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Use of low-threshold naloxone boxes for opioid overdose prevention in a Midwestern US State: a public health program

Pamela S Lynch1, Lou Gamalski1, Virginia Roys1

  • 1Harm Reduction Michigan, 124 Munson Avenue, Traverse City, MI, 49686, USA.

Harm Reduction Journal
|November 19, 2025
PubMed
Abstract

Insights

Harm Reduction Michigan’s naloxone box model significantly increased opioid overdose reversal kits distribution. This community-based approach, featuring accessible outdoor boxes, is vital for saving lives and reducing overdose deaths.

Area of Science:

  • Public Health
  • Harm Reduction Strategies
  • Community-Based Interventions

Background:

  • Opioid overdose remains a leading cause of death in the US and Michigan.
  • Naloxone is a critical, safe, and effective opioid overdose reversal medication.
  • Community-based naloxone distribution is a key overdose prevention strategy.

Purpose of the Study:

  • To evaluate the impact and effectiveness of Harm Reduction Michigan's innovative naloxone box model.
  • To assess the role of publicly accessible naloxone boxes in community-based distribution.
  • To understand stakeholder perceptions of the naloxone box model's contribution to overdose prevention.

Main Methods:

  • Implementation of an innovative, publicly accessible, unlocked outdoor naloxone box model by Harm Reduction Michigan.
  • Conducting stakeholder interviews to gather qualitative insights.
  • Analyzing secondary quantitative data on naloxone box stocking and placement.

Main Results:

  • 184 naloxone boxes distributed across 47 Michigan counties, with 24,428 doses dispensed (2023-2024).
  • Stakeholders universally viewed the model as impactful, crucial for saving lives, and democratizing access.
  • Naloxone boxes provide low-barrier, 24/7 access, fostering conversations about overdose and harm reduction amidst drug-related stigma.

Conclusions:

  • Naloxone box models are strengthened by partnerships with non-traditional hosts (e.g., restaurants, retail).
  • Meaningful involvement of people with lived experience is crucial for effective planning, implementation, and maintenance.
  • The model demonstrates a successful strategy for expanding naloxone access and supporting harm reduction efforts.
Keywords:
NaloxoneOpioidOverdoseSubstance use intervention, harm reduction

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