Implementation of Opioid Overdose Education and Naloxone Distribution Programs at Syringe Service Programs

In 2019, 94% of syringe service providers had implemented opioid overdose education and naloxone distribution programs.

In 2019, 94% of syringe service providers (SSPs) had implemented opioid overdose education and naloxone distribution (OEND) programs, according to a study published in the Morbidity and Mortality Weekly Report.

SSPs are associated with a reduction in HIV among persons who inject drugs and have led efforts to prevent opioid overdose deaths thanks to the integration of OEND programs. As part of these programs, laypersons are trained to respond during overdose events and provide access to naloxone as well as instructions for its delivery. The previous survey conducted in 2013 found that only 55% of SSPs in the United States (US) had implemented OEND programs.

In February 2019, all SSPs in the North America Syringe Exchange Network were sent an email requesting their participation in a survey in exchange for a $50 honorarium. Of the 342 known SSPs, 263 (77%) responded to the online survey.

Of participating SSPs, 94% had an OEND program, 65% of which had this program in place since 2016. Of the SSPs with OEND programs, 77% offered OEND services every time syringe services were offered, and 87% provided naloxone refills upon request. In the preceding 12 months, 96% of SSPs with OEND programs reported distributing an average of 3 doses of naloxone to 230,506 people they served. A total of 14 SSPs located throughout 6 of the 9 census divisions accounted for 54% of all naloxone doses distributed by SSPs during that time period.

SSP-based OEND programs in the Mountain, Pacific, and West North Central US Census divisions had the highest ratios of persons who received naloxone per opioid overdose death (13:16) and numbers of naloxone doses distributed per opioid overdose death (22:37). SSP-based OEND programs in the East South Central, Middle Atlantic, New England, and south Atlantic US Census divisions had low ratios of persons provided naloxone per opioid overdose death (1:6) and of naloxone dose distributed per opioid overdose death (4:10).

The results of this study indicated that there has been a substantial increase in the implementation of OEND programs within SSPs since 2013, but that the distribution of naloxone was primarily delivered by 6% of SSPs. A geographic distribution of SSP-based OEND delivery was observed to be highly concentrated in certain regions.

Study limitations include the fact that there were additional SSPs that were not included in the database, that the survey response rate was only 77%, and that the responses that were self-reported may be subject to bias.

“Ensuring that all SSP participants are provided access to a sufficient and consistent supply of naloxone over time can optimize efforts to reduce opioid overdose deaths,” concluded the study authors. “Public health initiatives might be enhanced with efforts to scale-up SSPs throughout the United States.”


Lambdin BH, Bluthenthal RN, Wenger LD, et al. Overdose education and naloxone distribution within syringe service programs – United States 2019. MMWR. 2020;69(33):1117-1121