Training Guide

Guide to Developing and Managing Overdose Prevention and Take Home Naloxone Projects


Originally Published: Fall 2012
Last Edited: May 2020

Written by: Eliza Wheeler, Katie Burk, Hilary McQuie, and Sharon Stancliff
Edited by: Emily Winkelstein

Images and photographs courtesy of: Maya Doe-Simkins, Mary Wheeler, Joanna Berton Martinez, N.O.M.A.D. (Not One More Anonymous Death), Nabarun Dasgupta and Roxanne Saucier.

Many thanks to following individuals and programs, not only for their valuable contributions to this manual, but also for their leadership, wisdom, guidance and creativity throughout the years:

Dan Bigg and CRA, Alice Bell and Prevention Point Pittsburgh/Overdose Prevention Project, Mary Wheeler and Healthy Streets/N.O.M.A.D., Lisa Raville and the Harm Reduction Action Center, Steve Alsum and The Clean Works program of The Grand Rapids Red Project, Joanne Peterson and Learn To Cope,  Mindy Domb and SPHERE Health Imperatives, Mik Hennessy and SOS, Fred Wells Brason, Nabarun Dasgupta and Project Lazarus, Alex Walley, Sarah Ruiz and the Massachusetts Overdose Education and Naloxone Distribution Program, Scott Burris, Leo Beletsky, Roxanne Saucier, Deborah Milbauer, Joanna Berton Martinez, Peter Davidson, T. Stephen Jones, Kevin Irwin, Alex Kral, Heather Edney (and the Santa Cruz Needle Exchange), and Anne Siegler.

Many thanks to the NOPE Working Group, and to the overdose prevention and naloxone programs in the US for sharing their materials, stories, and experiences with us! Special thanks to Maya Doe-Simkins for contributing so much to the writing of this manual, and for your tireless work on overdose prevention. Thank you.

Supported in part by M.A.C. AIDS Fund.

About National Harm Reduction Coalition

National Harm Reduction Coalition’s mission is to promote the health and dignity of individuals and communities affected by drug use. As a national advocacy and capacity building organization, NHRC aims to shift power and resources to people most vulnerable to structural violence and racialized drug policies. Learn more at www.harmreduction.org.

Layout and Design by Imaginary Office: www.imaginaryoffice.com

This publication was supported by Cooperative Agreement NUmber PS09-906 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.


  1. Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980-2008. Published December 2011. Accessed September 20, 2012.
  2. Pollini et al, 2005; Tobin et al, 2005; Davidsonn et al, 2003; Seal et al, 2003; Strang et al, 2000. Amy S.B. Bohnert, Kathryn Roeder, Mark A. Ilgen, “Unintentional overdose and suicide among substance users: A review of overlap and risk factors.” Drug and Alcohol Dependence. 110.3 (2010) 183-192. Print.
  3. Responses were collected from known naloxone distribution programs between October 5, 2010-November 12, 2010 using a Survey Monkey survey tool by Eliza Wheeler, DOPE Project Manager at the Harm Reduction Coalition. The survey was initiated as a project of the NOPE Working Group (Naloxone Overdose Prevention Education) in order to gather up-to-date data about the impact of US naloxone distribution programs. Published in the CDC Morbidity and Mortality Weekly Report, “Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010. February 17, 2012 / 61(06);101-105.
  4. Burris et al. / International Journal of Drug Policy 12 (2001) 237-248
  5. http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=097-0361
  6. https://www.cdc.gov/std/treatment/EPTfinalreport2006.pdf
  7. http://www.cdc.gov/std/EPT/legal/default.htm
  8. Burris S, Beletsky L, Castagna C, Casey C, Colin C, McLaughlin J.M. Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose. Drexel Law Review; 2009: 1(2):273-339. (http://ssrn.com/abstract=1434381)
  9. http://harm-reduction.org/images/stories/library/why_overdose_prevention_matters_for_hiv.pdf
  10. Treatment models developed by Maya Doe-Simkins, 2011.

Additional Resources

For more information on legal considerations related to naloxone, the following is a good place to start:

Burris S, Beletsky L, Castagna C, Casey C, Colin C, McLaughlin, J.M. Stopping An Invisible Epidemic: Legal Issues In The Provision Of Naloxone To Prevent Opioid Overdose. Drexel Law Review; 2009: 1(2):273—339. (http://ssrn.com/ abstract=1434381)

A few states have created varied regulations and policies around naloxone distribution, so learning if there are any existing state and local policies relevant to naloxone is important. Detailed state-by-state findings and analysis up to 2007 for naloxone distribution programs are available here: