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

## TL;DR

A public health program in Michigan used accessible naloxone boxes to prevent opioid overdoses, distributing thousands of doses and showing promise for reducing overdose deaths.

## Contribution

This study evaluates an innovative naloxone box model for community-based opioid overdose prevention in Michigan.

## Key findings

- 184 naloxone boxes were placed in Michigan, distributing 24,428 doses from 2023 to 2024.
- Stakeholders viewed the boxes as impactful for saving lives and reducing overdose stigma.
- Partnerships with non-traditional hosts and community involvement strengthened the model.

## Abstract

Despite reductions in overdose deaths reported nationally in 2025, overdose remains a leading cause of death in Michigan and the broader United States. Naloxone is a safe and highly effective opioid antagonist that can reverse opioid overdose, and community-based distribution to people at highest risk of overdose is a key overdose death prevention strategy.

In 2021, Harm Reduction Michigan (HRMI) launched an innovative naloxone box model to boost community-based naloxone distribution through publicly accessible, unlocked, outdoor naloxone boxes. To evaluate HRMI’s naloxone box model, we conducted stakeholder interviews and analyzed secondary quantitative data about naloxone box stocking and placement.

As of December 2024, HRMI has placed 184 naloxone boxes in 85 jurisdictions within 47 Michigan counties, resulting in 24,428 doses of naloxone distributed from 2023 to 2024 alone. Naloxone boxes are prevalent in some, but not all, counties with high overdose death rates, suggesting the need for data-driven placement to support equitable access. However, stakeholders universally perceived the naloxone box model as impactful and crucial to saving lives, noting that naloxone boxes democratize naloxone distribution through their low-barrier, 24/7 availability and relative anonymity. They noted that amid persistent drug-related stigma, naloxone boxes create opportunities for productive conversations about overdose, drug use, and harm reduction in communities.

These models are strengthened by partnership with non-traditional partners (such as restaurants or retail stores) who request to host boxes, along with meaningful involvement of people with lived experience of drug use, overdose, and interrelated conditions in box planning, implementation, and maintenance.

The online version contains supplementary material available at 10.1186/s12954-025-01333-6.