel methodology has in anticipating new adulterants, such as xylazine, in drug supplies that allow providers and emergency departments to respond better to public health responses (Centazzo et al., 2019). The wastewater data also inform analytics and algorithms to successfully predict drug overdoses up to 11 days in advance (Mathematica, 2024). While wastewater analysis has been utilized in major metropolitan areas in the past to understand drug use across the calendar year (Centazzo et al., 2019), recent evidence shows that wastewater methods can offer evidence to shape more humane and just drug-related policies. For example, wastewater analysis allowed two counties in Kentucky that decriminalized the use of fentanyl drug testing strips to observe a decrease in fentanyl in their water supply (Mathematica, 2024). This method is difficult to study, and often anonymous, owing to the nature of naloxone distribution and administration effort, waste water analysis allows us to understand and track where naloxone goes after leaving the hands of outreach workers and providers, as well as the location of where naloxone is administered, which is currently a gap in knowledge (Sugarman et al., 2023).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Future policy implications also include introducing legislation that requires insurance companies to reimburse hospitals for take-home naloxone prescriptions. Hospitals are key providers of emergency medical services, with up to one-third of persons dying of overdoses having accessed emergency services within the year before their death (Barefoot et al., 2020). Additional changes to policies on insurance and access laws could be modeled from some that already exist. For example, Naloxone Access Laws (NALs) were created to decrease barriers to access to and availability of naloxone, thereby allowing over-the-counter purchases in pharmacies and distribution through community-based efforts (Bohler et al., 2022). Although NALs are vital to naloxone availability, there is variability in NALs across the U.S. (Bohler et al., 2022). Medicaid is a major insurer for substance use services, often being a key reimbursement entity for naloxone distribution and prescription. One study reviewed NALs and their relationship with Medicaid reimbursement and reported consistent associations with increases in naloxone dispensing (Gertner et al., 2018). These findings highlight an important opportunity for streamlined policy to ensure consistent reimbursement of life-saving medications that can be prescribed over the counter and at hospital discharge, not just during the provision of emergency services (see \u003cem\u003eThe Naloxone Project\u003c/em\u003e in Colorado; naloxoneproject.com).\u003c/p\u003e\n\u003cp\u003eIn summary, this project was an investment from the State in response to the growing number of opioid overdoses prior to the start of the\u003cem\u003e\u0026nbsp;Access\u003c/em\u003e program. Since the implementation of the program, orders for naloxone have increased, as have opioid overdose reversals/naloxone administration. The \u003cem\u003eAccess\u0026nbsp;\u003c/em\u003eproject reduced one barrier to ensuring that lifesaving naloxone could be ordered, received, distributed, and administered at no cost to community organizations, healthcare organizations, and clinics working with historically underserved, marginalized, and less visible populations (including persons using opioids). While both naloxone orders and administrations continue, our results suggest that the intended goal of naloxone saturation within at-risk communities is improving, with more naloxone available when overdoses occur. However, more evaluation and outcome research is needed to better understand the longitudinal impact of naloxone distribution versus overdose rates.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDrug Overdose Prevention Program (DOPP)\u003c/p\u003e\n\u003cp\u003eOpioid Education and Naloxone Distribution (OEND)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterrater reliability (IRR)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmergency Medical Services (EMS)\u003c/p\u003e\n\u003cp\u003eFederally Qualified Health Center (FQHC)\u003c/p\u003e\n\u003cp\u003eIllinois Department of Public Health (IDPH)\u003c/p\u003e\n\u003cp\u003eSafe consumption sites (SCSs)\u003c/p\u003e\n\u003cp\u003eNaloxone Access Laws (NALs)\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocols were reviewed and approved by the Institutional Review Boards of the University of Illinois Chicago (IRB Protocol #2021-1201) and NORC at the University of Chicago (IRB Protocol #23-06-1382).\u0026nbsp;Informed consent was obtained from all participants who consented to the qualitative interviews. Informed consent did not apply to the quantitative data from this project, as it did not include any identifiable information and was not considered human subject research. All procedures were conducted in accordance with the ethical standards of the institutional research committees and with the Declaration of Helsinki of 1964 and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data analyzed during the current study are not publicly available, as this was not in the permissions and consent of the research study, and therefore cannot be shared. The\u0026nbsp;semi-structured interview guides can be found in the supplemental files.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this study was made possible through the Illinois Cannabis Regulation and Tax Act (CRTA) grant awarded to the Illinois Department of Human Services, Divisions of Substance Use Prevention and Recovery and Mental Health.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSB was the co-investigator of this project and oversaw the evaluation and reporting for the project; additionally, SB led the writing of the narrative for the background, the quantitative methodology and results, and the conclusion section. OG led the writing of the qualitative results and outlines for the background and conclusion sections. SB and OG collaborated on figure and table creation. AC, NM, and AG also participated\u0026nbsp;in\u0026nbsp;content development and\u0026nbsp;edits\u0026nbsp;for\u0026nbsp;the entire document. OG, AC, NM, and AG were the interview research team overseeing the qualitative portion of this study. KM oversaw the implementation of the\u003cem\u003e\u0026nbsp;Access\u003c/em\u003e project, contributed to discussion topics, and edited/approved the entire document.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis project was made possible through an intergovernmental agreement between the Jane Addams College of Social Work at the University of Illinois Chicago (UIC; PI: James Swartz) and the Illinois Department of Human Services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhmad FB, Cisewski JA, Anderson RN. Leading Causes of Death in the US, 2019\u0026ndash;2023. 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(2025). \u003cem\u003eDistribution Models and Strategies to Consider to Expand Access to Naloxone.