Narcan Distribution Collaborative

State: OH Type: Promising Practice Year: 2020

  • Hamilton County Public Health - Cincinnati, Ohio
    • Serving 45 Jurisdictions
    • 108 employees
  • Hamilton County
    • 813,684 residents
    • Median resident age 36.6
    • 52% Female, 48% Male
    • 65% Caucasian, 25% African American, 3% Asian, 3% Hispanic
  • Public health issue:
    • Increase in opioid overdoses and deaths resulting from opioid use.
    • Inadequate access to life saving Narcan® in community.
    • Increase in overdose deaths of 439% from 2009 to 2017 in Hamilton County.











Overdose Deaths










Opioid Related Deaths










  • Goal of project:
    • Demonstrate that expanding Narcan® Nasal Spray distribution from all access points to ALL individuals at risk of experiencing or witnessing an opioid overdose in the Greater Cincinnati area will significantly reduce the number of opioid-related deaths.
    • Rapidly and substantially increase distribution of Narcan® Nasal Spray throughout the community.
    • Reduce the number of fatal overdoses and those resulting in intensive care unit (ICU) admission.
    • Identify sustainable and effective distribution programs for Narcan®
  • Implementation:
    • A grant partnership with a local research university, treatment provider foundation, and the pharmaceutical manufacture of Narcan®.
    • Staff put in place at Hamilton County Public Health to manage program.
    • Initially provided 25,000 doses on 10/01/2017. Initial success lead to an additional 6,000 doses and an eventual monthly allotment of 2,808 doses that started on 01/01/2019 until the end of the program. Total program length was 2 years. (10/01/2017 - 10/31/2019)
    • Multiple distribution strategies and access points were identified, including:
      • Emergency departments
      • Community events
      • Inmates at Hamilton County Justice Center
      • Sterile syringe access programs
      • Organizations such as workplaces, housing agencies, treatment facilities, other non-profits
    • Partnerships throughout the region were formed with various healthcare entities, non-profits, first responders, and other LHDs.
    • By having access to large quantities of Narcan® along with funding from our partners, Hamilton Count Public Health was able to implement many different Narcan® distribution programs. These programs were then evaluated for their success in increasing access to Narcan® in the community along with their long-term sustainability.

  • Results:
    • 60,319 doses of Narcan® distributed throughout the region in a 24 month period.
    • Over 25,000 individuals trained in use of Narcan
    • Initial results show:
      • 30.3% decrease in unintentional opioid overdose deaths* 
      • 46.8% decrease in emergency department visits for overdoses*
      • 43.9% decrease in EMS dispatches for overdoses*
    • Multiple sustainable distribution programs were identified

Results for complete program are pending. Complete data including ICU admission data and full overdose death data will be available May, 2020.

*Report comparing 9 month periods before start of distribution and 9 months after distribution started

  • Were objectives met?
    • Object of distributing large amounts of Narcan® into the community was met
    • Objective of reducing fatal overdoses was met in preliminary data
    • Sustainable programs were identified and implemented using smaller Narcan® inventory
    • Additional objective evaluation awaiting full data analysis.
  • What factors led to success?
    • Obtaining buy in from partners and the community at large.
    • Having access to large quantities of Narcan® allowed Hamilton County Public Health and our partners to implement multiple distribution strategies to determine most effective means of distribution.
    • Dedicated staff for the Narcan® program were able to build a network of partners to distribute Narcan® and allowed Hamilton County Public Health to become the central point of contact for Narcan® in the region.
  • Public Health impact:
    • Reduction in fatal overdoses
    • Public awareness and access to Narcan®
  • Website for program:

Our practice was designed to saturate the Cincinnati region with lifesaving Narcan®, while also looking to create long term sustainable Narcan® distribution programs to ensure that Narcan® remains available to all at risk individuals that may need it. By forming innovative partnerships with local health systems, treatment providers, first responders, and other non-profit groups, we were able to create a collaborative effort in the community that allows for the flow of Narcan® to the community as a whole. 
By saturating the region with Narcan®, we were able to show that by increasing access to Narcan®, we were able to reduce the amount of fatal overdoses. 

A design of this initiative that sets it apart from other naloxone programs is the investment in a distribution infrastructure that was built. By brining on staff dedicated to the Narcan® program rather than relying on existing staff taking on more duties, we were able to build out a community wide distribution network that brings the availability of Narcan® to everywhere it is needed. As we continue to build new relationships while at the same time invest in existing connections, the Narcan® Distribution Collaborative is able adapt and shift focus as the landscape of the addiction crisis changes.

