“We compared public-access naloxone strategies using more than 14 000 cases of opioid poisoning in Metro Vancouver over a 6-year period. We found that the 647 take-home naloxone sites were within a 3-minute walk to more than one-third of all opioid poisonings and had high coverage efficiency (Table 2) [the top five location categories for coverage efficiency were: government office, take-home naloxone site, convenience store, retail store and pharmacy]. In addition to existing operations that distribute take-home naloxone kits, which are likely taken elsewhere, take-home naloxone site locations appear generally well-aligned with where opioid poisonings occur, so they are also good candidate locations for publicly accessible naloxone kits. Public-access naloxone at take-home naloxone locations is also logistically viable, with naloxone already readily available and trained staff who can respond to nearby opioid poisonings. These factors are also applicable to pharmacy-based blanket placement, which covered more than one-fifth of opioid poisonings. [..]
Optimization-based naloxone kit placement at transit locations outperformed all other strategies, covering as many as 2907 (20.6%) more poisonings than the second-best strategy (i.e., ranking-based placement at transit locations). On average, the optimization strategy needed only around half as many naloxone kits to achieve the same coverage as the next best approach (the ranking-based strategy at transit locations). For instance, to achieve around the same coverage level afforded by all 647 take-home naloxone sites, only 60 optimization-based locations were needed compared with 150 ranking-based locations. Optimization-driven placement can identify locations where opioid poisonings are most concentrated and therefore where naloxone kits are most valuable, leading to coverage especially in areas not covered by other strategies. Overall, a combination of blanket naloxone kit placement at take-home naloxone locations and optimization-driven placement in areas underserved by the take-home naloxone program may be the best approach.
To our knowledge, there have been only small-scale implementations of public-access naloxone kits, such as in neighbourhoods with high incidence of opioid poisoning. These studies identify the challenges of implementation and highlight the importance of government and community support for successful implementation. Data that systematically analyze public-access naloxone placement have been lacking; our findings may assist decision-makers, such as public health agencies, in optimizing deployment of public naloxone kits.
We assumed public naloxone kits would be accessible at any time, whereas some locations may be inaccessible at certain times of day; previous literature for cardiac arrest shows that one-third of public AEDs are inaccessible to nearby cardiac arrests outside business hours. For public-access naloxone programs to be successful, naloxone kits must be easily accessible at all times, which may be achieved by placement on the exterior of buildings along with clear indicative signage. Further research is needed to consider other implementation factors that may affect successful retrieval and administration of public naloxone kits.
As an intervention, public-access naloxone is still in its infancy, and challenges such as ownership and guardianship of naloxone kits, as well as the feasibility of placing naloxone in public, must still be addressed. Consideration must be given to funding the procurement and upkeep of public naloxone kits, which will likely need to come from public health agencies and levels of government rather than private individuals, as is the case for public AEDs.”
Full article, KHB Leung, BE Grunau, MK Lee, et al. CMAJ, 2025.3.17