\u003c/em\u003e Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://opioidprinciples.jhsph.edu/distribution-models-and-strategies-to-consider-to-expand-access-to-naloxone/\u003c/span\u003e\u003cspan address=\"https://opioidprinciples.jhsph.edu/distribution-models-and-strategies-to-consider-to-expand-access-to-naloxone/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMassachusetts Health Officers Association (MHOA). (2025). \u003cem\u003eSection II: Evidence-based Opioid Prevention Interventions.\u003c/em\u003e Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://opioid-toolkit.mhoa.com/evidence-based-opioid-prevention-examples/\u003c/span\u003e\u003cspan address=\"https://opioid-toolkit.mhoa.com/evidence-based-opioid-prevention-examples/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMathematica. (2024, April 30). \u003cem\u003eWastewater Data Offers Powerful Tool in Confronting Opioid Epidemic\u003c/em\u003e [News]. 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(2023, April 24\u003cem\u003e). Harm Reduction Framework.\u003c/em\u003e Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.samhsa.gov/substance-use/harm-reduction/framework\u003c/span\u003e\u003cspan address=\"https://www.samhsa.gov/substance-use/harm-reduction/framework\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSugarman OK, Hulsey EG, Heller D. Achieving the Potential of Naloxone Saturation by Measuring Distribution. JAMA Health Forum. 2023;4(10):e233338. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamahealthforum.2023.3338\u003c/span\u003e\u003cspan address=\"10.1001/jamahealthforum.2023.3338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWenger LD, Doe-Simkins M, Wheeler E, Ongais L, Morris T, Bluthenthal RN, Lambdin BH. Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach. Harm Reduct J. 2022;19(1):55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12954-022-00639-z\u003c/span\u003e\u003cspan address=\"10.1186/s12954-022-00639-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoon GH, Levengood TW, Davoust MJ, Ogden SN, Kral AH, Cahill SR, Bazzi AR. Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis. Harm Reduct J. 2022;19(1):73.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"naloxone distribution, harm reduction, public health, opioid overdose prevention, access to care, mixed-methods evaluation","lastPublishedDoi":"10.21203/rs.3.rs-7142082/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7142082/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eDespite over a 25% national decline in opioid overdose deaths in 2024, overdose remains a leading cause of mortality in the U.S., with persistent regional disparities. Illinois, for example, reported nearly 4,000 overdose deaths in 2022. Evidence-based interventions\u0026mdash;such as naloxone distribution\u0026mdash;have been integral in reducing fatalities. While naloxone programs vary, research supports broader community access as an effective strategy. In 2021, Illinois launched the \u003cem\u003eAccess\u003c/em\u003e program, a statewide initiative providing free nasal naloxone through an online portal to community organizations, hospitals, and clinics. This study evaluates the implementation and impact of the statewide program to inform future overdose prevention efforts.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA mixed-methods approach was used to evaluate implementation (qualitative) and outcomes (quantitative). Qualitative data included semi-structured interviews (n\u0026thinsp;=\u0026thinsp;15) with state policymakers, implementation partners, and participating organizations. Quantitative data focused on naloxone orders and administrations from two program-level tracking systems. Data were analyzed separately and then compared to interpret findings among the researchers. The evaluation covers three years of data, from July 2021 to June 2024.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eQuantitative analysis revealed a statistically significant relationship between naloxone orders and administrations, suggesting that increased community saturation is associated with more overdose reversals. Demographic trends showed a rise in administrations on Black individuals and a decline among Hispanic populations. Naloxone use increasingly occurred in residential settings, with a decline in 911 calls and hospitalizations post-administration. Qualitative findings emphasized the importance of no-cost access and a simple ordering process, which allowed organizations to redirect resources to other critical programming needs.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eThe Access program successfully expanded naloxone availability across Illinois, particularly among underserved populations. Key facilitators included free ordering and streamlined ordering. However, disparities in institutional participation and response behaviors highlight the need for continued stigma reduction and harm reduction education. Future efforts should focus on expanding uptake in low-barrier settings and conducting longitudinal evaluations to assess the sustained impact of naloxone distribution on overdose mortality.\u003c/p\u003e","manuscriptTitle":"A Mixed-Methods Evaluation of a Statewide Naloxone Distribution Project: Considerations for Future Implementation of Opioid Overdose Prevention Initiatives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 12:16:26","doi":"10.21203/rs.3.rs-7142082/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-15T18:27:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T02:17:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T01:45:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T22:34:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108027184082856281741721544597538403543","date":"2025-10-14T17:20:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207789010588412334543865304635855343730","date":"2025-10-13T21:33:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280693035680861938327827898943976615032","date":"2025-10-10T11:31:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T21:29:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T15:49:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T16:15:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-08T16:12:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"203a2812-2f58-4ae1-96e1-ea8a99c5f30b","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:11:43+00:00","versionOfRecord":{"articleIdentity":"rs-7142082","link":"https://doi.org/10.1186/s12889-026-26921-4","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-03-21 15:59:36","publishedOnDateReadable":"March 21st, 2026"},"versionCreatedAt":"2025-10-22 12:16:26","video":"","vorDoi":"10.1186/s12889-026-26921-4","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26921-4","workflowStages":[]},"version":"v1","identity":"rs-7142082","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7142082","identity":"rs-7142082","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}