Naloxone Distribution Project (NDP)
California hospitals are saving lives by giving naloxone, an opioid overdose reversal medication, directly to patients. Through the NDP, California hospitals can order free, take-home naloxone for distribution through their Emergency Departments (EDs). Hospitals in this program distribute naloxone and train patients, visitors, and community members on how to reverse an opioid overdose successfully. Although California state law requires the prescription of naloxone to patients who are at risk for overdose, these prescriptions often go unfilled. The distribution of free naloxone in the ED gets this life-saving medication into the hands of the community, which is a powerful strategy for preventing overdose.
Top 10 High-Volume Hospitals
Between January 2019 and December 2021, 93 California hospital EDs placed 157 orders for 63,816 units of free, take-home naloxone using CA Bridge’s Guide to Naloxone Distribution. We selected the top 10 hospitals by order volume and interviewed eight of these hospitals to learn more about their programs and the impact they are making in their communities.
- Highland Hospital in Alameda County – 13,824 naloxone kits
- Adventist Health Rideout Emergency Department in Yuba County – 7,200 naloxone kits
- Antelope Valley Hospital in Los Angeles County – 4,908 naloxone kits
- Community Regional Medical Center Emergency Department in Fresno County – 3,012 naloxone kits
- UC Davis Health in Sacramento County – 2,700 naloxone kits
- Northern Inyo Hospital District in Inyo County – 2,484 naloxone kits
- Watsonville Community Hospital in Santa Cruz County – 2,400 naloxone kits
- Doctors Medical Center Emergency Department in Stanislaus County – 1,620 naloxone kits
- Zuckerberg San Francisco General Hospital in San Francisco County – 1,476 naloxone kits
- Bakersfield Memorial Hospital in Kern County – 1,344 naloxone kits
Champions from the High-Volume Hospitals Share their Strategies
We spoke with key champions from eight of these hospitals, including ED physicians, pharmacists, and navigators, to learn more about what made these programs successful.
- At Watsonville Hospital, Dr. Marissa Haberlach and navigator, Ashlee De Herrera, provided extensive physician and nurse education. They collected stories from former ED patients about how naloxone saved their lives before entering drug treatment. This education helped providers feel more comfortable and excited to distribute naloxone.
- At Adventist Health & Rideout, Dr. Eileen Morley and navigator, Todd O’Berg, presented naloxone distribution as an extension of the hospital’s existing CA Bridge treatment program to help people see it as a continuum of care for people who use drugs.
- At Community Regional Medical Center, Dr. Rais Vohra and navigator, Chaia Vang, capitalized on word of mouth communication, including provider-to-provider and patient-to-patient education. In the community, they took every opportunity to talk about their naloxone distribution program and build partnerships with community organizations, such as schools and homeless shelters.
- At Northern Inyo Hospital District, navigator, Arelene Brown, and Dr. Anne Goshgarian were motivated by overdose deaths in their community and opted to do significant outreach work. Northern Inyo Hospital runs a syringe access program outside their ED and works with providers on Native reservations, probation offices, and county behavioral health providers to support as much of their rural population as possible.
Distribution Tips from High-Volume Hospitals
Naloxone received from the California Department of Health Care Services for distribution cannot be sold or billed for, so it requires alternative storage, record keeping, and distribution solutions. Because each hospital is unique, the distribution process looked different from hospital to hospital.
Operate the program out of the ED. Although some of the programs were successfully operated in the outpatient pharmacy, on-site substance use disorder clinics, and OB/GYN departments, in most cases, the ED led distribution.
Enable any ED staff member to distribute naloxone, including physicians, nurses, navigators, and support staff.
Allow anyone to receive naloxone from their ED, including current and former patients, friends, family, and visiting community members who were not registered as ED patients. A simple documentation system allowed for anonymous and efficient distribution.
Supply “secondary distributors” with larger supplies of naloxone for distribution. Secondary distributors are community members and small groups with a passion for overdose prevention that interface with communities at high risk for opioid overdose and pass on free naloxone provided by an ED’s naloxone distribution program. Secondary distribution, along with labeling naloxone kits with the hospital’s logo and navigator contact information, dramatically expanded the reach of ED-based naloxone distribution and information about ED-based drug treatment.
Store naloxone storage securely enough for the hospital’s protocol yet conveniently enough for quick distribution. Some hospitals opted for locked or unlocked cabinets inside secure rooms, such as an office or the charge nurse desk. Our highest volume site opted for unlocked drawers, cabinets, and shelves throughout the ED. This maximized accessibility and facilitated staff participation.
By distributing naloxone directly from the ED, providers are saving lives and supporting patients all across the state. We encourage every hospital to implement a naloxone distribution program with our Guide to Naloxone Distribution.