A mixed-methods evaluation of a statewide naloxone distribution project: considerations for future implementation of opioid overdose prevention initiatives

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 availability of naloxone in the community 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 naloxone administration responses and institutional participation highlight the need for continued efforts to reduce stigma and promote 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.