Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky

Hannah K. Knudsen; Sandra Back-Haddix; Shaquita Andrews-Higgins; Michael Goetz; Olivia A. Davis; Douglas R. Oyler; Sharon L. Walsh; Patricia R. Freeman

doi:10.1186/s13722-025-00553-2

Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky

Hannah K. Knudsen
, Sandra Back-Haddix
, Shaquita Andrews-Higgins
, Michael Goetz
, Olivia A. Davis
, Douglas R. Oyler
, Sharon L. Walsh
, Patricia R. Freeman

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone “hub with many spokes” model for scaling up this strategy. Methods: Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND. Results: Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients’ social networks. Community-level impacts included greater overall access and reduced stigma toward OEND. Conclusions: These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks. Trial registration: ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939

Original language	English
Article number	27
Journal	Addiction Science and Clinical Practice
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s13722-025-00553-2
State	Published - Dec 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

Funding

This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award number UM1DA049406. (ClinicalTrials.gov Identifier: NCT04111939). This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration or the NIH HEAL Initiative®. This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term) Initiative under award number UM1DA049406. (ClinicalTrials.gov Identifier: NCT04111939). This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration or the NIH HEAL Initiative.

Funders	Funder number
Substance Abuse and Mental Health Services Administration
National Institutes of Health (NIH)	Pro00038088, NCT04111939, UM1DA049406
National Institutes of Health (NIH)

Keywords

Evidence-based practice
Naloxone
Opioid overdose
Overdose education and naloxone distribution
Stigma

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s13722-025-00553-2

Cite this

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title = "Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky",

abstract = "Background: Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone “hub with many spokes” model for scaling up this strategy. Methods: Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND. Results: Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients{\textquoteright} social networks. Community-level impacts included greater overall access and reduced stigma toward OEND. Conclusions: These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks. Trial registration: ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939",

keywords = "Evidence-based practice, Naloxone, Opioid overdose, Overdose education and naloxone distribution, Stigma",

author = "Knudsen, \{Hannah K.\} and Sandra Back-Haddix and Shaquita Andrews-Higgins and Michael Goetz and Davis, \{Olivia A.\} and Oyler, \{Douglas R.\} and Walsh, \{Sharon L.\} and Freeman, \{Patricia R.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

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doi = "10.1186/s13722-025-00553-2",

language = "English",

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AU - Knudsen, Hannah K.

AU - Back-Haddix, Sandra

AU - Andrews-Higgins, Shaquita

AU - Goetz, Michael

AU - Davis, Olivia A.

AU - Oyler, Douglas R.

AU - Walsh, Sharon L.

AU - Freeman, Patricia R.

N1 - Publisher Copyright: © The Author(s) 2025.

PY - 2025/12

Y1 - 2025/12

N2 - Background: Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone “hub with many spokes” model for scaling up this strategy. Methods: Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND. Results: Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients’ social networks. Community-level impacts included greater overall access and reduced stigma toward OEND. Conclusions: These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks. Trial registration: ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939

AB - Background: Efforts to scale up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, was a major focus of the HEALing Communities Study (HCS). The aim of this analysis is to describe the qualitative perspectives of partner organizations regarding the impacts of implementing OEND in a state that used a naloxone “hub with many spokes” model for scaling up this strategy. Methods: Small group (n = 20) and individual (n = 24) qualitative interviews were conducted with staff from 44 agencies in eight Kentucky counties that implemented OEND from April 2020 to June 2022. Interviews were conducted between 6 and 8 months after the end of the intervention. Initial deductive coding used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, and then additional inductive sub-coding focused on passages within the OEND Effectiveness code. Thematic analysis was then utilized to identify themes regarding the impacts of implementing OEND. Results: Participants identified multi-level impacts of implementing OEND. At the individual-level, participants described lives being saved, greater access to naloxone for individuals served by the agency, reduced stigma toward OEND by clients, and greater client-level self-efficacy to respond to overdoses. Organizational impacts included improved staff readiness for overdose response, enhanced clinical relationships between staff and clients, and reduced staff stigma. Participants described positive impacts on their organizational networks and clients’ social networks. Community-level impacts included greater overall access and reduced stigma toward OEND. Conclusions: These qualitative data revealed that staff from agencies involved in a community-wide effort to scale up OEND perceived multi-level benefits, including saving lives, reducing stigma, improving naloxone access, and enhancing staff and client readiness, while strengthening organizational and community networks. Trial registration: ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939

KW - Evidence-based practice

KW - Naloxone

KW - Opioid overdose

KW - Overdose education and naloxone distribution

KW - Stigma

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VL - 20

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JF - Addiction Science and Clinical Practice

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ER -

Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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