Community naloxone distribution and administration reporting through the New York State overdose prevention program, 2016–2023: trends, reach, and overdose reversals

The opioid epidemic remains a critical public health crisis in the United States, with New York State (NYS) experiencing persistently high overdose mortality despite recent declines. Community-based naloxone distribution programs are a core, cost-effective overdose prevention strategy, equipping people at-risk individuals and their social networks with naloxone and overdose response training. This study examined the patterns of reported community naloxone administrations in New York State to better understand overdose response trends across demographic groups and settings. We conducted a descriptive analysis of naloxone kit distribution and reported community-administered naloxone events from 2016 to 2023 using data collected through the New York State Department of Health Opioid Overdose Prevention Program electronic ordering and reporting system. Analyses examined trends in distribution and overdose reversals, demographic characteristics, settings, naloxone administration characteristics, and survival outcomes across the years. Between 2016 and 2023, over 1.4 million naloxone kits were distributed and over 1 million individuals were trained statewide through more than 1,300 organizations operating nearly 6,000 distribution sites. A total of 18,690 community naloxone administrations were analyzed. Adults aged 25–44 accounted for 63% of overdose reversal, while the proportion involving older adults increased over time. Males consistently accounted for majority of reported overdose reversal over the years. Reported reversals among Black and Hispanic individuals also increased during the study period. Most reversals occurred in private residences (53.5%) and supportive housing settings (21%). By 2023, intranasal naloxone spray (4 mg dose) became the most widely used formulation (74.1%) and two doses of naloxone were most administered with the community. Survival following community naloxone administration remained consistently high over the years (94.4% to 98.1%). Findings highlight that community-based naloxone distribution systems and timely bystander intervention play an important role in preventing overdose deaths. The predominance of overdose reversals occurring in private settings reinforces the need for low-threshold naloxone access, peer-based distribution, and culturally responsive overdose prevention strategies. Continued investment in decentralized community overdose prevention infrastructure remains essential to addressing the evolving overdose crisis. Community-administered naloxone remains a cornerstone of overdose prevention in NYS. Expanding equitable naloxone access, strengthening peer-led distribution networks, and supporting community-based harm reduction infrastructure may further improve overdose capacity and reduce preventable overdose deaths.