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Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution conducted in West Virginia
  1. Toni Marie Rudisill1,
  2. Alexandria J Ashraf2,
  3. Herbert I Linn2,
  4. Sheena Sayres3,
  5. James E Jeffries4,
  6. Kelly K Gurka5
  1. 1 Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
  2. 2 School of Public Health, Health Research Center, Robert C Byrd Health Science Center, West Virginia University, Morgantown, West Virginia, USA
  3. 3 Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
  4. 4 West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child and Family Health, Charleston, West Virginia, USA
  5. 5 Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Toni Marie Rudisill, Department of Epidemiology, West Virginia University, Morgantown, WV 26506, USA; trudisill{at}


Background Overdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016–2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US.

Methods Structured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation.

Results The primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt.

Conclusions Based on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.

  • public health
  • behaviour change
  • education
  • program evaluation
  • drugs

Data availability statement

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  • Contributors TMR, HIL and KKG contributed to the design of the study and data collection instruments. TMR, AJA, HIL, SS and JEJ obtained the data. TMR and AJA analysed, coded and interpreted the data. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to manuscript preparation and approved the final version.

  • Funding TMR, AJA, HIL, SS and KKG all received support from the Centers for Disease Control and Prevention (grant R49 CE002109). All authors received support from the Centers for Disease Control and Prevention’s Prevention for States award (CDC-RFA-CE15-1501) and Substance Abuse and Mental Health Services Administration funding (B08T1010058).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.