Rural Variation in Access to Naloxone for Opioid Overdose Prevention

Research center:
Lead researcher:
Project funded:
September 2019
Project completed:
May 2021

Naloxone is a life-saving drug designed to rapidly reverse opioid overdose by quickly restoring normal breathing to a person whose respiration has slowed or stopped due to an overdose. Prior research on naloxone dispensing by emergency medical services found higher odds of naloxone use in rural areas but lower-than-expected use based on a much higher rate of overdose mortality compared to urban areas.

To our knowledge, there are no studies examining the outpatient pharmacy-based naloxone distribution in rural areas. A number of state regulatory changes impact naloxone access and dispensing, including innovative pharmacy access laws (prescriptive authority, protocols or standing orders, collaborative practice agreements) that allow pharmacists to directly dispense naloxone without first having received a prescription from another healthcare provider and immunity changes provided to pharmacists.

Widely varying rates of naloxone dispensing between states has been reported, and states that expanded Medicaid access have distributed more naloxone than those that did not expand Medicaid. Understanding the variability in naloxone access at the state level is an important first step, but examining naloxone distribution using rural constructs can help tailor local overdose prevention efforts. Therefore, we aimed to: 1) describe naloxone dispensing across the U.S. and compare the access by rurality; 2) examine variability in naloxone distribution and the effects of Medicaid expansion and pharmacy policy in rural areas; and 3) create at least two types of interactive mapping visualizations: naloxone distribution counts/rates in rural areas and a Kentucky street map of pharmacies distributing naloxone via protocol in the state.


  • Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2022
    This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
  • Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2021
    Naloxone is an opioid overdose reversal medication. Medicare beneficiaries benefit from access to naloxone because they have high rates of high-dose prescription opioids. This brief examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.