Drug overdose is the leading cause of accidental death in the United States, with over 65% of drug
related fatalities resulting from the use of opioids. The continually increasing rates of opioid overdose deaths in
the last two decades have led to the declaration of an opioid epidemic. Over a brief 15-year period, from 1999-
2014, drug overdose related deaths tripled and rates have continued to sharply escalate since then. Federal
agencies have responded to this crisis with various recommendations including enhancing harm reduction
approaches such as naloxone distribution. Naloxone is an opioid antagonist that can be used to reverse opioid
overdose. Though it is typically administered in Emergency Departments, laypersons have recently been
successfully trained through Opioid Overdose Education and Naloxone Distribution (OEND) programs to
recognize signs of opioid overdose and perform timely administration of naloxone in homes and community
settings while awaiting medical services. Several studies have demonstrated that OEND programs effectively
reduce opioid overdose mortality and are safe and cost-effective. However, OEND programs are typically
implemented in urban areas as part of large medical center research programs, needle exchanges, or drug
treatment programs. Individuals living in areas without these programs or services lack access to critical and
life-saving OEND. The current proposal will examine the acceptability and feasibility of online recruitment,
online opioid overdose education, and postal distribution of naloxone kits (N=80). Opioid users at risk for
overdose will be recruited online through Craigslist. If eligible, participants will complete an opioid use
questionnaire and will indicate if they are interested in receiving opioid overdose and naloxone administration
training. If interested, they will complete pre- and post-intervention knowledge questionnaires, engage in
audiovisual training, and half will be randomized to receive a naloxone kit in the mail while the other half will be
given information on where they can receive a naloxone kit. All participants will complete remote follow-up
assessments at 1, 2, and 3 months post study to evaluate naloxone kit use and outcomes. This study will
evaluate a novel approach to providing OEND to individuals with otherwise limited access to this type of
intervention. Successful implementation of remote OEND through this project would support future
employment of similar remote programs to expand this critical harm reduction strategy to high-risk individuals
in areas lacking traditional OEND programs.