Goals of project:

  • Demonstrate that expanding Narcan® Nasal Spray distribution from all access points to ALL individuals at risk of experiencing or witnessing an opioid overdose in the Greater Cincinnati area will significantly reduce the number of opioid-related deaths.
  • Rapidly and substantially increase distribution of Narcan® Nasal Spray throughout the community.
  • Reduce the number of fatal overdoses and those resulting in intensive care unit (ICU) admission.
  • Identify sustainable and effective distribution programs for Narcan®

Initial steps taken involved building a collaborative within our region that involved local health systems, treatment providers, first responders, and other non-profits. Staff were then hired to work at Hamilton County Public Health and facilitate continued partnership building and overall distribution efforts. 

Narcan® access points and distribution programs were identified and steps were taken to work with partners to implement distribution strategies. 

Data collected during the process was reviewed regularly to ensure effectiveness of ongoing efforts and distributions. 

The overall time frame of the program was 10/01/2017 - 10/31/2019. This was the length of the grant, but the overall efforts and distribution strategies that started with the NDC will be continued through Hamilton County Public Health using a smaller inventory of Narcan®. 

Stakeholders and their roles were:

  • University of Cincinnati
    • Providing data collection and analysis
  • Adapt Pharmaceutical
    • Provided Narcan®  and funding for program
    • Looking for evidence that wide spread distribution can have positive impact on overdose deaths
  • Foundation of Recovery
    • Grant coordination and Narcan®  distribution
  • UC Health
    • Funding and distribution through EDs
  • Mercy Health
    • Funding and distribution through EDs
  • The Christ Hospital
    • Funding and distribution through EDs
  • TriHealth
    • Funding and distribution through EDs
  • Cincinnati Children's Hospital Medical Center
    • Funding and distribution through EDs
  • Deaconess Associations Foundation
    • Funding and distribution
  • Interact for Health
    • Funding
  • Hamilton County Sheriff
    • Partnership in distribution
  • Hamilton County Heroin Coalition – Board of County Commissioners
    • Funding

Monthly meetings were held for all stakeholders to attend to discuss ongoing efforts, data collected, and any improvements or new initiatives. As the collaborative moved forward, new partners were brought in as interest in obtaining Narcan® grew in the region and new areas of need were identified. 

Hamilton County Public Health and the Narcan Distribution Collaborative participated in many local community events in order to help build a strong relationship with the community at large. Trainings, outreach, and Narcan distributions took place at sporting events, health fairs, community festivals, local council meetings, religious based groups, and many other community oriented locations and events. A strong partnership was formed by bringing training, support, and resources to places where it would have the most impact.

Startup funding for the project was approximately $825,000 and was provided by the partners listed above. This funding was used to hire staff to handle distribution, outreach, trainings, and overall program management. As stated previously, Narcan was provided through Adapt Pharmaceutical to HCPH. By working with the major health care systems as well as non-profit organizations in the region, enough funding was brought in to eliminate the need for public tax dollars.

Objectives of the program are:

  • Demonstrate that expanding Narcan® Nasal Spray distribution from all access points to ALL individuals at risk of experiencing or witnessing an opioid overdose in the Greater Cincinnati area will significantly reduce the number of opioid-related deaths.
  • Rapidly and substantially increase distribution of Narcan® Nasal Spray throughout the community.
  • Reduce the number of fatal overdoses and those resulting in intensive care unit (ICU) admission.
  • Identify sustainable and effective distribution programs for Narcan®

Data was collected in partnership with University of Cincinnati and Hamilton County Public Health Division of Epidemiology. Primary data was collected when Narcan® was distributed to individuals in the community. This data included:

  • Age
  • Race/Ethnicity
  • Gender
  • Veteran Status
  • Zip code of residence
  • Zip code of distribution

Additional data collected during distribution included a short survey that asked individuals:

  • Have you used Narcan® in the past?
  • Have you ever overdoses?
  • Do you have a history of substance use?
  • Have you ever been in a formal treatment program?
  • Have you been released from a correctional facility in the last 30 days?
  • What is you intended use for this Narcan®?
    • Keep on site
    • If I overdose
    • If a friend or family member overdoses
    • If I see someone overdose

Other data sources that were used to evaluate effectiveness of the program included overdose data that is collected by Hamilton County Public Health from local EMS and emergency departments. This data shows the number of EMS dispatches to suspected overdoses along with the number of emergency department visits for overdoses. In addition, opioid overdose death data is collected from the Hamilton County Coroner. Data from the coroner is delayed up to 9 months due to length of investigations and determining cause of deaths in suspected overdoses.

