Examining geographic disparities in access to no-cost naloxone in North Carolina: A cross-sectional survey of naloxone distribution programs.

Marley G, Shubel C, Thorpe CT, Annis IE, Delamater P, Carpenter D, Ostrach B. Examining geographic disparities in access to no-cost naloxone in North Carolina: A cross-sectional survey of naloxone distribution programs. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2025 Jun 1; 41(3):e70069, DOI: 10.1111/jrh.70069.

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Abstract:

PURPOSE: The objective of this study was to comprehensively identify the programs that distribute naloxone at no-cost in North Carolina, identify where and to whom these programs distribute naloxone, and evaluate disparities in reported naloxone distribution by geographic area. METHODS: A cross-sectional online survey was delivered to potential no-cost naloxone distributors in NC identified by a community advisory panel. Descriptive statistics and Fisher exact tests were utilized to identify disparities in naloxone access by population served (people who use drugs, people who inject drugs) and location of naloxone distribution (rural; urban/suburban). RESULTS: Approximately 76.5% (241/315) of respondents representing 341 different programs reported that their program(s) distributed no-cost naloxone to community members. Programs represented included health departments (n = 81), treatment programs/centers (n = 59), and syringe service programs(SSPs) (n = 41), among others. Programs reported distributing naloxone most frequently to people who use drugs (94.2%) and people with a substance use disorder history (94.3%). No-cost naloxone distribution was reported less frequently to all patient populations in rural ZIP codes when compared to urban ZIP codes, including justice-involved populations (86.4% vs. 98.3%) and individuals leaving treatment or detox (87.9% vs. 98.6%). CONCLUSION: This study indicates that although most areas in NC were served by at least one no-cost naloxone program, distribution to rural populations may be limited, indicating a need for increased public investment in no-cost naloxone distribution to populations at greatest risk of overdose.