Evaluating demographic variation in no-cost naloxone distribution in North Carolina: a cross-sectional survey study

The objective of this study was to identify naloxone distribution resources, as well as to evaluate potential differences in naloxone distribution by demographic population utilizing a naloxone distribution score. We utilized a cross-sectional online survey of potential no-cost naloxone distributors in North Carolina (NC) to identify their program type, where programs distribute no-cost naloxone, and to whom no-cost naloxone distribution was distributed in 2023. This information was utilized to create a naloxone distribution measure at the ZIP code level. A total of 241 survey responses for programs were identified as distributors of no-cost naloxone to community members in NC. At least one no-cost naloxone distributor served all demographic populations in over 92% of NC ZIP codes. The Non-Hispanic (NH) White group had the highest mean naloxone distribution score of 30.2 (SD = 8.9) across all ZIP codes, suggesting greater distribution to this demographic. After adjusting for the size of the race/ethnicity population in GEE models, all minority race/ethnicity groups had significantly lower naloxone distribution than the NH White group. The naloxone distribution score calculated suggests NH White populations may be served by no-cost naloxone distributors more frequently when compared to other populations.