Combining these sources of data allowed the evaluation of the overall distribution program.

In a preliminary evaluation of the effectiveness of the NDC efforts a 9 month report that compared February 2017 to October 2017 and October 2010 to July of 2018 showed a 30.3% decrease in opioid overdose deaths. The same report showed a 46.8% decrease in ED visits for overdoses and a 43.8% decrease in EMS dispatches for overdoses. In 2018 unintentional overdose deaths dropped to 357, from a 10 year peak of 444 in 2017, showing a 21.7% decrease in overdose deaths from 2017 to 2018.

Location data from distributions showed areas of Hamilton County where Narcan® was being distributed. This data was compared to locations of patients who presented to local EDs with suspected opioid overdoses. Through use of heat maps we were able to show that we were effectively distributing Narcan® to areas of Hamilton County that had the highest rates of overdoses. 

Continued monitoring of data will allow for improved distribution strategies including ensuring that Narcan® is distributed to the higher risk areas of Hamilton County as they may change. In addition, using the data provided we are able to look for trends in demographics to better identify groups that may be experiencing changes in overdose rates (such as different ethnic populations). We can compare this data to our distribution data to ensure that we are properly targeting these groups. Distribution strategies will be adjusted continually as needed to target these at risk groups.

Increased communication among our partners that did not attend regular meetings is one area of improvement. When working with partners that would be distributed on behalf of the NDC, there needed to be clear expectations of what data would be collected and how frequently that data would be sent to Hamilton County Public Health. At times, some partners did not provide adequate data during their individual distributions of NDC Narcan®. Going forward, these expectations are being clearly communicated with any partner handling distributions on behalf of the NDC.

Additional changes that could benefit the program would be a stronger anti-stigma campaign among both healthcare staff and the community as a whole. Distribution efforts through local EDs was hampered at times due to lack of staff buy in. This could be addressed by working with our healthcare partners to develop staff training programs. Additional marketing could be used in the community to help reduce overall stigma that surrounds Narcan®.

Multiple sustainable programs were identified from the Narcan Distribution Collaborative that are able to be continued, utilizing a smaller available inventory. While the data showed that large amounts of Narcan® distributed in a community can have an impact on public health, budgets outside of specific grants often do not allow for this volume of Narcan® to be available to most LHDs. 

With sustainability in mind Hamilton County Public Health staff worked to develop programs that would have a large impact on the availability of Narcan® in the community while maximizing the available allotment of Narcan®.

Programs that will continue on while utilizing a smaller inventory are:

  • Ensure that high risk populations have access to Narcan®
    • Through partnerships with housing agencies and treatment providers, Narcan® is kept on hand for use as well as distribution. 
    • Hamilton County Public Health's sterile syringe access program distributes Narcan® directly to individuals suffering from substance use disorder.
  • Work with businesses and community organizations to keep Narcan® on-hand that would available to individuals to use.
    • Utilize the service entities protocols provided by the Ohio Board of Pharmacy to assist businesses and organizations to be able to keep Narcan® on-hand for use by employees and volunteers. This model allows for 2-3 kits to be accessible to many individuals for use.
  • Partner with Hamilton County Sheriff to ensure that persons about to be released from the Hamilton County Justice Center have access to Narcan® at the time of their release. 
    • Narcan® is distributed during select visitation hours to friends and family visiting inmates.
    • Training is provided to willing inmates close to their release date and Narcan® is placed in their property to be given to them at their release.
  • Partner with first responders to provide Narcan® to individuals who recently overdosed and if able, their family members
    • Local QRT and EMS departments in partnership with Hamilton County Public Health have implemented a leave behind program to leave Narcan® at the scene of any EMS dispatch. 
  • Community wide distribution events
    • At community events and health fairs identified as serving targeted populations Hamilton County Public Health staff will provide Narcan® and training to interested attendees.

The initial grant through Adapt Pharmaceutical was not renewable. With the smaller Narcan® inventory, Hamilton County Public Health was unable to continue providing Narcan® to all original partners. Several of these partners have made purchasing Narcan® for distribution a priority, allowing their individual distribution efforts to continue. Other partners who were not present in the beginning of this project have since reached out to Hamilton County Public Health in order to collaborate distribution efforts. This has included providing Hamilton County Public Health with Narcan® to distribute as well as utilizing our extensive distribution network to distribute their own allotments of Narcan®.

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